甲状腺癌患者最想知道的,名肿瘤专家全告诉你!

2017-05-27 健康时报网 健康时报网

采访专家高明:天津市肿瘤医院副院长,甲状腺肿瘤科主任医师,中国抗癌协会甲状腺癌专业委员会主任委员。擅长:头颈部常见肿瘤的诊治及常见外科术式,特别对功能性和微创甲状腺外科,以及中晚期甲状腺癌、全喉及各种部分喉切除手术等。出诊时间:每周五上午。周晓红:重庆市肿瘤医院头颈外科主任,中国抗癌协会头颈专委会委员、中国抗癌协会甲状腺专业委员会委员;擅长:头颈肿瘤的综合治疗,包括甲状腺肿瘤微创及甲状腺恶性肿

采访专家

高明:天津市肿瘤医院副院长,甲状腺肿瘤科主任医师,中国抗癌协会甲状腺癌专业委员会主任委员。擅长:头颈部常见肿瘤的诊治及常见外科术式,特别对功能性和微创甲状腺外科,以及中晚期甲状腺癌、全喉及各种部分喉切除手术等。出诊时间:每周五上午。

周晓红:重庆市肿瘤医院头颈外科主任,中国抗癌协会头颈专委会委员、中国抗癌协会甲状腺专业委员会委员;擅长:头颈肿瘤的综合治疗,包括甲状腺肿瘤微创及甲状腺恶性肿瘤的规范化综合治疗;出诊时间:每周一上午。

张成瑶:重庆市肿瘤医院头颈外科主治医师,医学博士;擅长:甲状腺肿瘤的综合治疗及早期筛查、口腔肿瘤的修复治疗,头颈肿瘤的基因靶向治疗及基础研究。在国内外医学期刊多次发表学术论文数十篇。

5月22日~26日是第九届国际甲状腺知识宣传周,天津市肿瘤医院近日公布的甲状腺癌十年发展趋势显示,近年来甲状腺癌发病率增长近5倍,发病增长率位列肿瘤发病率第一,并且成为大城市女性风险最高的癌症之一。为此,本期选择了患者最为关心,也是在诊疗中最常问医生的几个问题,或许可以帮到您。

问题一

甲状腺结节和甲状腺癌的患者越来越多,为啥这几年得甲状腺癌的人这么多呢?

过去诊断甲状腺疾病主要靠医生手摸,但受结节的位置、大小、患者脖子粗短、肥胖等影响,有的能被医生摸出来,有的则摸不出来,所以说查出甲状腺肿瘤的几率并不高,所以感觉这个病得的少。而现在,颈部B超、CT等各类先进的影像学检查,使过去无法触摸到的1厘米以下的结节以及甲状腺周围的血流改变都能清晰可见,自然发现甲状腺有问题的患者会增加,再加上体检人群的逐年增加,尤其是微小乳头状癌检出比率比过去明显提高了。

问题二

有这样一个现象,门诊中看甲状腺癌的大多是女病友,是女性更容易得这个病吗?

甲状腺癌已经上升至女性恶性肿瘤第3位,但目前科学上还回答不了为什么女性发病率更高,可能和雌激素及雌激素受体有一定关系,但是男性中也有甲状腺癌发生。另外,这个病与情绪和压力也有一定关系,相对来说女性受情绪影响更大,但这都不是决定性的因素。此外,生活环境、遗传因素等均与甲状腺癌的发生有关。不管是男性还是女性,平时都可以自查一下:照镜子时仔细观察脖子是否变粗;手指反扣在甲状腺部位,用拇指仔细触摸是否有肿块。

问题三

体检查出甲状腺小肿块,有的医生说需要切,有的却说不用切,到底听谁的?

这个让患者颇为困惑的问题,在医生那里似乎也有比较大的分歧和不规范。2016年,中国抗癌协会甲状腺癌专业委员会集结了目前国际上关于甲状腺微小癌诊疗的权威观点,出台了国内首个《甲状腺微小乳头状癌诊断与治疗专家共识》,明确指出对于部分单发、低危的甲状腺微小癌,不提倡“一切了之”,而是需要经过专业医生的研判,在充分考虑患者意愿和心态的前提下,可以考虑选择暂不手术,采取密切观察随访。

问题四

在医院检查的时候查出有甲状腺结节,那么这些小结节会不会发展成癌症?

在体检时查出的甲状腺结节,只有5%~15%为甲状腺癌,所以即使查出是有结节,也不要过于恐慌,有结节不一定就是甲状腺癌。虽然结节不一定都是癌症,但是也建议所有在体检中发现的甲状腺结节患者要及时到正规医院进行血清甲状腺激素的水平检测和颈部超声检查,早诊早治。其中甲状腺激素的水平是否正常反映了甲状腺功能的情况,而颈部超声检查则反映了甲状腺内有无结节以及颈部淋巴结有无增多和形态的变化等情况。

问题五

如果不幸得了甲状腺癌,那么是手术效果好还是选择放化疗呢?

专家提示甲状腺癌诊治不应停留在一刀切或是切不切的争议中,而应让患者明白,从进医院看病那刻起,所接触的医生除了外科,还有内分泌科、影像科、核医学科的医生等。功能性外科手术在甲状腺癌根治方面显现出良好的应用前景,如今的手术治疗更加关注对喉返神经、喉上神经及甲状旁腺功能性的保护,在保障患者生命健康的同时,最大限度的保留人体组织的功能,更加提倡提高术后的生活质量,同时分子靶向药物的应用也更加广泛。

问题六

甲状腺癌是个“重男轻女”的癌,那么甲状腺癌对于女性妊娠有影响吗?

手术是甲状腺癌最重要的治疗手段之一,目前绝大多数的甲状腺癌手术均需要实施全身麻醉。由于妊娠早期(1~3个月)的手术麻醉可能会影响胎儿重要器官的发育,也会使自发性流产的风险升高,而在妊娠后期(7~9个月)手术易诱发早产。因此,对于孕期出现肿瘤进展需要手术治疗的孕妈妈,在妊娠中期(4~6个月)实施手术是相对安全期。如果在整个孕期进行定期监测(每月一次)均未发现肿瘤明显进展,手术可以推迟至产后再实施。

问题七

得了甲状腺癌,很多人最关心的就是还能活多长时间?得了癌症就没办法了?

在大多数恶性癌症中,甲状腺癌相对来说是“温和”的,它一般不会侵害其他器官,只要规范治疗,不少患者可以长期生存。甲状腺癌主要分为乳头状癌、滤泡状癌、髓样癌、未分化癌四种。超过90%的甲状腺癌是分化型甲状腺癌,大部分的分化型甲状腺癌进展缓慢,近似良性病变,10年生存率很高。早期的分化型甲状腺癌的20年生存率能达到90%以上,术后一般只要按时定量吃药、定期复查即可,部分患者需要行术后的碘131治疗。

问题八

甲状腺癌在45岁之前早诊早治疗效好,那么超过这个年龄是不是就治不好了?

以往45岁确实是之前的一个治疗分界点,现在已经逐渐扩大到55岁了。甲状腺癌确实是一个很特殊的按年龄来分的癌症,存在一定生物学基础的,按着这样的年龄划分之后,该年龄段以下的分化型甲状腺癌就只有I期和II期,预后相对较好,即便出现转移了,治疗效果依旧比较好。但是超过这个分界岭之后治愈效果就要弱一些。去年底,最新的文献及AJCC将甲状腺癌TNM分期的年龄分界调整为55岁,而不再是以往认同的45岁。

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    2017-09-17 KO229256262

    很好.学习了

    0

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    2017-06-07 flysky120

    多多专家的治疗学习

    0

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    2017-05-31 flysky120

    学习一下知识了

    0

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    2017-05-28 往日如昨

    继续学习中谢谢

    0

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    2017-05-28 往日如昨

    学习了谢谢分享

    0

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    2017-05-28 luominglian113

    学习了,谢谢分享

    0

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    2017-05-28 jetleo

    学习了

    0

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    2017-05-28 日月生辉

    介绍很全面,向病人解释多了点明确性!

    0

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