Thyroid cancer accounts for 1.3% of systemic malignant tumors and 4.8%-16.5% of thyroid tumors, and is the most common tumor of the endocrine system. It is the most common tumor of the endocrine system. Generally, it is more common in females, with a male to female ratio of 1:2-1:4, while the proportion of thyroid cancer in male thyroid nodules is much higher than that in females; in children thyroid nodules, the proportion of thyroid cancer can be as high as 50%-70%, and most of them are well differentiated papillary carcinomas with good prognosis. Although thyroid cancer can occur from children to the elderly, it is different from the general feature of cancer occurring in the elderly, but it occurs in young adults. It has been reported that thyroid cancer accounts for 15.6%-28.7% of single nodules in the thyroid gland, while multiple nodules account for about 10%.
Pathological classification and clinical manifestations
1.Papillary thyroid carcinoma.
It is the most common malignant tumor of thyroid gland, accounting for about 60%-70% of all thyroid cancers, and is a low-grade malignant tumor. It occurs in young women. The ratio of male to female is 1:2.7. The number of patients increases significantly after the age of 20, the most frequent after the age of 30-40, and decreases significantly after the age of 50. It is usually solitary, but few are multiple, but the smallest one can be a few millimeters. It is easy to metastasize to cervical lymph nodes, and can also metastasize to lung and bone.
Clinical manifestations: Patients have no conscious symptoms, and the cancer grows slowly, so it is usually diagnosed late, from the onset to the consultation can be as long as 10-30 years. Most of them lack obvious malignant manifestations, and about half of them are misdiagnosed as benign. Most of the tumors are single, a few are multiple or bilateral. More than half of them are soft gelatinous hardness, only 1/4 are hard, irregular, with indistinct margins, generally with good mobility, and some of the masses are poorly mobile. Smaller tumors can be less than 1 cm in diameter and are often difficult to palpate, with cervical lymph node metastases being the main complaint. Larger tumors can be more than 10 cm in diameter or larger, often with cystic changes, and are often misdiagnosed as thyroid cysts. In advanced stage, the tumor may involve the surrounding soft tissues or tracheal cartilage and fix the tumor, or involve the recurrent laryngeal nerve and cause hoarseness. A few of them are combined with different degrees of dyspnea, swallowing discomfort and other symptoms.
2.Follicular adenocarcinoma of thyroid.
It is less common than papillary adenocarcinoma, accounting for about 20% of thyroid adenocarcinoma and ranking the second. It develops rapidly and is a moderate malignant tumor, mostly migrating to lung and bone through blood.
Clinical manifestations: generally long duration of disease, slow growth, a few recent faster growth, often lack of obvious local malignant manifestations. The masses are several centimeters in diameter or larger, mostly solitary, a few can be multiple or bilateral in onset, solid, hard and tough, with unclear borders.
3.Undifferentiated thyroid cancer.
It is the most malignant type of thyroid cancer, accounting for 10-15% of all thyroid cancers, mostly seen in old and frail people.
Clinical manifestations
Long-term history of enlarged thyroid gland with recent rapid enlargement and local compression symptoms, such as dyspnea, dysphagia, jugular vein anger, hoarseness, etc., is due to tumor compression or invasion of trachea, esophagus, jugular vein and laryngeal nerve. The pain in the neck, hard and fixed lump with unclear boundary.
4.Medullary carcinoma of thyroid
Medullary carcinoma of thyroid, also known as parafollicular cell carcinoma, is a malignant tumor arising from parafollicular cells of thyroid gland. The incidence is mainly sporadic, but a few are familial. It is a moderate malignant tumor with early lymphatic metastasis and can metastasize hematologically to the lung.
Clinical manifestations.
It mostly presents as isolated and hard nodules, mostly solitary. Familial medullary carcinoma is mostly bilateral. Nodules may have mild pressure pain. It is usually slow. A few of them may develop rapidly and die within a short period of time. The tumor may invade the surrounding tissues, and the corresponding compression and obstruction symptoms, such as difficulty in breathing and hoarseness, may occur.
5.Primary squamous cell carcinoma of thyroid
It is very rare, accounting for about 1%-3% of thyroid cancer. It is common in the elderly.
Clinical manifestations
It often has a history of enlarged thyroid gland with hard texture. Later on, the tumor grows rapidly and compresses or invades the surrounding tissues, resulting in dyspnea, dysphagia, hoarseness, etc. The prognosis is poor and death usually occurs within a few days of treatment.
6.Primary mucinous adenocarcinoma of the thyroid
It is a very rare carcinoma in the form of nodules. Because this type of carcinoma is so rare, the age of prevalence, gender and prognosis cannot be determined.
7.Malignant tumor of thyroid interstitial gland
<1>Malignant lymphoma of thyroid gland: The incidence rate is about 2% of that of thyroid cancer. It can occur in all ages, but is rare in childhood and mainly seen in older women;
<2>Plasmacytoid sarcoma of the thyroid gland: very rare, often found in older women;
<3>Hemangiosarcoma of the thyroid: slightly more common in men than women, often metastasizing to the lungs, lymph nodes, and bones, with metastases that bleed very easily.
<4>Fibrosarcoma of the thyroid: very rare, commonly found in areas with a high incidence of goiter.
<5>Osteosarcoma of the thyroid: very rare, most often seen in adults, often metastasizing to the lung, liver area, or lymph nodes.
1.Thyroid function tests are normal.
2. Ultrasound examination of thyroid gland: color ultrasound may reveal a mass with unclear borders and abundant blood flow.
3.Thyroid nuclear scan: the scan is cold nodules.
4.X-ray examination of neck: When the tumor is huge, the trachea can be seen to be compressed or displaced, and calcified images can be seen in some tumors.
5.Needle aspiration cytology examination: the confirmation rate is 80%.