Kirurško liječenje tumora štitnjače

master's thesis

• Title (english): Surgical treatment of thyroid cancer
• Author: Filip Bacan
• Mentor: Vladimir Bedeković (mentor)
• Committee member: Marko Velimir Grgić (predsjednik povjerenstva)
• Committee member: Mirko Ivkić (član povjerenstva)
• Committee member: Vladimir Bedeković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2015-07-15, 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
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Štitnjača je endokrina žlijezda smještena u prednjoj vratnoj regiji koja izlučivanjem svoja dva hormona, trijodtironina (T3) i tiroksina (T4), utječe na rad gotovo svih organa u organizmu. Relativno je mala, ali vrlo često zahvaćena patološkim procesima koji se očituju kao čvorovi. Benigni čvorovi u štitnjači podrazumijevaju strumu, upale i dobroćudne tumore, a u kliničkoj slici dominiraju znakovi hipo- ili hipertireoze. Od malignih procesa najčešći su epitelni tumori (karcinomi) nastali malignom alteracijom folikularnog epitela ili parafolikularnih C-stanica u slučaju medularnog karcinoma. Svi maligni, ali i većina benignih formacija štitnjače liječe se kirurški, sa ciljem odstranjenja cijelog patološkog procesa. Opsežnost operativnog zahvata ovisi o veličini tvorbe i malignom potencijalu što jednom riječju nazivamo stadijem tumora. Njega određujemo prema podacima iz TNM klasifikacije koji su dobiveni pre- i intraoperativnom analizom čvora. Od operativnih zahvata najčešće se izvodi lobektomija za odstranjenje svih benignih, ali i niskih stadija dobro diferenciranih malignih tumora. Za sve ostale maligne formacije, terapija izbora je totalna tireoidektomija sa disekcijom vrata u slučaju metastaza u regionalnim limfnim čvorovima. Ako isključimo rijetke tumore, anaplastični i medularni, liječenje najčešćih tipova tumora, papilarnog i folikularnog, u pravilu je uspješno s izrazito visokom stopom preživljenja. To osobito vrijedi za papilarni karcinom koji spada u izlječive malignome sa 100% petogodišnjim preživljenjem. Medularni karcinom građen je od C-stanica i ima lošiju prognozu sa petogodišnjim preživljenjem od 50%, a u terapiju su uključeni i radioterapija i kemoterapija. Anaplastični je karcinom neizlječiv tumor sa sto postotnom smrtnošću unutar prve dvije godine od postavljanja dijagnoze. Na sreću, iznimno je rijedak.

Abstract (english)

The thyroid gland, or simply the thyroid, is an endocrine gland located in the anterior region of the neck. It secretes two very important hormones, triiodothyronine (T3) and thyroxine (T4) which regulate the function of almost all organs in the human body. Thyroid is relatively small, but very often affected by pathological processes that are manifested as nodes in the gland. Benign thyroid nodess include goiter, inflammation and benign tumors, with dominant clinical signs of hypothyroidism or hyperthyroidism. The most common malignant processes are epithelial tumors (carcinomas) incurred as a result of malignant alteration of follicular epithelium or even of parafollicular C-cells in case of medullary carcinoma. All of the thyroid cancers are treated surgically. Extensiveness of the surgery depends on the stage of the tumor, which is provided from the TNM classification based on diagnosis. Most commonly used operative technique is lobectomy which is indicated for the treatment of all benign tumors, and also malignant tumors of low stage. For all the other malignancies, the treatment of choice is a thyroidectomy with or without neck dissection depending on intraoperative findings of regional metastatic disease. When excluding rare, non-differentiated types of tumors, (anaplastic and medullary), treatment of the most common types of cancer, papillary and folliculary is generally successfull with a very high survival rate. Papillary carcinoma has the best prognosis with survival rate of 100%. Follicular thyroid carcinoma is slightly less curable with survival rate of >70%. Undifferentiated tumors have great metastatic potential and are difficult to treat. Five year survival rate of patients with medullary carcinoma is less then 50%. Anaplastic thyroid cancer has a very poor prognosis due to its aggressive behavior and resistance to any treatment. Luckily, it is extremely rare.

• Keywords: štitnjača; tumori; liječenje; prognoza
• Keywords (english): thyroid; cancer; treatment; prognosis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:621054
• 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: 2016-04-11 08:33:08