Thyroid cancer is a relatively rare, malignant tumor disease of the thyroid gland. In Germany, around 5,000 to 6,000 people are diagnosed with the disease every year, with women being affected more frequently than men. Symptoms only appear late in the course of the disease. A cure is possible in up to 90 percent of cases. The chances of recovery are even better for the less aggressive forms of tumor.
Here you will find further information and selected thyroid cancer specialists and centers.
Thyroid cancer is a rare, malignant cancer. It is caused by malignant cells in the thyroid gland. Doctors also refer to thyroid cancer as thyroid carcinoma or struma maligna ("malignant goitre").
Not every change in the thyroid gland is also a malignant cancer. Most enlargement of the thyroid gland is due to iodine deficiency. Also with
can also lead to an enlargement of the thyroid gland ( goitre). Only in rare cases is it actually thyroid cancer.
Thyroid cancer can lead to an enlargement of the thyroid gland (goitre) © amazing studio | AdobeStock
Doctors differentiate between four different types of thyroid cancer, depending on the tissue from which the tumor originates. These also differ in terms of their aggressiveness, progression and therefore prognosis:
Papillary thyroid carcinoma is the most common type © bilderzwerg | AdobeStock
In Germany, between 5000 and 6000 people are diagnosed with thyroid cancer every year. Around 700 to 800 people die from it. This means that 0.2 to 0.3 percent of cancer-related deaths are caused by thyroid cancer.
Thyroid cancer is the 15th most common new cancer in men and 14th in women. Women are more than twice as likely to develop thyroid cancer as men.
The average age of onset is 55 years. Worldwide, the incidence of thyroid cancer is increasing in all age groups.
Thyroid cancer is the result of degenerated thyroid cells. The cells that can degenerate in thyroid cancer include
The type of tissue is of great importance for the treatment and prognosis of thyroid cancer.
Nodular thyroid changes require special attention. They appear in scintigraphic diagnostics as "cool or cold nodules". This refers to low-functioning or non-functioning thyroid tissue. They are often associated with thyroid cancer.
The ultrasound examination often shows the nodules, which have an increased risk potential, with little echogenicity.
A closer examination is necessary for so-called "cold nodules" © bilderzwerg | AdobeStock
Like any malignant tumor, thyroid cancer can grow into surrounding tissue. In addition, metastases can form. They spread via the lymph vessels and the bloodstream. Lung metastases and bone metastases develop preferentially in thyroid cancer.
Medullary thyroid carcinoma is familial in 1/4 to 1/3 of cases. It can also be associated with the formation of new tumors of the adrenal medulla and parathyroid glands.
Another risk factor is high-energy radiation, such as that which occurs during X-ray examinations. X-ray irradiation of the neck area in childhood, for example, is considered particularly problematic.
Even after the Chernobyl reactor disaster, scientists in the particularly affected areas found a connection between the intensity of the radiation and the incidence of thyroid cancer in children.
An enlarged thyroid gland alone is not a risk factor for the development of cancer. Only in the case of certain changes in the tissue or the formation of nodules is special medical action required.
In the early stages, thyroid cancer usually causes no symptoms.
An immediate visit to the doctor is recommended if an enlargement of the thyroid gland develops within a few weeks and feels very rough. The same applies if a long-standing goitre suddenly continues to grow. An increase in neck circumference can be determined by measurement. It is usually noticeable that the top button of a shirt or blouse can no longer be fastened.
Palpable lumps in the neck area are also a possible symptom. These can be enlarged lymph nodes.
An enlarged thyroid gland and palpable lumps are possible symptoms of thyroid cancer © medistock | AdobeStock
In most cases, a medical examination is necessary to distinguish a benign goitre from malignant thyroid cancer. Some symptoms can be explained by the position of the pathologically altered thyroid gland on the trachea and its proximity to the larynx.
It is not necessarily the case that
a malignant disease. If you suddenly experience hoarseness, you should consult a doctor immediately to clarify the cause of this symptom.
As with any cancer, early detection and treatment of thyroid cancer is important. First of all, the doctor will take your medical history as part of a medical history interview. Your description of the symptoms and their duration are important to the doctor. Information about cancer in your family or possible exposure to ionizing radiation from your childhood and adolescence is very useful.
The examination methods used to diagnose thyroid cancer include
The doctor feels the thyroid gland with the fingers of both hands. This provides initial information on the size and surface area of the organ. It is important to check whether the thyroid gland can be swallowed and whether the nodules feel particularly rough.
The doctor also palpates the neck region for conspicuous palpable lymph nodes.
If a tumor is suspected after palpation of the thyroid gland, the next step is an ultrasound examination. The ultrasound examination provides information on
of the thyroid gland and any nodules in the thyroid gland.
Tissue changes reflect the ultrasound signal differently. The information "low echo" or "high echo" can therefore be used to make initial statements about the pathological changes.
A definitive clarification of the benign or malignant nature of the nodules is not yet possible with this method.
Examination of the thyroid gland using ultrasound © Alexander Raths | AdobeStock
Thyroid scintigraphy can be used to differentiate between cold and hot nodules. The doctor administers a low-level radioactive substance (technetium) for this purpose. This accumulates in the thyroid tissue and provides information on metabolic activity.
Nodular areas with reduced or no metabolic activity are "cold nodules". They require special monitoring or clarification.
An additional special scintigraphy (MiBi) can also contribute to a better classification of the suspicious areas.
A blood test for thyroid hormones can provide further information. The blood is checked in particular for triiodothyronine (T3) and tetraiodothyronine / thyroxine (T4). They provide information on thyroid disorders and their activity.
A tumor marker (calcitonin) is only available for one form of thyroid carcinoma. It enables early detection of this type of tumor. If necessary, a special test is carried out to check this value.
However, most forms of thyroid cancer cannot be detected by laboratory tests.
Palpation of the thyroid gland and blood test for thyroid hormones © Peakstock | AdobeStock
If necessary, the doctor can obtain additional information about the carcinoma using imaging procedures:
A fine needle biopsy is used to examine the tissue for malignant tumor cells. The doctor punctures suspicious "cold nodules" under ultrasound guidance. This allows cells to be obtained for microscopic examination. In some cases, the type of thyroid cancer can be determined before the operation.
However, this method has limitations, so that not every examination can detect or reliably rule out thyroid cancer. In these cases, the final histological examination is performed after surgical removal of the suspected thyroid gland.
Fine needle biopsy of the thyroid gland to obtain a tissue sample for subsequent microscopic examination © bilderzwerg | AdobeStock
Medullary thyroid carcinoma is often genetic. Genetic analysis (detection of the RET protooncogene mutation) allows a statement to be made about familial clustering . This means that family members at risk can be specifically screened for thyroid cancer.
Sometimes this type of cancer is also associated with other diseases. These include tumors of the adrenal medulla or the parathyroid gland. Genetic analysis can provide information on this.
Several therapies are available for the treatment of thyroid cancer.
The most important treatment option for thyroid cancer is surgical removal of the thyroid gland (thyroidectomy). As part of this thyroid operation, the surgeon usually also removes the lymph nodes in the neck.
During an operation, part or all of the thyroid gland is removed © Bergringfoto | AdobeStock
The removed tissue is examined histologically in the laboratory. If the examination results confirm that it is a malignant tumor, radioiodine therapy may follow a few weeks later. Radioactive iodine accumulates in any remaining thyroid tissue, causing it to die.
This treatment concept is the most common form of therapy for carcinoma of the thyroid gland and is very successful.
As the removal of the thyroid gland deprives the body of important hormones, hormone therapy with medication is necessary. The thyroid hormones administered, such as L-thyroxine, now replace the thyroid function.
Radiation is an option if there are still remnants of tumor tissue in the body.
Thyroid carcinoma is usually not susceptible to chemotherapy. Chemotherapy is therefore only considered for the advanced stage of thyroid cancer, i.e. when metastases are already present.
The most promising therapy basically depends on the type of thyroid cancer in question.
This is the most common form of thyroid cancer. One or more foci can be detected in the thyroid gland. If this tumor forms metastases, this first occurs via the lymphatic channels in the surrounding lymph nodes. Papillary thyroid carcinoma has the best chances of recovery (ten-year survival rate approx. 93 percent).
A single small tumor up to 1 cm in size (microcarcinoma) does not require complete thyroidectomy and removal of the cervical lymph nodes.
Partial or complete removal of the thyroid gland © bilderzwerg | AdobeStock
In the case of larger tumors or detection of multiple tumors, treatment consists of
If the cancer is an incidental finding after a normal thyroid operation, a follow-up operation is performed as soon as possible.
This form of thyroid cancer is also common. Here too, the chances of recovery are very good (ten-year survival rate approx. 85 percent). However, the prognosis depends on a further subdivision into special subgroups of this form of thyroid cancer.
Cancer metastases preferentially occur via the bloodstream in the lungs and bones. The lymph nodes can also be affected.
Even with this form of cancer in a certain subgroup, no extensive thyroidectomy and lymph node removal is required if a "microcarcinoma" is detected.
Standard therapy for all other tumors is also here
This rare thyroid cancer is very malignant and tends to occur in older patients. Due to the very rapid growth of the tumor into the surrounding area and the metastases, curative surgical treatment is not always possible.
Radiotherapy is used to avoid complications caused by the carcinoma.
This form of thyroid cancer is rare. It is the only form of cancer for which a tumor marker (calcitonin) is available, which can be determined by taking a blood sample.
This type of cancer develops from the so-called C-cells. Radioiodine therapy is therefore not possible due to the lack of iodine storage.
Complete removal of the thyroid gland is therefore the method of choice.
Due to the early development of lymph node tumors
is necessary.
Surrounding organs are only removed in the case of advanced tumors.
The average ten-year survival rate is 75 percent. Decisive for the prognosis are
Genetic analysis is required for this form of thyroid cancer in order to clarify the extent to which there is a familial clustering or combination with other diseases.
Affected family members are treated using an individualized therapy concept. This is based on the specific genetic change identified.
The chances of recovery depend primarily on the form and initial spread of the thyroid cancer. The general rule of cancer treatment also applies: the earlier a carcinoma is detected and treated, the better the chances of recovery.
The involvement of the lymph nodes appears to have only a minor influence on the prognosis.
The most common forms of thyroid cancer(papillary and follicular carcinoma) generally have very good prospects of recovery. The prerequisite is early treatment and the implementation of the treatment concept of surgery and radioiodine therapy.
Papillary carcinoma and follicular carcinoma rarely metastasize. Therefore, these patients can be completely cured in 80 to 90 percent of cases.
If medullary carcinoma is detected early, the chances of recovery are similarly good. In the case of metastases, the 5-year survival rate is 50 to 60 percent.
The cure and prognosis for very fast and very aggressively growing anaplastic thyroid carcinomas is more difficult. Here, the 5-year survival rate is less than 10 percent.
A thyroid specialist is a specialist in oncology. He plans and implements the treatment in an interdisciplinary team with specialists from other fields (e.g. endocrine surgery, nuclear medicine).
Patients should seek treatment in specialized thyroid cancer clinics. A high quality of treatment is guaranteed there.
Patients may also be able to benefit from the latest therapies by participating in clinical trials.
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