Follicular thyroid cancer (FTDC) is a malignant tumor originating from the cells of the thyroid follicles, which are responsible for the synthesis and secretion of thyroid hormones. This type of cancer stands out among other forms of thyroid malignancies due to its relatively aggressive behavior and metastatic features. FTDC is usually diagnosed in people over 45 years of age, and women suffer from this form of cancer 2-3 times more often than men. Although FTDC is the second most common type of thyroid cancer, its early detection and modern treatment methods significantly improve the prognosis.
History of the disease and interesting historical facts
The history of follicular thyroid cancer research dates back to the early 20th century, when systematic observations and descriptions of thyroid pathology first began. In the 1930s, scientists identified various types of thyroid tumors, but follicular cancer remained the subject of research for a long time, accumulating a wealth of data on its morphology and clinical manifestations. In the 1960s, the first successful operations to remove follicular cancers were performed, which significantly improved the survival rate of patients. Interestingly, until the 1950s, FRTC was considered a relatively rare form of cancer, but with the increase in the diagnosis of thyroid diseases due to the improvement of imaging methods such as ultrasound diagnostics, an increase in the number of cases of its detection is observed.
Epidemiology
According to the World Health Organization, follicular thyroid cancer accounts for about 10-15% of all thyroid cancer cases. According to statistics, the incidence of FTD varies depending on the region and the balance with other forms of cancer. Higher incidence rates are reported in countries with high iodine deficiency, indicating a possible link between iodine deficiency and the development of thyroid cancer. In general, about 30-40 thousand new cases of FTD are recorded worldwide each year. High incidence is observed in the age group of 45-65 years, and the risk increases every year.
Genetic predisposition to this disease
Follicular thyroid cancer is often associated with certain genetic mutations and abnormalities. Studies have shown that changes in genes associated with thyroid oncogenesis may play a key role in the pathogenesis of FTC. In particular, mutations in the RAS and PAX8 genes are observed. It has been established that activation of RAS mutation leads to cell transformation, while abnormalities in the PAX8 gene can contribute to proliferation and impaired differentiation of follicular cells. In addition, familial cases of follicular thyroid cancer may be associated with hereditary syndromes such as multiple endocrine neoplasia syndrome type 2 (MEN-2).
Risk factors for the development of this disease
Risk factors that contribute to the development of follicular thyroid cancer can be classified as follows:
- Physical factors:
- Age: The risk increases after age 45.
- Gender: Women are more susceptible to the disease than men.
- Chemical factors:
- Long-term exposure to radioactive iodine.
- Exposure to chemicals such as benzene and certain pesticides.
- Other factors:
- Personal or family history of thyroid disease.
- Autoimmune diseases such as Hashimoto's thyroiditis.
- Lack of iodine in food.
Diagnosis of this disease
Diagnosis of follicular thyroid cancer involves several stages, starting with a clinical examination and ending with complex laboratory and instrumental studies. The main symptoms that may indicate the development of a tumor include:
- Enlargement of the thyroid gland (goiter).
- A feeling of pressure or discomfort in the neck area.
- Variable difficulty swallowing or breathing.
- Voice changes.
Laboratory tests usually include thyroglobulin and thyroid hormone levels to assess thyroid function. Radiological tests, such as thyroid ultrasound, play an important role in diagnosis, allowing easy visualization of the presence of nodules in the gland. Once a suspicious nodule is detected, a fine-needle aspiration biopsy can be performed to determine the nature of the lesion and, if necessary, exclude it from the list of possible malignancies.
Differential diagnosis includes exclusion of papillary carcinoma as well as benign nodules such as adenoma, which requires a careful approach by an experienced specialist.
Treatment
Treatment of follicular thyroid cancer is based on a combination of surgical, radiation and pharmacological therapy. The main method of treatment is surgical removal of the tumor, which often includes total or subtotal removal of the thyroid gland. This operation eliminates the main problem and reduces the risk of recurrence.
Pharmacological treatment involves the use of hormone replacement therapy to normalize thyroid hormone levels after surgery. In some cases, when necessary, radioactive iodine therapy may be recommended to eliminate residual tumor cells.
Other treatments include chemotherapy, but its use in FTC is limited and is not usually the first choice.
List of medications used to treat this disease
- Levothyroxine (Euthyrox, L-Thyroxine) is used for replacement therapy after surgery.
- Radioactive iodine (I-131) - used to destroy residual tumor tissue and metastases.
Disease monitoring
Monitoring the patient's condition after treatment for follicular thyroid cancer is an integral part of the medical process. Control stages usually include regular examinations by an endocrinologist, thyroid ultrasound, and thyroglobulin tests. Prognosis for patients with follicular thyroid cancer can be favorable, especially when the disease is detected at an early stage; however, the risk of recurrence remains a concern, especially in aggressive forms of the disease.
Complications may include the development of metastases to the lymph nodes or other organs, which requires additional attention and adjustment of therapy.
Age-related features of the disease
Follicular thyroid cancer may have different clinical manifestations depending on the patient's age. In young people, the disease usually manifests itself more aggressively, while in older patients, despite a higher incidence, a less aggressive course of the disease may be observed. In people over 65 years of age, there is an increased risk of metastasis and common comorbidities, which makes the treatment approach more sophisticated and multifactorial.
Questions and Answers
- What is follicular thyroid cancer?
Follicular thyroid cancer is a malignant tumor that arises from follicular cells responsible for the synthesis of thyroid hormones. - What are the main symptoms of follicular cancer?
The main symptoms include an enlarged thyroid gland, discomfort in the neck, difficulty swallowing and changes in the voice. - How is follicular cancer diagnosed?
Diagnosis includes clinical examination, ultrasound, laboratory tests and fine needle biopsy. - What is the treatment for follicular thyroid cancer?
Treatment includes surgery, hormone replacement therapy and, if necessary, radioactive iodine. - What is the prognosis for patients with follicular cancer?
The prognosis depends on the stage of the disease, but with early diagnosis and adequate treatment, the chances of a full recovery are high.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov emphasizes the importance of timely diagnosis and regular monitoring of the condition of patients suffering from follicular thyroid cancer. “It is necessary to undergo annual examinations with an endocrinologist and not to ignore changes in health,” the doctor notes. He also advises monitoring the level of iodine in the diet and it would be useful to discuss supplement options with a doctor. All patients should be informed about the symptoms of the disease and seek medical help if there are alarming signs.
