What are the symptoms of thumb tumor?

Mainly depends on whether it is benign or malignant. Benign patients can be treated conservatively or not. Malignant surgery is good.

Thyroid tumor is a common and frequently-occurring disease in clinic, most of which are benign lesions, and a few are cancer, sarcoma and malignant lymphoma. The incidence of female is obviously higher than that of male, and the ratio of male to female is about 1: 2 ~ 3.

I. Etiology

The cause of thyroid tumor is still unknown. At present, there are two main causes of differentiated thyroid carcinoma (including papillary carcinoma and follicular carcinoma): one is radiation and the other is endemic goiter.

Second, the classification of diseases

Thyroid tumors are divided into benign and malignant types.

(1) Benign thyroid tumor

Mainly thyroid adenoma, accounting for about 60% of thyroid diseases. Most of them are women. According to domestic statistics, the ratio of male to female is 3: 1. The onset age is mostly in the active period of thyroid function, that is, 20 ~ 40 years old, and the onset gradually decreases after 40 years old.

(ii) Malignant thyroid tumor

1. Thyroid cancer, of which papillary adenocarcinoma accounts for about 75%; Follicular carcinoma accounts for about10% ~15%; Medullary carcinoma accounts for about 3% ~10%; Undifferentiated cancer accounts for about 5% ~ 10%.

2. Thyroid malignant lymphoma rarely occurs only in the thyroid gland, and is often a part of systemic malignant lymphoma.

3. Metastatic cancer is rare.

4. Thyroid sarcoma and other primary malignant tumors are extremely rare.

Third, the diagnosis method of thyroid diseases

(1) Asking about medical history and physical examination

At the same time, we must check the cervical lymph nodes and pay attention to distinguish whether the cervical tumor originated from the thyroid gland.

(2) Radionuclide examination

This examination should be a routine diagnostic method for thyroid, and the radionuclides are: 13 1I and 99mTc. According to the absorption function of thyroid gland, nodules can be divided into four categories:

1. The concentration of nucleolin in hot nodule thyroid nodule is higher than that in surrounding tissues, which is more common in follicular adenoma or adenocarcinoma or toxic adenoma.

2. Warm nodules are more common in the recovery period of adenoma, nodular goiter, Hashimoto's disease and subacute thyroiditis.

3. Cold nodules are more common in undifferentiated thyroid carcinoma, medullary carcinoma, thyroid cystic degeneration and acute subacute thyroiditis.

4. Cold nodules are often thyroid cancer, but they are not absolute.

(3) Ultrasonic inspection

To detect the shape, size and number of thyroid masses and their relationship with carotid sheath; Determine whether the mass is cystic or solid; Clearing cervical lymph nodes; And as a positioning device for puncture examination.

(4) X-ray, CT and magnetic resonance imaging

The cervical radiograph can show the tumor range, different calcification images and their relationship with trachea and esophagus.

CT and MRI can clearly show the size and shape of thyroid tumor and its relationship with trachea, esophagus, blood vessels and even nerves, and fully define the scope of tumor invasion, thus providing scientific basis for surgery.

(5) Fine needle aspiration cytology

Advantages: simple operation; No anesthesia is needed (children can accept it); There is no risk of bleeding and cancer cell implantation and metastasis; The positive rate is high, the false positive rate is very few, and the false negative rate is about 10%.

(6) Laboratory inspection

Knowing whether thyroid function is abnormal is helpful to clarify the nature of goiter. Commonly used are: T3, T4, TSH, FT3, FT4, TGA, MCA, plasma calcitonin, ESR, etc.

Fourth, thyroid cancer.

Thyroid cancer is composed of many cancers with different biological behaviors and pathological types, and its onset age, growth rate, metastasis route and prognosis are obviously different. For example, the postoperative 10 survival rate of papillary adenocarcinoma is nearly 90%, while the course of undifferentiated carcinoma is very short, usually only a few months. The treatment of thyroid cancer involves surgery, radiotherapy, chemotherapy and endocrine therapy, but surgery is the main treatment.

There are four different types of thyroid cancer:

(I) Papillary adenocarcinoma

Papillary adenocarcinoma is the most common thyroid cancer in clinic, accounting for about 3/4 of the total thyroid cancer, with a good degree of differentiation. Among them, those with a diameter less than 1cm are called microcarcinoma, and most of the tumors formed by papillary adenocarcinoma have no capsule, usually single or multiple lesions. The disease is prone to cervical lymph node metastasis and lung metastasis may occur in the late stage.

1. General data Papillary adenocarcinoma can occur at any age, both men and women, but it is common in young and middle-aged women, and the peak age of onset is 20 ~ 40 years old. The course of the disease progresses slowly, and some patients often find cervical lymph node enlargement and come to see a doctor. If not treated in time, the further development of cancer can invade adjacent important organs, such as trachea, recurrent laryngeal nerve, common carotid artery and internal jugular vein, leading to dyspnea, hoarseness and other symptoms, and obviously affecting the therapeutic effect.

2. Surgery is the first choice for treatment. Even for patients with advanced stage, don't give up surgery easily. Surgical methods include: thyroidectomy, extended thyroidectomy, combined radical thyroidectomy and palliative thyroidectomy. Advocate therapeutic cervical lymph node dissection, but do not advocate preventive cervical lymph node dissection. Functional neck dissection is the main method of neck lymph node dissection. The focus of the operation is to completely remove the tumor and metastatic lymph nodes and protect the parathyroid gland and recurrent laryngeal nerve.

3. Adjuvant therapy includes endocrine therapy, that is, thyroxine tablets 80 ~ 1.20mg/ day. Even after radical surgery, endocrine therapy should be supplemented. Radiotherapy, advanced patients can be assisted.

4. Typical case Chen Mou, male, 38 years old, bank clerk. He was admitted to the hospital on1September, 1995 because he found the tumor of the left upper neck for more than 7 years. Physical examination: the sternocleidomastoid muscle in the left upper neck can touch a hard mass of 5 ″× 4 ″, the bilateral thyroid gland can touch a hard mass, and the remaining neck can touch swollen lymph nodes. Suspected diagnosis: bilateral thyroid cancer with cervical lymph node metastasis. Rapid pathological examination during the operation confirmed the diagnosis of bilateral thyroid papillary adenocarcinoma. Combined radical operation of bilateral thyroid cancer, taking thyroxine tablets after operation, has survived healthily so far.

(ii) Follicular carcinoma

It is a well-differentiated thyroid cancer with follicular structure as the main histological feature, which is called differentiated thyroid cancer together with papillary adenocarcinoma.

1. General data Follicular carcinoma is more common in middle-aged and elderly women aged 40-60, with a long course of disease, slow growth, clear tumor boundary and capsule, similar to thyroid adenoma, and prone to blood metastasis.

2. Treatment: radical surgery, followed by endocrine therapy and radiotherapy.

3. Typical case Liu, female, 54 years old, retired worker. He was admitted to the hospital in March of 1999 because of right anterior cervical tumor for more than 3 years and hoarseness for half a month. Physical examination: the right thyroid region is 4㎝×5㎝ tumor, with medium hard and smooth texture and poor mobility. There are swollen hard lymph nodes in the right neck, with the largest size of 2㎝×2㎝, which are arranged in a string. Fixing the right vocal cord under fibrolaryngoscope. Pathologically diagnosed as follicular carcinoma of the right thyroid, combined radical operation was performed on the right thyroid carcinoma, followed by radiotherapy and thyroxine tablets, and it has survived for more than 5 years.

(3) Undifferentiated cancer

1. General data is rare in clinic, and it is a highly malignant tumor; Most of them are found in elderly men, with an average age of over 60; The course of disease is short and develops rapidly. The main manifestations are masses in the anterior cervical region, hard and fixed, and the boundary is often unclear. It is easy to invade trachea, recurrent laryngeal nerve, esophagus and carotid sheath, causing hoarseness, dyspnea, dysphagia and neck and ear pain. Enlarged lymph nodes often appear on both sides of the neck; It is prone to distant metastasis.

2. The treatment is mainly radiotherapy, and surgery can be done at a very early stage. The vast majority of patients have lost the opportunity of active treatment at the time of initial diagnosis.

3. Typical case Li, male, 67 years old, farmer. He was admitted to the hospital because of a mass in front of the neck with gas shorter than 200 1, 1 1 for 3 days. Physical examination on admission: a 3× 3 mass can be touched in the anterior cervical thyroid region, which is firmly fixed with trachea, with unclear boundary and enlarged bilateral cervical lymph nodes. After admission, the condition developed rapidly, with swallowing obstruction on the third day, hoarseness on the fourth day, and the mass increased to 7cm×5cm on the eighth day, and invaded subcutaneous tissue. The patient gave up treatment and was discharged. Diagnosis: Undifferentiated thyroid cancer.

(4) Medullary carcinoma

Medullary carcinoma originates from thyroid parafollicular cells, also known as parafollicular cell carcinoma or C cell carcinoma. Clinically, besides thyroid mass and cervical lymph node metastasis, there are some unique symptoms, such as chronic diarrhea (30%) and facial flushing. Serum calcitonin concentration can be significantly higher than normal, which is related to its secretory function (APUD tumor).

Medullary carcinoma is a moderate malignant tumor, which can occur at any age, and the incidence rate is the same for men and women. Treatment is also based on radical surgery.

Verb (abbreviation of verb) conclusion

The vast majority of thyroid cancers are differentiated thyroid cancers; There are obvious differences in the characteristics, treatment methods and prognosis of different pathological types of thyroid cancer. Mainly surgical treatment; Advocate therapeutic cervical lymph node dissection, not preventive cervical lymph node dissection; Radiotherapy is the main adjuvant therapy, endocrine therapy is suitable for the treatment of all thyroid cancers, and chemotherapy is generally not advocated; The treatment of thyroid cancer should also follow the principle of individualization.

Supplement:

Principles of treatment

1. Multiple thyroid nodules are generally benign lesions. If the thyroid function is normal or decreased, try thyroxine treatment for a period of time, and the nodules may subside. However, multiple nodules may have secondary hyperfunction or canceration, and surgical treatment is still appropriate. 2. A single thyroid nodule, especially hard and elastic, is cystic by B-ultrasound, and can usually be treated with thyroxine. If the lump disappears, no operation is needed. For fast-developing solid masses with hard texture, especially those with enlarged cervical lymph nodes, or solitary nodules in children, adolescents and men, malignant tumors may need immediate surgical treatment.

Medication principle

Thyroid gland is one of the important endocrine organs of human body, and thyroxine participates in the growth, development and metabolism of human body. Because the production of thyroxine in the body will be affected after most of one or both sides of thyroid tumor are removed, thyroxine tablets in item "C" must be given as compensatory treatment after operation, especially for young patients. However, postoperative patients with thyroid cancer are not sensitive to all anticancer drugs, and only use a large amount of thyroxine to produce negative feedback, thus delaying tumor recurrence and achieving good results in clinic.

accessory examination

Clinically, manual examination is the most basic method to locate thyroid masses, and there are many methods such as "A", "B" and "C". But in order to make an accurate qualitative examination, only puncture or biopsy can make a qualitative diagnosis. Therefore, appropriate auxiliary examination should be carried out according to the specific conditions of patients, which is conducive to diagnosis and timely surgical treatment.

Curative effect evaluation

1. cure: symptoms and signs disappeared without recurrence. 2. Improvement: the symptoms and signs disappeared and recurred in a short period of time. 3. Untreated: Some undifferentiated cancers are difficult to be surgically removed, and sometimes only tracheotomy is performed to relieve dyspnea.