Have you ever noticed a small lump in your neck? Or has a doctor mentioned it to you during an examination? Sometimes a small lump like this can be the first sign of a condition called Papillary Thyroid Cancer (PTC). Don't worry, we'll talk about it in detail and simply.
What is papillary thyroid carcinoma (PTC)? What is the thyroid gland?
Simply put, papillary thyroid cancer (PTC) is a type of cancer that develops in our thyroid gland. It starts in the follicular cells of the thyroid gland. These cells produce a protein called thyroglobulin . The most important thing to know is that PTC is the most common type of thyroid cancer.
Now let's look at what the thyroid gland is. Imagine it, in the front of your neck, under the skin, a small butterfly-shaped organ. That's the thyroid gland. This is part of our endocrine system . Its main job is to produce and release hormones that control many important functions in our body.
When it comes to PTC, it is usually a very slow-growing cancer. Also, it often only develops on one side (lobe) of the thyroid gland.
Are there different subtypes of `PTC`?
Yes, there are several subtypes of `PTC`. Of these, the follicular subtype is the most common. It is sometimes called `mixed papillary-follicular variant`. The other subtypes are not as common. However, they can grow and spread a little faster . Such subtypes are:
- `Column`
- `Tall cell`
- `Insular`
- `Diffuse sclerosis`
Sometimes `PTC` is also called `papillary thyroid carcinoma` .
Who gets papillary thyroid cancer?
Actually, PTC can develop in anyone. However, it is most common in middle-aged adults . Also, women are more likely to develop this condition than men.
PTC is a very rare condition in children. However, it is the most common type of thyroid cancer in children.
How common is this `PTC`?
Thyroid cancer is a relatively common condition. However, as we mentioned earlier, 80% to 85% of cases are of the PTC type. That means that about eight out of ten people who develop thyroid cancer have this type.
Is `PTC` a serious condition?
Cancer of any type is serious. It requires medical treatment and can spread (metastasize) to other parts of the body. However, the prognosis for PTC is very good compared to other types of thyroid cancer.
Most of the time, PTC can be treated successfully. It is also very rare for it to cause death. Therefore, it is important not to panic and follow proper medical advice.
Where does `PTC` spread first?
If PTC spreads, it is most likely to spread first to the lymph nodes in the neck . These nodes are small bean-shaped structures that are part of our body's lymphatic system and immune system.
How far does `PTC` spread?
Although PTC grows slowly, it can often spread to the lymph nodes in the neck. Roughly speaking, about 30% of people with PTC will have spread to other areas (metastatic papillary thyroid cancer) at the time of diagnosis .
What are the symptoms of `PTC`?
Often, the main sign of PTC is the appearance of a painless nodule in the thyroid gland . Other symptoms may also be absent.
However, very rarely, some people may experience pain in the neck, jaw, or ear . If the lump becomes large enough to press on our windpipe or esophagus, it can cause difficulty breathing or swallowing .
Important: If you notice a new lump in your neck, even if it's not painful, you should definitely see a doctor. The earlier you identify it, the more successful the treatment.
What are the causes of `PTC`?
Scientists still don't know the exact cause of PTC, but they have identified several risk factors that increase the risk of developing the condition, including radiation exposure and certain genetic conditions .
Radiation exposure and `PTC`
People who have been exposed to significant amounts of ionizing radiation in their history are more likely to develop PTC. The ways in which this radiation can be exposed are:
- High-dose external radiation treatments are given to the neck to treat cancer or other non-cancerous conditions, especially in childhood.
- Radiation exposure from nuclear power plant accidents. For example, after the Chernobyl nuclear accident in 1986, the number of PTC patients in the surrounding areas increased from 3-fold to 75-fold.
Genetic conditions and `PTC`
There are several genetic (inherited) conditions associated with PTC:
- Familial Adenomatous Polyposis (FAP / Gardner syndrome ): This is a rare, inherited condition. It causes a person to develop many polyps in their colon and rectum, which can become cancerous. People with FAP are also at increased risk of developing tumors in other parts of the body, including the thyroid gland. The condition is caused by an inherited mutation in the APC gene.
- Werner syndrome : This is also a rare condition. It shows signs of abnormally rapid aging (progeria). People with Werner syndrome are at increased risk of developing cancer. The most common type is thyroid cancer. More than 80 different mutations in the WRN gene have been found in people with this condition.
- Carney complex type 1 : This condition also increases the risk of developing various types of tumors, including thyroid tumors. It is often caused by mutations in the PRKAR1A gene.
However, it should be remembered that only 5% of all PTC patients are associated with such genetic conditions.
How to identify `PTC`?
Most often, a PTC presents as a lump in the thyroid gland. You may have felt it yourself, or a doctor may find it during a routine neck examination. Sometimes, the lump is found incidentally during a scan for another condition.
Your doctor may order the following tests to diagnose PTC:
- Imaging tests : These tests can help identify a thyroid nodule. For example, a thyroid ultrasound , CT scan , and/or MRI scan may be done.
- Fine needle aspiration (needle biopsy ): A doctor will often take a small sample of tissue (biopsy) from your thyroid nodule using a very thin needle. A pathologist will look at the tissue under a microscope to see if there are any cancer cells and, if so, what type of thyroid cancer it is.
Sometimes, your doctor may refer you for genetic counseling to see if you have a genetic condition that causes PTC, as well as other types of tumors.
How is PTC treated?
Treatment for PTC depends on the size of the tumor and whether the cancer has spread.
Surgery is the main and most common treatment for PTC. Depending on the size and location of the tumor, your surgeon may remove part of the thyroid gland (lobectomy) or the entire gland (thyroidectomy). If the cancer is in the thyroid glands, the surgeon will remove the affected glands either at the same time as the thyroid surgery or in a second surgery.
Important: If your entire thyroid gland is removed (total thyroidectomy), you will need to take thyroid hormone pills for the rest of your life .
Additional treatments for PTC are:
- Radioiodine therapy : Thyroid cells and PTC cells absorb the mineral iodine (found in some foods). For this reason, doctors sometimes use a radioactive form of iodine to destroy any normal thyroid tissue left after the thyroid gland has been removed, as well as any cancerous thyroid tissue that may remain.
- Radiation therapy : Radiation kills cancer cells and stops them from growing. In external radiation therapy, a machine directs powerful beams of energy directly at the tumor. In internal radiation therapy, radioactive seeds are placed inside or around the tumor.
- Chemotherapy : Chemotherapy drugs given intravenously (IV) or orally (oral) kill cancer cells and stop the cancer from growing. However, only a small percentage of people with thyroid cancer need chemotherapy.
What are the side effects and complications of `PTC` treatment?
A possible side effect of thyroidectomy and radioiodine therapy is permanent hypothyroidism. Therefore, if you have either or both of these treatments, you will need to take thyroid hormone pills for the rest of your life.
There are several complications that can occur during thyroid surgery:
- Infection.
- Accidental removal or damage to the parathyroid glands , which control the level of calcium in your blood.
- Damage to the recurrent laryngeal nerve, which runs behind the thyroid gland. This can cause the voice to become hoarse and weak.
Possible side effects of radioactive iodine treatment:
- Nausea and vomiting.
- Sialadenitis - swollen salivary gland.
- Transient thyrotoxicosis.
- Pulmonary fibrosis is a disease that causes scarring of the lung tissue.
- Temporary or permanent infertility.
- A small risk of developing leukemia , breast cancer, or bladder cancer.
Can `PTC` be prevented?
Many people who develop thyroid cancer have no specific risk factors. Therefore, most cases of PTC cannot be prevented.
Exposure to radiation, especially during childhood, is a known risk factor for PTC. Because of this, doctors no longer use radiation for less serious conditions. Children are also exposed to radiation from imaging tests such as X-rays and CT scans, but in much lower doses. It is not clear to what extent they increase the risk of PTC.
If someone in your family has had thyroid cancer, you may want to get genetic counseling . This will help determine if you have a genetic condition that puts you at higher risk of developing PTC. If you do, your doctor may recommend prophylactic surgery to remove your thyroid gland before cancer develops.
What is the prognosis of PTC?
In general, the prognosis for PTC is very good , especially if you are under 40 years of age and the tumor is small. PTC can often be treated successfully. Even if it has spread to the lymph nodes in the neck, it is rarely fatal.
Factors that can reduce the likelihood of recovery include:
- Being over 55 years of age at diagnosis.
- The tumor is getting bigger .
- The cancer has spread to distant parts of the body .
- Having a rare, aggressive subtype of `PTC` (e.g. `tall cell variant`, `diffuse sclerosis variant`, `solid variant`).
Can you survive `PTC`?
The survival rate for PTC is very high . More than 90% of adults with PTC live for at least 10 to 20 years after treatment.
When should I see a doctor about `PTC`?
If you are diagnosed with PTC, you will need to meet with your medical team regularly to monitor the progress of your treatment. You will also need to have long-term follow-up visits every 6 to 12 months for at least five years to check for recurrence.
If your thyroid gland was removed and/or radioactive iodine treatment was given as part of your treatment, you will need to take thyroid hormone pills for the rest of your life . A doctor will monitor your thyroid hormone levels throughout your life to make sure your medication dose is right for you.
Being diagnosed with cancer, no matter what type, can be a shock. However, the good news is that the prognosis for PTC is often very good. Your medical team will work with you to determine the best treatment plan for you.
## Important things to remember (Take-Home Message)
Okay, so, from what we've talked about, these are the most important things you need to remember:
- Papillary thyroid cancer (PTC) is the most common type of thyroid cancer and has the best prognosis.
- The main sign is a painless lump in the neck. If you see something like that, definitely see a doctor.
- Surgery is the main treatment. Radioactive iodine therapy may also be necessary.
- If the thyroid gland is completely removed, you will have to take thyroid hormones for the rest of your life .
- The earlier this condition is detected, the more successful the treatment. Therefore, regular medical checkups and following advice are very important.
- Don't be afraid. You are not alone. There are doctors, family, and friends to help you.
I hope this information is helpful to you. If you have any questions, don't hesitate to ask your doctor. Stay healthy!
` Thyroid cancer, papillary thyroid cancer, PTC, neck nodules, thyroid surgery, radiation therapy, hormone therapy
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