Differentiated thyroid cancer, with a recurrence rate of about 30% after surgery
Differentiated thyroid cancer (DTC), which includes papillary and follicular carcinomas, is the predominant type of thyroid cancer, covering more than 90% of patients. Its main treatment is surgery. So, does having surgery mean you are cured?
In fact, there is no accepted professional standard for a “cure” for thyroid cancer, and about 30% of patients with DTC will have a postoperative recurrence or metastasis, with 2/3 of them occurring within 10 years of surgery.
What factors may increase the risk of recurrence?
What factors may increase the risk of recurrence?
Some factors may sow the seeds for postoperative recurrence, such as having lymph node metastases in the neck at the time of surgery, extrathyroidal invasion or distant metastases, a family history of thyroid cancer, and residual cancer from surgery.
According to the 2015 American Thyroid Association (ATA), thyroid cancer with the following factors is at higher risk of recurrence:
- Tumor invasion of the soft tissues surrounding the thyroid gland visible to the naked eye;
- Tumor not completely removed;
- Distant metastases are present;
- Pathologic stage of N1 (with regional lymph node metastasis) and metastatic lymph nodes greater than 3 cm in maximum diameter;
- An abnormally high postoperative serum Tg (thyroglobulin) level, as determined by the physician;
- Thyroid follicular carcinoma with extensive vascular infiltration (>4 lesions with vascular invasion).
There is no clear medical evidence that a particular food may increase the risk of recurrence. However, you should pay attention to iodine in your diet, and foods with high iodine content such as kelp and nori are recommended to be eaten sparingly. If available, use non-iodized salt for cooking, but if you have adolescent children at home who are developing, it is not necessary to be demanding to consume non-iodized salt. This is because iodine is essential for the physical and intellectual development of children.
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What are the possible “signs” of relapse?
After radical surgery, what are the “signs” of recurrence?
After radical surgery, almost all patients experience varying degrees of neck pain or discomfort. Is this a sign of recurrence?
No.
This is not the case. There is no clear relationship between pain and recurrence of metastasis, for example. During surgery, nerve, muscle, vascular, and other tissue damage can lead to neck discomfort and pain during the recovery period, which can be reduced by rehabilitation exercises.
The presence of the following conditions suggests that you need to pay extra attention:
- A postoperative review reveals a new neck mass, so get an ultrasound to determine its nature.
- Abnormal blood markers.
- The main biochemical markers to follow after surgery are TSH (thyroid-stimulating hormone) and Tg, which are usually reviewed every 3 to 6 months. If you have had a total thyroidectomy and have no Tg-producing thyroid cancer lesions or thyroid tissue, Tg should be reduced to very low levels, and if Tg is detected in the serum and is higher than normal, this often indicates residual or recurrent thyroid cancer lesions.
- Elevated serum calcitonin and carcinoembryonic antigen suggest possible recurrence of medullary thyroid cancer.
How to detect the “first signs” of recurrence early?
After surgery, come to the hospital regularly.
Following up regularly after surgery and completing the necessary tests as prescribed is a reliable way to detect recurrence or metastasis early. Generally, follow-up is every 3 months for one year after surgery; after that, the interval between follow-ups is extended as appropriate, for example, every 6 months. If thyroxine tablets need to be adjusted, thyroid function should be rechecked 1 month after the adjustment to observe the effect of the medication.
Remind you that these are general principles, but if your condition fluctuates or your doctor requires additional reviews, be sure to follow your doctor’s instructions.
Summary
Thyroid cancer can recur after surgery, and you should follow up regularly with your doctor to detect recurrence and metastases as soon as possible.
Co-written by Dr. Shuwen Yang, Cancer Hospital of Fudan University