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Breast and Thyroid Surgery

DIAGNOSIS AND TREATMENT OF BREAST AND THYROID CANCERS

Breath cancer is ranked first and thyroid cancer is ranked second in women in our country. Breast cancer is the most common cancer in women all around and it also accounts most cancer deaths, while thyroid cancer is not very prevalent in women around the world, but it is the second most common cancer in our country. As is the case with all other cancers, both cancers require early diagnosis that plays a very important role in selection of treatment and subsequent processes.

BREAST CANCER

One out of every 8 women around the world is at risk of breast cancer in her life; the risk increases incrementally in every 10 years after the age of 40. According to the data published by Turkish Statistics Institute for 2014, 17,000 women are diagnosed with breast cancer and 3853 women died due to breast cancer. The figures are 3981 for 2016, 4057 for 2017 and 4264 for 2018. This increment indicates that we cannot hinder deaths secondary to breast cancer despite advanced technological means and easy access to doctor. Well-developed screening programs for breast cancer are available in our country, but their development followed the incidence in general population and cost estimations. Accordingly, monthly self-examination as of 20, examination by a doctor once every two years, annual examination after age of 40 and mammography once every two years are recommended for breast screening and women are advised to follow the screening until the age of 69. However, it seems essential that women are examined by a doctor annually rather than once every two years and self-examination is not skipped, considering the fact that life expectancy is recently longer and the condition is diagnosed at younger or older ages. Therefore, we advise self-examination at monthly intervals as of 20 and examination by a doctor annually as well as imaging modalities in the light of examination findings.

Imaging Studies For Breast

Adjunct diagnostic methods include breast ultrasound up to age of 40 and contrast-enhanced MRI (breast is scanned with an MRI Scanner after a contrast agent is intravenously administered) in case of a suspicious finding in the ultrasound. If no material finding is detected with these modalities, examinations are maintained at above mentioned intervals. If imaging studies demonstrate any benign or malignant lump or a cyst – a formation that does not progress into cancer, the interval of examination is shortened to 6 months. If there is any lump that is suspicious for cancer, TRU-CUT, also called thick needle biopsy, is a requisite to identify the lesion. If the thick needle biopsy points to a cancer, there are some other tests that identify the sub-types and determine its hormone-sensitivity in order to select a certain treatment protocol in advance.

Mammography is added to these tests after the age of 40. In Mammography, breast tissue is imaged with X-ray after the breast is compressed between two cassettes in two positions. This imaging modality is especially superior for early diagnosis of microcalcifications – the malignant calcium deposition that progresses into cancer. This imaging study is necessarily combined with ultrasound in the reproductive age in order to minimize the error margin, as breasts are large and dense at this period. One should always remind that all these radiology studies are performed and reviewed by same radiologist. Moreover, all imaging studies of breasts should be comparatively reviewed by the doctor in each encounter, but this fact is usually ignored.

Treatment Options

After breast cancer is diagnosed, treatment protocol is determined for each patient according to stage of disease and sub-tyoe of cancer. Surgery is usually the first-line treatment that is followed by other complementary therapies for Stage I and II cancers and partially for Stage III tumors, but we first need to employ medication treatment, also called chemotherapy, for advanced stages, spread of tumor to other body parts and certain Stage III subtypes. Next, re-assessments are done and a decision is made for the surgery. For patients with an early stage cancer who are undergone surgery, pathology report and hormone analyzes are reviewed jointly by an oncologist to make final decision about chemotherapy.

Surgeries for Breast Cancers

Recently, there are various surgical options, ranging from “modified radical mastectomy” that involves total removal of breast and dissection of axillary lymph nodes depending on the stage to “breast sparing surgery”, where the tumor is resected by a leaving a safe and clean margin, the sentinel lymph nodes that drain the axillary zone are stained with special dyes and removed, if pathologist reports positive result intraoperatively for the “frozen section”, or otherwise, axillary lymph nodes are left untouched; in other words, breast sparing surgery offers the least trauma possible to the breast. This second option is preferred for early stage cancers; the decision is dictated by sub-type of tumor, location of cancer in breast, presence of one tumor vs. multiple tumors and size of breasts. If breast sparing surgery is performed for a patient, radiotherapy is required in most cases in order to minimize the risk of relapse in the same breast. Postoperative chemotherapy requirement is again reviewed jointly by an oncologist according to many variables.

THYROID CANCER

Although thyroid cancer is regarded as a less serious public health problem relative to other cancers and its incidence is relatively lower in the general population, it is the second most common cancer in Turkish women probably as neck imaging is frequently ordered by doctors in routine health checks, technological advancement of imaging devices increased the detection rate of small cancers and people are attaching more importance to health check-up. The diagnosis was incidentally made in the past, while a surgery was carried out for overproduction of thyroid hormones, multiple nodules in thyroid gland or an isolated adenoma; recently, the most common type of thyroid cancer begins on the background of thyroiditis – a non-inflammatory condition of the thyroid gland – that develops when the dietary iodine intake causes production of thyroglobulin and the body produces a certain type of cell to cope with this substance.

It is reported that increased iodine in diet, radiation and certain carcinogenic substances lead to thyroid cancer. It is also common in nodules that develop on the background of Hashimato’s thyroiditis. Their prognosis is better relative to other subtypes.

Diagnosis in Thyroid Cancers

If the condition is diagnosed at an early stage, the treatment usually involves total or partial removal of the thyroid gland, However, medical history and physical examination are as important as imaging studies to make a decision about the treatment. Here, the best screening modality is ultrasound of the neck. If this method detects a nodule, it should not be skipped. A suspicious nodule requires ultrasound-guided biopsy with a syringe needle in order to establish the final diagnosis. If any suspicious lymph node is identified in the neck, it should also be biopsied before the operation to determine the stage of tumor. The diagnosis is also assisted with other imaging modalities, such as computerized tomography and MRI of the neck and scintigraphy.

Treatment Options for Thyroid Cancer

Treatment is surgery for incidentally diagnosed cancers, early stage tumors and a small isolated nodule that is smaller than one centimeter. Thyroid gland is either unilaterally or bilaterally removed. Next, radioactive iodine therapy is planned, but the thyroid tissue and relevant lymph nodes of the neck, if required, should be removed surgically for aggressive diseases, multifocal cancers and spread of cancer to cervical lymph nodes. These patients require external thyroid hormone supplementation in the rest of their lives. Neck radiotherapy may be required for very aggressive subtypes, such as anaplastic cancer.

 

Both cancers are not fatal, if they are detected at early stage, and therefore, you should not ignore check-ups. We should not ignore annual breast examinations and imaging studies as well as tests and imaging studies for thyroid gland.

The earlier, the better…

Keeping alive is an art…

 

 

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