WordNet

suggestive of a thyroid disorder; "thyroid personality"
of or relating to the thyroid gland; "thyroid deficiency"; "thyroidal uptake" (同)thyroidal
any malignant tumor derived from epithelial tissue; one of the four major types of cancer

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甲状腺 / 甲状腺の
がん,がん腫

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/03 20:29:10」(JST)

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Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, ^[1] or it can be a malignant neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer.^[2] Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men.^[2]^[3] The estimated number of new cases of thyroid cancer in the United States in 2010 is 44670 compared to only 1690 deaths.^[4] Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.

Diagnosis[edit source | edit]

Further information: Thyroid nodule

The first step in diagnosing a thyroid neoplasm is a physical exam of the neck area. If any abnormalities exist, a doctor needs to be consulted. A family doctor may conduct blood tests, an ultrasound, and nuclear scan as steps to a diagnosis. The results from these tests are then read by an endocrinologist who will determine what problems the thyroid has. Hyperthyroidism and hypothyroidism are two conditions that often arise from an abnormally functioning thyroid gland. These occur when the thyroid is producing too much or too little thyroid hormone respectively.^[4]

Thyroid nodules are a major presentation of thyroid neoplasms, and are diagnosed by ultrasound guided fine needle aspiration (USG/FNA) or frequently by thyroidectomy (surgical removal and subsequent histological examination). FNA is the most cost-effective and accurate method of obtaining a biopsy sample.^[5] As thyroid cancer can take up iodine, radioactive iodine is commonly used to treat thyroid carcinomas, followed by TSH suppression by high-dose thyroxine therapy.

Nodules are of particular concern when they are found in those under the age of 20. The presentation of benign nodules at this age is less likely, and thus the potential for malignancy is far greater.

Classification[edit source | edit]

Thyroid neoplasm might be classified as benign or malignant.

Benign neoplasms[edit source | edit]

Thyroid adenoma is a benign neoplasm of the thyroid. Thyroid nodules are very common and around 80 percent of adults will have at least one by the time they reach 70 years of age. Approximately 90 to 95 percent of all nodules are found to be benign.^[4]

Malignant neoplasms[edit source | edit]

Main article: Thyroid cancer

Thyroid cancers are mainly papillary, follicular, medullary or anaplastic thyroid cancer.^[2] Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men.^[2]^[6] Nearly 80 percent of thyroid cancer is papillary and about 15 percent is follicular; both types grow slowly and can be cured if caught early. Medullary thyroid cancer makes up about 3 percent of this cancer. It grows slowly and can be controlled if caught early. Anaplastic is the most deadly and makes up around 2 percent. This type grows quickly and is hard to control.^[4] The classification is determined by looking at the sample of cells under a microscope and by which type of thyroid cell is present. Other thyroid malignancies include thyroid lymphoma, various types of thyroid sarcoma, smooth muscle tumors, teratoma, squamous cell thyroid carcinoma and other rare types of tumors.^[7]

Treatment[edit source | edit]

Treatment of a thyroid nodule depends on many things including size of the nodule, age of the patient, the type of thyroid cancer, and whether or not it has spread to other tissues in the body. If the nodule is benign, patients may receive thyroxine therapy to suppress thyroid-stimulating hormone and should be reevaluated in 6 months.^[2] However, if the benign nodule is inhibiting the patient's normal functions of life; such as breathing, speaking, or swallowing, the thyroid may need to be removed.

Sometimes only part of the thyroid is removed in an attempt to avoid causing hypothyroidism. There's still a risk of hypothyroidism though, as the remaining thyroid tissue may not be able to produce enough hormones in the long-run.

If the nodule is malignant or has indeterminate cytologic features, it may require surgery.^[2] A thyroidectomy is a medium risk surgery that can result complications if not performed correctly. Problems with the voice, nerve or muscular damage, or bleeding from a lacerated blood vessel are rare but serious complications that may occur. After removing the thyroid, the patient must be supplied with a replacement hormone for the rest of their life. This is commonly a daily oral medication prescribed by their endocrinologist.

Radioactive Iodine-131 is used in patients with papillary or follicular thyroid cancer for ablation of residual thyroid tissue after surgery and for the treatment of thyroid cancer. Patients with medullary, anaplastic, and most Hurthle cell cancers do not benefit from this therapy.^[2] External irradiation may be used when the cancer is unresectable, when it recurs after resection, or to relieve pain from bone metastasis.^[2]

References[edit source | edit]

^ Chapter 20 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.
^ ^a ^b ^c ^d ^e ^f ^g ^h Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. "Thyroid and Parathyroid Cancers" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
^ Al-Zaher N, Al-Salam S, El Teraifi H. Thyroid carcinoma in the United Arab Emirates: perspectives and experience of a tertiary care hospital. Hematol Oncol Stem Cell Ther 2008;1:14-21. "Hematology/Oncology and Stem Cell Therapy"
^ ^a ^b ^c ^d National Cancer Institute. What You Need to Know About Thyroid Cancer National Cancer Institute, 2010.Print
^ Schmitt, Fernando. "Thyroid Cytology: Is FNA Still The Best Diagnostic Approach?"International Journal of Surgical Pathology,June 2010,vol 18, p.201-204.
^ Al-Zaher N, Al-Salam S, El Teraifi H. Thyroid carcinoma in the United Arab Emirates: perspectives and experience of a tertiary care hospital. Hematol Oncol Stem Cell Ther 2008;1:14-21. "Hematology/Oncology and Stem Cell Therapy"
^ DeLellis R.A.; Lloyd R.V.; Heitz P.U. et al., eds. (2004). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Endocrine Organs. Lyon, France: IARC Press. pp. 94–123. ISBN 92-832-2416-7. |displayeditors= suggested (help)

External links[edit source | edit]

Thyroid Cancer Clinical Trials Page of the American Thyroid Association
Nuclear Medicine Information =– Thyroid Diseases
Thyroid Cancer- National Cancer Institute
Diagnostic patient information

UpToDate Contents

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1. 分化型甲状腺癌：マネージメントの概要 differentiated thyroid cancer overview of management
2. 甲状腺乳頭癌の概要 overview of papillary thyroid cancer
3. 濾胞性甲状腺癌の概要 overview of follicular thyroid cancer
4. 甲状腺髄様癌：臨床症状、診断、および病期分類 medullary thyroid cancer clinical manifestations diagnosis and staging
5. 甲状腺未分化癌 anaplastic thyroid cancer

English Journal

Effectiveness of chemotherapy in advanced differentiated thyroid cancer: a systematic review.

Albero A1, Lopéz JE1, Torres A1, de la Cruz L1, Martín T2.
Endocrine-related cancer.Endocr Relat Cancer.2016 Feb;23(2):R71-84. doi: 10.1530/ERC-15-0194.
In differentiated thyroid carcinoma refractory to radioactive iodine (CDT-RTI), chemotherapy has been considered for decades to be the only systemic therapy with palliative purpose. Phase II studies assessing the efficacy of different chemotherapy outlines have been published. Nevertheless, phase II
PMID 26683454

CXCL16 signaling mediated macrophage effects on tumor invasion of papillary thyroid carcinoma.

Cho SW1, Kim YA1, Sun HJ1, Kim YA1, Oh BC1, Yi KH1, Park do J1, Park YJ2.
Endocrine-related cancer.Endocr Relat Cancer.2016 Feb;23(2):113-24. doi: 10.1530/ERC-15-0196. Epub 2015 Nov 11.
Macrophages in tumor microenvironment have pivotal roles in tumor growth, metastasis, and angiogenesis. We investigated the interacting mechanism of macrophage actions in human papillary thyroid cancer (PTC). Co-cultures of macrophage/PTC significantly increased the cancer cell migration potentials,
PMID 26559672

Pediatric Head and Neck Malignancies.

Qaisi M1, Eid I2.
Oral and maxillofacial surgery clinics of North America.Oral Maxillofac Surg Clin North Am.2016 Feb;28(1):11-9. doi: 10.1016/j.coms.2015.07.008.
Head and neck malignancies are rare in pediatric patients, and represent 12% of all pediatric malignancies. The incidence for these head and neck tumors is 1.49 cases per 1,000,000 person-years. Among the most common pediatric head and neck malignancies are lymphomas (27%), neural tumors including p
PMID 26614697

Japanese Journal

Surgery : Identification and preservation of the parathyroid gland during total thyroidectomy in dogs with bilateral thyroid carcinoma : a report of six cases

FUKUI Sho,ENDO Yoshifumi,HIRAYAMA Kazuko [他]
The journal of veterinary medical science 77(6), 747-751, 2015-06
NAID 40020518646

甲状腺未分化癌 (特集臨床医に必要な内分泌疾患の病理学)

加藤良平,近藤哲夫,中澤匡男
内分泌・糖尿病・代謝内科 = Endocrinology, diabetology & metabolism 40(5), 367-371, 2015-05
NAID 40020501144

濾胞腺腫,濾胞癌と被包型乳頭癌濾胞亜型 (特集臨床医に必要な内分泌疾患の病理学)

覚道健一,若狭朋子,太田善夫 [他]
内分泌・糖尿病・代謝内科 = Endocrinology, diabetology & metabolism 40(5), 362-366, 2015-05
NAID 40020501133

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★リンクテーブル★

リンク元	「甲状腺癌」「cancer of the thyroid」「甲状腺がん」「thyroid gland cancer」
関連記事	「thyroid」

「甲状腺癌」

　　[★]

英: thyroid cancer, thyroid carcinoma
ラ: carcinoma thyreoidea
関: 甲状腺腫瘍、甲状腺

まとめ

YN.D-41

甲状腺濾胞由来の甲状腺癌は組織型から分化型と未分化型に分けられる。

前者は放射線療法・化学療法に対する感受性は低く適応とはならないが、後者は放射線・化学療法の適応となる。

分化型には乳頭癌と濾胞癌がある。
乳頭癌は甲状腺癌の中で最も頻度が高い。好発年齢は30-50歳と比較的若年であり、女性に多い(男女=1:8)。発育は緩徐で転移はリンパ行性であり、血行性転移は稀である。組織的には濾胞内への乳頭状増殖が見られる。腫瘍内に砂粒小体を認め、組織的に核内封入体を認めるのが特徴的である。術後10年生存率は90%と予後良好である。治療は手術、TSH抑制療法、遠隔転移例に対しては131I大量療法を行う。
濾胞癌は甲状腺癌の中で2番目に多く(5-10%)、年齢・性別の特徴は乳頭癌と同様である。発育は緩徐で、リンパ行性の転移があるが、血行性転移がよく見られるのが乳頭癌と異なる。転移する組織には肺、骨・肝に多い。組織的には濾胞の増殖が認められる。予後は術後10年生存率80-90%と良好である。治療は乳頭癌と同じである。
未分化型は未分化癌である。
未分化癌は甲状腺癌の2-4%をしめている。分化型と異なり60歳以上に多く、性差も著しく違わない(男女=1:2)。発育は急激であり、赤沈上昇、CRP上昇などの炎症所見をきたす。診察上、可動性に乏しく、有痛性である。転移は血行性もリンパ行性もありうる。組織上、N/C比の大きい未分化細胞の増殖が認められる。67Gaシンチの取り込みを見たのち、試験切開もしくは手術を行うが、増殖が早いために手術不能である場合が多く、ほとんどの場合放射線治療もしくは化学療法を行うことになる。術後10年生存率は0%である。
傍濾胞細胞由来の腫瘍に髄様癌がある。甲状腺癌の1-2%と最も少ない。好発年齢は30-50歳と若く、男女比も分化型と比べて大きくない(男女比=1:2)。増殖は分化型と同様、緩徐である。転移はリンパ行性も血行性もあるが、リンパ行性優位である。組織的には異型細胞が認められ、間質にはアミロイドが沈着してるのが特徴的である。検査上、CEA高値、カルシトニン高値であるのが特徴的である。治療法は手術である。であり、予後は術後10年生存率は60-70%と比較的良好である。
悪性リンパ腫は甲状腺癌のうち2-4%をしてめいる。疫学は未分化癌と同様であり、急激に増殖する。転移はリンパ行性であり、血行性は少ない。組織的には非ホジキンリンパ腫である。67Gaシンチ、試験切開を行ってステージの決定を行い、放射線療法か化学療法を行う。術後10年後生存率は50-70%である。