Papillary Thyroid Carcinoma

Papillary thyroid carcinoma (PTC) is a subtype of thyroid cancer originating from the follicular cells of the thyroid gland. It typically develops gradually, with no noticeable symptoms in the initial stages. PTC is identified during the routine physical exams, or clinical tests, which comes up as thyroid nodules. Now, over time, these nodules grow which lead to PTC and then patients slowly experience the symptoms.

The thyroid gland is the largest organ of the human endocrine system, located at the base of the neck. This butterfly-shaped gland has two lobes connected by a tissue bridge named isthmus. This organ plays a key role in maintaining the essential functions of the human body through hormones. These hormones, primarily triiodothyronine (T3) and thyroxine (T4), regulate various physiological processes, including metabolism, heart rate, body temperature, mood and behaviour, and brain development.

Causes and Risk Factors

The causes and risk factors associated with papillary thyroid carcinoma can be divided into two parts. Here are the details –

Genetic Predispositions

• Health conditions such as Gardner syndrome, Cowden disease, and familial adenomatous polyposis (FAP) can increase the risk of developing papillary thyroid carcinoma.
• Also, it may come from a rare condition called Werner syndrome. This causes unusual and rapid ageing due to quick mutation of the WRN gene. 

Environmental and Lifestyle Risk Factors

• If an individual receives radiation therapy for cancer treatment during childhood, then he/she has the risk of developing this disease. 
• Exposure to nuclear accidents and numerous toxic chemicals affects the natural function of the thyroid gland, leading to this disease. 

Symptoms and Early Diagnosis

The common signs and symptoms of PTC are –

• Lump on thyroid 
• Hoarseness or sore throat
• Difficulties in breathing, specifically during the time of lying down 
• Trouble in swallowing

Importance of Early Detection

• Papillary thyroid carcinoma is a slow-growing cancer. Thus, early detection makes the treatment more effective and prevents the cancer from spreading to other body parts.
• It also reduces the risk of aggressive therapies such as radioactive iodine therapy. Instead, the patient can recover with less invasive surgery such as lobectomy. 

Diagnostic Approaches

The diagnosis of PTC has two approaches. Here are the details –

Imaging Techniques: Ultrasound and MRI

• Ultrasound: This technique uses sound waves to create an image of thyroid nodules. Then, the doctor will detect the size and shape and collect other information from the image. 
• MRI: These scans use strong magnets and radio waves to detect papillary thyroid cancer. Also, it can detect if the cancer has been spread to nearby or distant body organs. 

Biopsy and Molecular Testing

• Biopsy: Usually, this technique applies to those who have nodules larger than 1 cm. Doctors use a fine needle aspiration (FNA) technique to collect samples from suspected PTC nodules. The riskier nodules are those that have excessive calcium build-ups or no clear border. 
• Molecular testing: It helps analyse genetic alterations (DNA and RNA alterations) of nodules. Moreover, molecular testing helps understand the aggressiveness of malignant nodules. 

Treatment Options

Here are the treatment options patients have –

• Surgical Interventions: In most cases, doctors remove the entire thyroid gland and lymph node to eliminate further chances of complications. For minor papillary cancer, the doctor may remove some parts of the gland. 
• Radioactive Iodine Therapy: It’s a one-time therapy that doctors suggest after testing the post-surgery thyroid condition. For this therapy, the patient is required to take radioactive iodine pills. This pill kills the leftover cancerous cells, if there are any. This treatment doesn’t have any side effects.

Prognosis and Long-term Management

In terms of prognosis and long-term management, here is the needed information –

Survival Rates and Recurrence

• The survival rate of PTC is high. More than 90% of patients survive for at least 10-20 years after receiving the treatment. 
• Up to 20% of patients experience PTC recurrence at some point in their lifetime. It has been reported that the average recurrence time is between 6 months and decades later. 
• People with 55+ years of age have a worse prognosis. 

Follow-up Care and Monitoring

• PTC patients require long-term monitoring for at least 5 years for every 6-12 months intervals. 
• Individuals having thyroid surgery and/or radioactive iodine therapy should take thyroid medication for the rest of their lives.  Thus, the healthcare provider will routinely monitor their thyroid hormone level to understand if the medication works for them.

Complications and Side Effects

The complications of surgery include –

• Hypoparathyroidism
• Seroma
• Vocal cord paralysis

The complications of radioactive iodine therapy include -

• Thyroiditis
• Dry mouth
• Sore throat

So, here are some tips to manage the side effects of the therapy –

• It’s mandatory to have regular follow-up and communication with the doctor
• Adopt a balanced and nutrition-rich diet 
• Chewing gum helps to fix issues related to dry mouth and salivary gland
• Drink adequate water to get hydrated
• Involve in walking, yoga, and other activities
• Engage in meditation as a stress management activity

Lifestyle and Dietary Considerations

Here are some lifestyle and dietary changes that you need to adapt to get better –

• Maintain a healthy diet with high-fibre and low-fat
• Avoid starchy foods
• Stop cigarette smoking
• Avoid alcohol consumption
• Increase water intake
• Patients undergoing radioactive iodine therapy are advised to follow a low-iodine diet to enhance treatment effectiveness. Suitable foods include fresh fruits, vegetables, egg whites, matzo crackers, and black coffee or tea.
• Avoid fast food 
• Avoid herbal supplements
• Avoid iodised salt, dairy products, and seafood
• After the completion of the treatment, sufficient iodine intake is recommended

Conclusion

Papillary thyroid carcinoma is a slow-growing thyroid cancer that has the potential to be fatal if left untreated. Since it does not exhibit any early symptoms, it is often difficult to identify this condition. But, a careful eye for symptoms and a quick diagnosis can help to find out and start treatment. With the plan including surgery and therapy accompanied by dietary and lifestyle changes, patients can get better.

Like any other type of cancer, the importance of early detection and intervention cannot be stressed enough. It gives doctors more time to monitor and resolve the conditions without surgery. All in all, it increases the chances of survival drastically, giving the needed hope to patients.