Thyroid Cancer
Thyroid cancers can arise from the cells of the thyroid, which we usually call epithelial cells, but they can also arise from very different types of cells (such as medullary thyroid cancer).
Papillary thyroid cancer accounts for 85% of epithelial cancers and almost all of the patients around you who report having thyroid cancer have this type of cancer. The prognosis is generally good, with fatal complications and spread being rare. In recent years, this tumor type is incidentally found in one out of every 5-6 patients I have operated on with the diagnosis of nodular goiter and causes serious concerns in most of my patients. Although there has been an increase in the spread and mortality rates of papillary thyroid cancer in recent years, it can actually be considered very low on the basis of the total rate.
The treatment of papillary thyroid cancer is surgery, radioactive iodine therapy (better known as atomic therapy) is generally useful as an adjunctive treatment in the postoperative period. Although the treatment is surgical, the options are many, by determining the risk groups, lobectomy (removal of one side of your thyroid gland), total thyroidectomy (removal of the entire thyroid gland), total thyroidectomy and removal of the central compartment lymph nodes, and removal of the lateral compartment lymph nodes in areas of spread are available. As a surgeon who has been performing all of these surgeries for years, I can say that the results of these surgeries are generally satisfactory.
Unfortunately, tall cell, hobnail, solid and columnar variants, which are subtypes of papillary thyroid cancer, are tumor types that show much more aggressive behavior. Subtypes such as tall cell and hobnail, which are much more aggressive especially when they are seen at a young age, require surgery with good preoperative evaluation. Since we often see lymph node spread in patients with these subtypes before surgery, we prefer to perform the surgery as a whole in a single session. Although papillary thyroid cancer is a very detailed cancer, unfortunately, in hands that do not have enough experience in its behavior, it can lead to recurrent surgeries due to deficiencies in the first surgeries.
The answers to the questions “Will something happen to my vocal cords?”, “Will my voice be hoarse?”, which are the most frequently asked questions by patients, are mostly related to the surgical technique. In the hands of surgeons who perform thyroid surgery intensively, the possibility of injury to the nerves that stimulate your vocal cords is extremely low, and although injuries are very rare, in the hands of an experienced surgeon, it is possible to recognize and repair injuries during surgery. For this reason, it is very important that thyroid surgeries are performed by a surgeon specialized in endocrine surgery.
Apart from injuries to the nerves leading to the vocal cords, another complication is low calcium levels due to temporary damage to the parathyroid glands that metabolize calcium during surgery. Especially in recent years, we see this complication more frequently due to the removal of all lymph tissues in extensive cancer surgeries. Although we preserve the parathyroid glands during surgery, their blood supply is slightly impaired and parathormone and calcium levels may be low for 1-2 months. This condition manifests itself with numbness in the hand after surgery and this problem can be solved with calcium pills in the early postoperative period. The most common cause of low parathormone is the extent of the surgery, so the incidence is very low in a patient undergoing lobectomy or total thyroidectomy only.
Serum accumulation and swelling in the operation area, which we call seroma, occurs in almost all patients. It occurs in the first week of surgery and disappears spontaneously between the 3-4th weeks. The accumulated serum is formed by the accumulation of the patient’s own serum in the area where we remove the thyroid gland and disappears by absorption.
Although medullary thyroid cancer is generally seen in familial inherited syndromes, the number of patients without such a syndrome is higher, especially in patients I have operated on recently. Medullary thyroid cancer is a very aggressive tumor type unlike papillary cancer. Although it usually has a more benign course in randomly detected patients, it can be very aggressive in familial syndromes and in patients with a tendency to progress, and therefore its surgical treatment should also be aggressive. Preoperative evaluation is very important in patients with medullary thyroid cancer, tests such as calcitonin hormone should be requested from patients with suspicion, and neck ultrasound evaluation should be performed by an experienced radiologist.
Anaplastic thyroid cancer is one of the worst known cancers of all cancer types. Although there are a very limited number of patients who can be treated surgically, treatment is mostly based on preventing obstruction of the airways and providing life support. Unfortunately, treatment options are very limited in the majority of anaplastic thyroid cancer patients admitted to our clinic.