Thyroid tumors and endocrine glands

Ultrasound of the neck is a noninvasive examination that is easy to perform. It provides high-resolution images of the thyroid gland and thus enables the following Highlight the presence of even very small nodules, which cannot be manually discovered, to assess their size and main characteristics. It also allows examination of the status of surrounding tissues and lymph nodes.

Fibrolaryngoscopy is an endoscopic examination that the ENT specialist may deem necessary to check the movement of the vocal cords and to detect any abnormalities on their surface. To perform it, a fiber-optic fiberscope is used, which, through a thin, flexible tube introduced through the patient’s nose, allows the physician a direct view of the area to be analyzed.

The examination is performed in an ENT outpatient clinic and can be done without the need for anesthetic or under local anesthesia.

Thyroid scintigraphy is used to assess the overfunction of one or more nodes within the thyroid gland and helps to discriminate their benign or malignant nature.

The patient is administered, intravenously, a radioactive tracer (radiopertecnetate, 99mTc) that is picked up by thyroid cells. The radiation emitted by the tracer is detected by a special device (gamma camera) that processes the information and produces a map of the thyroid gland in which different types of nodules can be distinguished.

The procedure is simple and painless, and administration of the radiopharmaceutical does not cause allergic reactions.

These radiological examinations may be necessary to get a better definition of the extent of the disease.

Parathyroid Scintigraphy with 99mTc-sestaMIBI and PET scan with 18F-Choline are examinations that may be necessary when ultrasound or laboratory tests show a morphologic or functional abnormality of the parathyroid glands, small oval-shaped structures that are located near the thyroid gland or, more rarely, within it or in the mediastinum.

If the ultrasound scan shows the presence of suspicious nodules, it is necessary to take some cells from them To ascertain whether they are benign or malignant nodules. The collection, which is done through a procedure called needle aspiration, is usually done within seven days of the specialist visit.

Needle aspiration is an outpatient procedure that does not require anesthesia. It consists of the introduction into suspicious nodules, under ultrasound guidance, of a fine needle with which a few cells are taken, which will then be examined by theanatomic pathologist to identify their characteristics.

The cytological examination, i.e.examination of the cellular material taken from the nodules, first determines whether the nodules are benign (the most common case) or malignant. If a tumor is confirmed, the anatomo-pathologist will define its characteristics.

Thyroid cancers are divided into three main types:

• carcinoma differentiated, which may be papillary or follicular;
• carcinoma bone marrow;
• carcinoma undifferentiated or anaplastic.

Papillary and follicular differentiated carcinomas are the most common (75% and 15% of all thyroid cancer cases, respectively) and also have the most favorable prognosis, with a survival rate of 90% at 20 years after diagnosis.

Medullary carcinoma affects 5-10% of all cases of thyroid cancer. In one out of four cases it may be caused by hereditary mutation of the RET gene. This tumor tends to spread to other organs but also has a relatively favorable prognosis.

Anaplastic carcinoma is the rarest of thyroid cancers (1-3% of cases) but also the most aggressive and difficult to treat.

The cytology examination report will also indicate the degree of malignancy of the nodules Examine yourself. Depending on how high the probability is that a nodule is malignant, the report will contain the abbreviation TIR followed by a number between 1 and 5.

This is the meaning of each acronym:

• TIR 1: Needle aspiration did not provide sufficient cells to make a correct diagnosis, and it is generally recommended that the repeat examination with the exception of cystic lesions (TIR 1 C);
• TIR 2: nodule benign;
• TIR 3: (TIR 3A and TIR 3B) examination of cells is not sufficient to make the diagnosis, the tissue of the nodule must also be examined (histological examination);
• TIR 4: suspected malignancy of the nodule;
• TIR 5: malignant nodule.

Surgery is usually the first planned treatment, which may be followed by any adjuvant therapies, that is, aimed at reducing the risk of metastasis or disease recurrence after surgery.

It is generally preferred to to remove the entire gland (thyroidectomy surgery). However, if the malignant nodule is small, it can be treated by conservative lobectomy surgery, i.e., by theRemoval of only the part of the gland affected by the disease.

Thyroidectomy surgery is performed through anincision made in the anterior part of the neck. During surgery, to improve its effectiveness and avoid further subsequent surgery, the surgeon may perform intraoperative sampling of suspicious nodules or lymph nodes adjacent to the tumor.

Surgery is always performed using the recurrent nerve monitoring (those that determine vocal cord movement), in order to reduce the risk of postoperative complications. In fact, a lesion of these nerves can result in impaired voice and sometimes even difficulty in breathing.

Complementary or adjuvant therapies are indicated after surgery in cases of aggressive tumors that may recur or tend to invade other organs. The main adjuvant therapies for thyroid cancer are. radio-iodine therapy and the biological therapies.

Radio-iodine Radiometabolic Therapy is used when the papillary or follicular thyroid tumor has spread to neighboring tissues, neck lymph nodes or other organs, or if it shows special histological features (such as the presence of aggressive variants).

The therapy, which is aimed at eliminating any remaining cancer cells in the body after surgery, consists of taking oral capsules of radioactive iodine (131I), which is picked up by residual thyroid cells (benign and malignant) and destroys them by electron emission.

Treatment involves a few days’ hospitalization in the Nuclear Medicine Department, which is necessary to allow physical decay of the administered radiopharmaceutical and/or its elimination by dejection.

Biological therapies (targeted or molecularly targeted therapies) are targeted drugs toward certain molecules present only on tumor cells and acting against one or more tumor-specific growth mechanisms. They are indicated in rare cases where radio-iodine therapy has not been effective and in advanced or metastatic cancer.

The choice of the most suitable biological therapy is made based on the histological features of the tumor, including whether there are mutations in the tumor cells.

The impact of cancer in a person’s life also affects the psychological sphere: getting cancer is in fact always a traumatic event that affects all dimensions of a person and can generate anxiety, fear, anger, and depression.

At the Candiolo Institute, alongside cutting-edge therapies, the treatment and care pathway always includes a qualified psycho-oncological support that helps the patient cope positively not only with treatment but also with the delicate phase of physical and psychological recovery.

You can also participate in psychological support groups to compare yourself with others who have gone through or are going through the same experience.

To ensure timely and direct support and receive prompt answers to concerns and questions, a dedicated helpline is in place at the Candiolo Institute for all patients.

Monday through Friday, from 8 a.m. to 5 p.m., you can contact the secretariat of the Oncology Day Hospital at 011.993.3775, reporting the need for urgent consultation.

The patient will be quickly put in touch with their medical specialist for clear answers and immediate support.

The cancer patient is a person with complex needs who requires multidisciplinary support not only for the cancer disease but also for all related issues.

At the Candiolo Institute, patients who need or request it can access specialists in different areas to receive nutritional support, physical therapy, pain therapy, and management of other associated conditions.

The Social Service Department of the Candiolo Institute conducts information and orientation interviews for patients and their families on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).

The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. (phone: 011 9933059).

With the conclusion of the treatment course begins the follow-up period, which consists of a long-term follow-up program customized for each patient based on the type of cancer treated, age, and risk of disease recurrence (recurrence).

Most thyroid tumors have a low risk of recurrence; however, since the tumor can recur even many years after diagnosis, periodic checkups should be performed throughout life.

During follow-up visits, the patient’s health condition is assessed and the results of any required tests, usually blood tests and ultrasound of the neck, are viewed; only in selected cases may the physician prescribe radio-iodine scintigraphy or other second-tier tests (CT, PET, or MRI scans).

Patients whose thyroid gland has been removed must take lifelong hormone replacement therapy, which is necessary to provide the body with hormones normally produced by the thyroid gland that are essential for the performance of many vital functions. Therapy is taken daily by mouth.

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.