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How do you know if a nodule is cancerous?

To know the risks of a nodule we use two examinations, ultrasound and analysis of the cells of the nodule by puncture. Each of these examinations makes it possible to assess the risk of cancer. For nodules that have a significant risk, an ablation procedure will be advised. For nodules which are not doubtful, monitoring will be put in place which will mainly be based on regular ultrasound scans. 

The main treatment is carried out by an operation which will remove the cancerous nodule and all or part of the rest of the gland. Total thyroidectomy is performed for cancers that have a risk of spreading beyond the gland. The lymph nodes are the first to be affected by cancer cells emerging from the thyroid. When a node is diseased, we speak of lymphadenopathy. Surgical treatment of lymph nodes is called lymph node dissection.

How is thyroid cancer treated?

Are there different varieties of thyroid cancer?

There are two main varieties; thyroid cancer:

- differentiated cancers which arise from the multiplication of vesicular cells. These are the same cells that produce thyroid hormones, which explains the fact that cancer cells most often retain the capacity to capture iodine. We can therefore administer radioactive iodine to treat these cancers when there are metastases. Papillary cancers and vesicular cancers are the two most common types of differentiated cancers.

- Medullary cancers which arise from small islands of cells located in the middle of each of the lobes of the thyroid. These cells produce calcitonin. The calcitonin assay is used for the diagnosis of these cancers.

Can thyroid cancers be hereditary?

A small number of thyroid cancers are hereditary. This concerns papillary cancers; we are talking about familial cancer from the third case onwards. There is no genetic diagnosis and screening of other family members will be done by ultrasound. Medullary cancers can also be hereditary with the possibility of a genetic test to detect family members who carry the mutation and who will therefore need to be treated medically.

Can thyroid cancer be treated without removing the entire gland?

The main goal of surgery for cancer is to remove the diseased part and a strip of healthy tissue around it. To do this, a lobe of the thyroid must most often be removed (the operation is then called a lobectomy).

This type of conservative surgery is indicated for less aggressive cancers which have a local evolution. The elements which make it possible to define a potentially aggressive cancer are: the size of the cancer, its type, its extension outside the gland itself (visible in ultrasound or on a scanner), the existence of diseased lymph nodes identified on ultrasound, age.

Removal of the entire thyroid gland is most often necessary to allow the use of radioactive iodine. The latter, administered after the operation, will be fixed by the diseased cells which have been able to graft into an organ at a distance from the thyroid: we speak of metastases; Thyroid cancers are likely to cause metastases to the lungs, bone or brain. For the treatment of metastases with iodine to be effective, it is necessary to no longer have normal thyroid tissue because the latter will always capture iodine as a priority, preventing iodine from circulating to reach the diseased cells elsewhere in the body. 

Most often, radioactive iodine is administered preventively for cancers that are at risk of metastasis even if no metastasis has been detected during the assessment. The iodine assessment carried out approximately 2 months after the operation is also essential to detect possible metastases which often give no symptoms.

When is removal of the entire gland necessary to treat thyroid cancer?

Thyroid cancers spread very early to the lymph nodes.

The nodes located around the gland (this sector is called the central compartment) are the most frequently affected, which is why in the case of cancer the initial treatment most often involves removal of the lobe sick and the ablation of the ganglia of the central compartment which surround this lobe.

In certain cases the disease spreads further towards the lymph nodes located along the internal jugular vein (lateral compartment) which will require a more extensive operation with removal of these nodes (we speak of lateral lymph node dissection ). This more important operation is carried out when diseased lymph nodes are detected on ultrasound.

When should cancer treatment include removal of neck lymph nodes?

Usual monitoring is based on carrying out an ultrasound of the neck and taking a blood test. The ultrasound looks for the appearance of a tumor in the operated region or in the neck lymph nodes. If diseased tissue is spotted on the ultrasound, we speak of a recurrence. Very often doubt persists about the ultrasound images, which will lead to punctures for cell analysis. The blood test allows the measurement of thyroglobulin; this is most often not measurable after ablation of the thyroid. If the thyroglobulin is measurable and especially if it increases, there will be a strong suspicion of cancer recurrence. The frequency of monitoring is biannual at the beginning then annually. 

More serious cancers, with metastases, require more complex monitoring methods.

How is thyroid cancer monitored after surgery?
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