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Se recomand utilizarea ecografiei tiroidiene asociat cu examenul citologic prin biopsie-aspiraie cu ac fin CBAF ca tehnic diagnostic de linia nti pentru identificarea i caracterizarea bolii tiroidiene nodulare I, A n cazul unei prelevri necorespunztoare, se recomand repetarea CBAF, iar n cazul neoplaziei foliculare, cu niveluri normale de hormon stimulator tiroidian Papillary thyroid cancer fdg pet i aspect rece la papillary thyroid cancer fdg pet tiroidian, se poate lua n considerare intervenia chirurgical IV, B Msurarea papillary thyroid cancer fdg pet serice de calcitonin CT reprezint o metod fiabil de stabilire a diagnosticului de cancer tiroidian medular i trebuie s fac parte din evaluarea diagnostic a nodulilor tiroidieni IV, B.

Tratamentul iniial al CTD const n tiroidectomie total sau subtotal dac diagnosticul a fost stabilit nainte de intervenia chirurgical.

Pot fi acceptate i intervenii chirurgicale mai limitate n cazul CTD monofocal diagnosticat prin examen histologic la finalul operaiei efectuate pentru afeciuni tiroidiene benigne, dac tumora este mic, intratiroidian i are un tip histologic favorabil papilar clasic sau varianta folicular a cancerului papilar sau folicular minim-invaziv I, A.

Intervenia chirurgical este urmat de regul de administrarea I pentru ablaia tuturor esuturilor tiroidiene restante i a unei posibile tumori microscopice reziduale.

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Ablaia cu iod radioactiv este indicat la pacienii cu risc nalt IV, Bdar nu este recomandat la pacienii cu risc redus IV, D. La pacienii cu risc intermediar decizia trebuie s fie individualizat. Dup tratamentul chirurgical, se recomand iniierea terapiei cu hormoni tiroidieni pentru substituia secreiei hormonale terapie de substituie i pentru inhibarea TSH, care poate fi un stimul de cretere al celulelor tumorale terapie de supresie.

La luni de la tratamentul iniial, se recomand evaluarea testelor funciei tiroidiene FT3, FT4, TSH pentru a se verifica caracterul adecvat al terapiei supresoare cu LT4, urmat la luni de o etap de screening care const ntr-un examen clinic, o ecografie cervical, determinarea nivelurilor serice ale Tg bazale i dup stimularea cu rhTSH, nsoite sau nu de WBS n scop diagnostic I, A Monitorizarea ulterioar a pacienilor care au fost considerai a fi liberi de papillary thyroid cancer fdg pet la momentul primei evaluri de urmrire va consta n examinri clinice, determinri ale nivelurilor serice bazale ale Tg n timpul terapiei cu LT4 i ecografie cervical, efectuate anual.

Tratamentul bolii locoregionale recidivate are la baz asocierea papillary thyroid cancer fdg pet intervenia chirurgical i papillary thyroid cancer fdg pet cu iod radioactiv, suplimentate cu radioterapie extern dac nu este posibil excizia chirurgical complet sau dac tumora nu capteaz semnificativ iodul radioactiv IV, B.

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Metastazele la distan au anse mai mari de vindecare n cazul n care capteaz iod radioactiv i dac au dimensiuni reduse i localizare pulmonar; n caz contrar, sunt posibile numai tratamentul paliativ i prelungirea supravieuirii. Chimioterapia nu este indicat i trebuie s fie ncurajat participarea la studii clinice IV, B.

Pentru pacienii cu CTM fr semne de metastaze ganglionare la examenul clinic i ecografia cervical, tratamentul const n tiroidectomie total indiferent dac CTM este sporadic sau ereditar, asociat cu disecie profilactic bilateral a ganglionilor limfatici centrali IV, B.

Anca P. Stoian et al. The incidence of thyroid cancer is significantly different between male and female patients. Thyroid cancer is also the only form of cancer where age can be considered a staging variable. Identifying biological prognostic factors such as age or sex is important as it helps select an optimal personalized therapy.

Cel mai bine este ca disecia cervical lateral s fie rezervat pentru pacienii cu examinri imagistice preoperatorii pozitive IV, Papillary thyroid cancer fdg pet. Dup tiroidectomia total, se va administra tratament de substituie cu tiroxin pentru meninerea concentraiilor serice ale TSH ntre limitele normale IV, B.

Intervenia chirurgical este tratamentul principal al recidivelor locale i regionale, dac este posibil IV, B. CTSD include tipuri histologice tumorale agresive, cum sunt subtipurile trabecular, insular i solid. Tratamentul iniial este reprezentat de tiroidectomia total. Pacienii cu boal nerezecabil sau cu boal locoregional persistent dup intervenia chirurgical pot fi tratai prin radioterapie extern V, C.

Administrarea chimioterapiei, papillary thyroid cancer fdg pet agent unic sau n regimuri combinate, de exemplu cu cisplatin i doxorubicin, poate oferi doar rspunsuri pasagere i incomplete V, C. Dac este posibil, papillomas size cu CTSD trebuie s fie inclui n studii clinice de papillary thyroid cancer fdg pet a unor terapii noi Tabelul 4. Cancerul tiroidian anaplazic CTA este cea mai agresiv tumor tiroidian i unul dintre cele mai agresive cancere umane.

Carcinomul tiroidian anaplazic afecteaz mai frecvent femeile, dar raportul dintre sexul feminin:masculin este de aproximativmai mic dect cel calculat pentru tipurile histologice papilar sau folicular.

Aceast tumor i are originea n celulele foliculare ale glandei tiroide, dar nu pstreaz niciuna dintre caracteristicile biologice ale celulelor originale, de exemplu captarea iodului sau sinteza Tg. CTA poate aprea de novo, dar n majoritatea cazurilor se dezvolt dintr-o tumor tiroidian preexistent bine difereniat, dup producerea unor mutaii suplimentare, n special mutaia p53 [39]. Diagnostic Diagnosticul se stabilete de obicei cu uurin, pe baza aspectelor clinice tipice: mas de mari dimensiuni, dur, care invadeaz regiunea cervical i determin papillary thyroid cancer fdg pet compresive dispnee, tuse, paralizia corzilor vocale, disfagie i rgueal.

Din cauza comportamentului agresiv al CTA, cel mai recent manual de stadializare a papillary thyroid cancer fdg pet elaborat de American Joint Committee a clasificat toate CTA n categoria tumorilor T4 i stadiu IV, indiferent de dimensiunile lor i de extensia tumoral total [11].

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Tratament Tratamentul CTA nu a fost standardizat i, din pcate, nu exist nc un tratament eficace: intervenia chirurgical, chimioterapia, radioterapia utilizat singur sau n combinaie, nu amelioreaz supravieuirea. Intervenia chirurgical este recomandat pentru controlul local al leziunilor rezecabile.

cancerul-tiroidian

Agentul citotoxic utilizat cel mai frecvent mpotriva carcinoamelor anaplazice este doxorubicina n monoterapie sau n combinaie cu cisplatina. Rezultatele au fost dezamgitoare.

Adugarea bleomicinei sau a altor ageni nu a crescut eficacitatea acestei combinaii. Recent, paclitaxel a fost utilizat ntr-un studiu papillary thyroid cancer fdg pet i a determinat unele mbuntiri ale ratelor de rspuns, dar nu i ale supravieuirii. Sunt necesare strategii terapeutice inovatoare; de aceea, sunt n curs de studiere strategii noi, cum sunt terapia intit de exemplu cu axitinib i sorafenibagenii de perturbare a funciei vasculare de exemplu combrestatin-A4 fosfat, anticorpi monoclonali mpotriva VEGF, de exemplu bevacizumab, cetuximabterapia de supresie genic tumoral i ageni papillary thyroid cancer fdg pet sistare a ciclului celular [40].

Pn n prezent, niciunul dintre aceti ageni nu a avut rezultate bune n tratamentul CTA; de aceea, sunt necesare cercetri noi pentru a contracara agresivitatea acestei tumori [30]. Conflict de interese Toi autorii au raportat lipsa unor conflicte poteniale de interese.

Thyroid cancer incidence patterns in the United States by histologic type, Thyroid ; Advances in diagnostic practices affect thyroid cancer incidence in France.

cancerul-tiroidian

Eur J Endocrinol ; Increasing incidence of differentiated thyroid cancer in the United States, Cancer ; Thyroid carcinoma in children and adolescents in Ukraine after the Chernobyl nuclear accident: statistical data and clinicomorphologic characteristics. Dean DS, Gharib H.

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Epidemiology of Thyroid Nodules. European Thyroid Cancer Taskforce. European consensus for the management of patients with 11 differentiated thyroid carcinoma of the follicular epithelium.

Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules. J Clin Endocrinol Metab ; Impact of protooncogene mutation detection in papillary thyroid cancer fdg pet specimens from thyroid nodules improves the diagnostic accuracy of cytology.

New York: SpringerVerlag. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the DRS American Thyroid Association staging system.

Unmodifiable variables related to thyroid cancer incidence

Delayed risk stratification, to include the response to initial treatment surgery and radioiodine ablationhas better outcome predictivity in differentiated thyroid cancer patients. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study.

J Clin Endocrinol ; A comparison of 50 mCi and MBq mCi iodine administered doses for recombinant thyrotropinstimulated postoperative thyroid remnant ablation in differentiated thyroid cancer.

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Low-activity 2. Follow-up of low-risk differentiated thyroid cancer patients who underwent radioiodine ablation of postsurgical thyroid remnants after either recombinant human thyrotropin or thyroid hormone withdrawal. Recombinant human TSHassisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal.

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J Nucl Med ; Radioactive iodine administered for thyroid remnant ablation following recombinant human thyroid stimulating hormone preparation also has an important adjuvant therapy function. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on patients.

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The use of ultrasensitive thyroglobulin assays reduces but does not abolish the need for TSH stimulation in patients with differentiated thyroid carcinoma. J Endocrinol Invest ; Risk-adapted management Pacini et al. A single recombinant human thyrotropinstimulated serum thyroglobulin measurement predicts differentiated thyroid papillary thyroid cancer fdg pet metastases three to five years later. Limited value of repeat recombinant human thyrotropin rhTSH -stimulated thyroglobulin testing in differentiated thyroid carcinoma patients with previous negative rhTSH-stimulated thyroglobulin and undetectable cervical cancer without hpv virus serum thyroglobulin levels.

Predictive value of recombinant human TSH stimulation and neck ultrasonography in differentiated thyroid cancer patients. Kloos RT.

Thyroid cancer recurrence in patients clinically free of disease with undetectable or very low serum thyroglobulin values. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluorodeoxy-Dglucose-positron emission tomography scanning. Long-term outcome of papillary thyroid cancer fdg pet with distant metastases from papillary and follicular thyroid papillary thyroid cancer fdg pet benefits and limits of radioiodine therapy. New treatment modalities in advanced thyroid cancer.

Ann Oncol ; Brilli L, Pacini F. Targeted therapy in refractory thyroid cancer: current achievements and limitations.