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Surgery For Thyroid Cancer

Thyroid cancer is a growing problem worldwide

It affects women 3 times more commonly than men, and half of affected individuals are under 45 years of age (1).

  Scar appearance 3 months after surgery.
Scar appearance 3 months after surgery.
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With timely and careful treatment, thyroid cancer is readily curable. Complete surgical resection of the entire thyroid and affected lymph node compartments is the cornerstone of treatment. An ultrasound examination of the neck is an essential part of preparation for surgery – an exam performed by an experienced clinician will reveal any enlarged lymph nodes that are potentially involved with cancer (2, 3).

A recent study by investigators at the MD Anderson Cancer Center demonstrated that thyroid cancer operations performed by non-specialists are incomplete in up to 40% of cases (4). Unfortunately, an inadequate initial operation means that the patient is not cured, and frequently necessitates a second operation to remove all diseased tissues. Repeat operations in the neck carry increased levels of risk to the patient.

Papillary thyroid cancer, the most common type of thyroid cancer, is known to involve lymph nodes (almost always within the neck) in as many as 70% of cases (5). New research suggests that “compartment-oriented” lymph node removal at initial operation is likely to benefit many patients by reducing the chance of incomplete operations and recurrent cancer (6).

At the UCLA Endocrine Surgical Unit, most patients with papillary thyroid cancer undergo compartment-oriented lymph node dissection at the time of their initial thyroidectomy. Care is individualized based on the size of the tumor, ultrasound findings, and any additional risk factors the patient may have, including:

  • Family history of thyroid cancer
  • Male sex
  • Age <25 or >45
  • History of radiation exposure

Most operations for thyroid cancer can be accomplished using an incision measuring approximately 5 cm (2 in) in length. Whenever possible, the incision is placed over a natural skin crease to achieve the best cosmetic result.

Figure:
Scar appearance in an individual of Mediterranean descent, 3 months after surgery for thyroid cancer.

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References

1. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. Jama. 2006;295(18):2164-7.

2. Ito Y, Tomoda C, Uruno T, et al. Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg. 2004;28(5):498-501.

3. Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946-54; discussion 954-5.

4. Kouvaraki MA, Lee JE, Shapiro SE, Sherman SI, Evans DB. Preventable reoperations for persistent and recurrent papillary thyroid carcinoma. Surgery. 2004;136(6):1183-91.

5. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399-407.

6. Sywak M, Cornford L, Roach P, Sidhu S, Delbridge L. Prophylactic level six lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. In press.

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