Lokalno invazivni papilarni karcinom štitnjače

master's thesis

• Title (english): Locally invasive papillary thyroid cancer
• Author: Ema Čaušić
• Mentor: Mario Bilić (mentor)
• Committee member: Drago Prgomet (predsjednik povjerenstva)
• Committee member: Krsto Dawidowsky (član povjerenstva)
• Committee member: Mario Bilić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Papilarni karcinom štitnjače je najčešća novotvorina u štitnjači i svrstava se u diferencirane karcinome štitnjače. Klinička prezentacija ovog karcinoma je najčešće kao bezbolni palpabilni čvor na vratu. Zlatni standard u dijagnostičkoj obradi papilarnog karcinoma je citološka punkcija pod kontrolom ultrazvuka. Terapija papilarnog karcinoma štitnjače se sastoji od primarnog kirurškog liječenja, poslijeoperativne radiojodne ablacije i TSH supresijske hormonske terapije. Papilarni karcinom štitnjače ima odličnu prognozu, a faktori koji mogu negativno utjecati na tijek bolesti su starija životna dob, muški spol, pojava metastaza te lokalna invazija tumora. Lokalna invazivnost papilarnog karcinoma štitnjače nije česta prezentacija. Invazijom tumora su najčešće zahvaćeni infrahioidni mišići, povratni laringealni živac i gornji aerodigestivni trakt. Lokalnom invazijom još mogu biti zahvaćeni jednjak, unutarnja jugularna vena i karotidna arterija. Postoje mnogi znakovi i simptomi koji se mogu javiti pri kliničkom pregledu, te klinička slika varira ovisno o zahvaćenim strukturama. U dijagnostičkoj obradi osim standardnih metoda u evaluaciji karcinoma štitnjače, važne su i slikovne metode kao što su CT ili MR za pravilnu procjenu veličine tumora te planiranja kirurškog zahvata. Kirurško liječenje lokalno invazivne bolesti varira od kompletne resekcije do shave metoda. U slučaju površinske invazije tumora koriste se manje radikalne shave tehnike, a u slučaju veće invazije i prolaska kroz punu debljinu stijenke okolnih organa preporuča se kompletna resekcija zahvaćenog dijela. U terapiji se osim kirurškog odstranjenja tumora koristi adjuvantna terapija TSH supresijom, radiojodna ablacija te ponakad i adjuvantno vanjsko zračenje.

Abstract (english)

Papillary thyroid cancer is the most common type of malignancy of the thyroid and it is classified under the category of well-differentiated thyroid cancers. The most common clinical presentation of this cancer is a solitary thyroid nodule. Fine needle aspiration biopsy is the golden standard for evaluating thyroid nodules. The treatment of papillary thyroid cancer consists of primary surgical management, postoperative radioiodine remnant ablation, and TSH suppression therapy. Papillary thyroid carcinoma has a good overall prognosis, but there are several factors that negatively influence the course of the disease – age older than 45 years, male sex, metastatic disease and locally invasive disease. Locally invasive presentation of papillary thyroid disease is not common. The spread of cancer usually affects the strap muscles, recurrent laryngeal nerve, and the upper aerodigestive tract. Local invasion can also affect the oesophagus, internal jugular vein, and carotid artery. Since the tumour spread can affect various structures of the neck, clinical presentation varies depending on the affected tissue. Diagnostic procedures include standard evaluation of thyroid nodule and additional imaging studies in order to evaluate the extent of a tumour and plan for a surgical procedure. The surgical approach for locally invasive tumour varies from complete resections to shave techniques. In the setting of superficially invasive carcinoma, shave technique is recommended. For the intraluminal spread, complete resection techniques are required. Apart from surgical treatment recommended course of action is also radioiodine remnant ablation, TSH suppression therapy and sometimes external beam radiation therapy.

• Keywords: štitnjača; papilarni karcinom; lokalno invazivni; lokalno agresivni
• Keywords (english): thyroid; papillary cancer; locally invasive; locally aggressive
• Language: croatian
• URN:NBN: urn:nbn:hr:105:811054
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-10 08:18:36