The earlier a large thyroid cancer is found, the more scarless surgery becomes possible
Page information
Gangnam St. Peter's Hospital 26-01-09 00:00Main content
Thyroid cancer symptoms and treatment
Usually there are no symptoms at all, and a lump in the neck is often found on ultrasound
Pressure in the neck or a change in your voice calls for detailed examination… the surgical approach is decided by the type of cancer
[Baeksesidae = Bae Ji-young, reporter] #. Kim Young-mi, 62, a homemaker, was recently diagnosed with early-stage thyroid cancer and found herself in a quandary. She was relieved to be told that the cure rate is high when it is caught and treated early, but she was also told that surgery involving a horizontal incision at the front of the neck could leave a scar resembling a neck wrinkle. She then learned about ‘transoral endoscopic surgery,’ which is approached through the inside of the mouth and leaves no visible external scar, and after thorough consultation with the medical team she decided to have that operation. The surgery was completed successfully, and Kim is now recovering quickly.
Thyroid cancer is relatively common among the various forms of cancer. Indeed, according to the 2021 national cancer registry statistics released by the National Cancer Center, the incidence of thyroid cancer was 68.6 cases per 100,000 population, ranking first in incidence for the third consecutive year.
The problem is that, because the thyroid is an organ located at the front of the neck, surgical scars are relatively easy to see. In fact, quite a few people always cover the scar with a scarf or muffler after thyroid cancer surgery.
Yoon, Yeo Gyu, Director of the Thyroid Center at St. Peter's Hospital, said, “The basic treatment for thyroid cancer is thyroidectomy, and because the conventional approach involved cutting directly through the skin, many patients were troubled by the scar even after recovery,” adding, “Recently, however, cases of endoscopic surgery that reduces scarring have been increasing sharply.”
◇Causes and symptoms of thyroid cancer
The thyroid sits about 2-3 cm below the thyroid cartilage, the prominence at the front of the neck known as the Adam's apple. A lump forming in the thyroid is called a ‘thyroid nodule’, and about 5-10% of all patients with thyroid nodules are diagnosed with thyroid cancer.
Director Yoon, Yeo Gyu explained, “Thyroid nodules themselves are a very common condition, found in about 30% of ultrasound examinations, and in most cases there are no symptoms at all, the nodule being discovered incidentally through an ultrasound screening or similar test,” adding, “If a nodule suddenly grows larger or there is a feeling of pressure in the neck, however, or if a change in the voice or shortness of breath develops, a detailed thyroid cancer work-up using ultrasound and fine needle aspiration is needed.”
If thyroid cancer is diagnosed, the first step is to determine the type of cancer. Thyroid cancer is divided into four broad types: ▲papillary carcinoma ▲follicular carcinoma ▲medullary carcinoma ▲poorly differentiated and anaplastic carcinoma. Most thyroid cancers are papillary or follicular carcinoma, which have a relatively good prognosis with treatment.
Papillary thyroid carcinoma, which accounts for 75-80% of all thyroid cancers, is a cancer in which the tumor grows in a single cluster and progresses very slowly. Its 10-year survival rate is also over 90%, and most patients can return to normal life without problems after treatment. Follicular carcinoma, which accounts for 20% of all thyroid cancers, likewise has a good prognosis because the cancer cells grow slowly.
By contrast, medullary, poorly differentiated and anaplastic carcinoma are rare, accounting for only 0.2-1% of all thyroid cancers, but they carry a poor prognosis because they metastasize and grow quickly. Anaplastic carcinoma in particular is so high-risk that it is classified as stage 4 at the time of diagnosis.
◇Treatment of thyroid cancer
All thyroid cancer treatment is based on surgery, but the extent of surgery and the treatment method may vary somewhat with the patient's condition. By extent, surgery is generally divided into ‘total thyroidectomy’, which removes the entire thyroid, and ‘lobectomy’, which removes only the lobe containing the tumor. In some cases, ‘subtotal thyroidectomy’, which leaves part of the thyroid, or ‘neck dissection’, which also removes surrounding lymph nodes, is performed.
Once the extent of surgery is determined, the surgical approach is decided. Thyroid cancer surgery falls broadly into two types: ‘open skin incision’ and ‘endoscopic surgery’. The cervical incision approach, performed through a 4-5 cm incision in the skin below the Adam's apple, is one of the traditional methods long in use; it can be performed regardless of how far the cancer has progressed, but has the drawback of leaving a scar on the front of the neck.
Endoscopic resection can resolve this concern. BABA (bilateral axillo-breast approach) endoscopic surgery is performed by making micro-incisions of less than 1 cm in both armpits and at the areolae and inserting an endoscope to reach the lesion. It not only reduces the burden of scarring but has no effect whatsoever on breastfeeding or breast cancer screening.
Going a step further, the recently devised ‘transoral endoscopic surgery’ is a ‘scarless technique’ designed to leave no scar at all: three micro-incisions are made in the mucosa between the lower gum and the lip, and an endoscope is inserted to perform the operation.
Director Yoon, Yeo Gyu explained, “The oral mucosa heals very quickly and leaves almost no scar once healed,” adding, “Because there is no skin wound, patients can shower immediately after surgery and return to daily life easily, and the risk of skin adhesion and the level of pain are relatively low, so patient satisfaction is very high.”
However, not every thyroid cancer patient can undergo endoscopic resection, because eligibility for endoscopic surgery depends on the location and size of the cancer and the risk of metastasis.
Director Yoon, Yeo Gyu stressed, “The smaller the cancer and the earlier the stage, with lower risk of metastasis, the more likely endoscopic surgery becomes, and the better the surgical prognosis.”
Usually there are no symptoms at all, and a lump in the neck is often found on ultrasound
Pressure in the neck or a change in your voice calls for detailed examination… the surgical approach is decided by the type of cancer
[Baeksesidae = Bae Ji-young, reporter] #. Kim Young-mi, 62, a homemaker, was recently diagnosed with early-stage thyroid cancer and found herself in a quandary. She was relieved to be told that the cure rate is high when it is caught and treated early, but she was also told that surgery involving a horizontal incision at the front of the neck could leave a scar resembling a neck wrinkle. She then learned about ‘transoral endoscopic surgery,’ which is approached through the inside of the mouth and leaves no visible external scar, and after thorough consultation with the medical team she decided to have that operation. The surgery was completed successfully, and Kim is now recovering quickly.
Thyroid cancer is relatively common among the various forms of cancer. Indeed, according to the 2021 national cancer registry statistics released by the National Cancer Center, the incidence of thyroid cancer was 68.6 cases per 100,000 population, ranking first in incidence for the third consecutive year.
The problem is that, because the thyroid is an organ located at the front of the neck, surgical scars are relatively easy to see. In fact, quite a few people always cover the scar with a scarf or muffler after thyroid cancer surgery.
Yoon, Yeo Gyu, Director of the Thyroid Center at St. Peter's Hospital, said, “The basic treatment for thyroid cancer is thyroidectomy, and because the conventional approach involved cutting directly through the skin, many patients were troubled by the scar even after recovery,” adding, “Recently, however, cases of endoscopic surgery that reduces scarring have been increasing sharply.”
◇Causes and symptoms of thyroid cancer
The thyroid sits about 2-3 cm below the thyroid cartilage, the prominence at the front of the neck known as the Adam's apple. A lump forming in the thyroid is called a ‘thyroid nodule’, and about 5-10% of all patients with thyroid nodules are diagnosed with thyroid cancer.
Director Yoon, Yeo Gyu explained, “Thyroid nodules themselves are a very common condition, found in about 30% of ultrasound examinations, and in most cases there are no symptoms at all, the nodule being discovered incidentally through an ultrasound screening or similar test,” adding, “If a nodule suddenly grows larger or there is a feeling of pressure in the neck, however, or if a change in the voice or shortness of breath develops, a detailed thyroid cancer work-up using ultrasound and fine needle aspiration is needed.”
If thyroid cancer is diagnosed, the first step is to determine the type of cancer. Thyroid cancer is divided into four broad types: ▲papillary carcinoma ▲follicular carcinoma ▲medullary carcinoma ▲poorly differentiated and anaplastic carcinoma. Most thyroid cancers are papillary or follicular carcinoma, which have a relatively good prognosis with treatment.
Papillary thyroid carcinoma, which accounts for 75-80% of all thyroid cancers, is a cancer in which the tumor grows in a single cluster and progresses very slowly. Its 10-year survival rate is also over 90%, and most patients can return to normal life without problems after treatment. Follicular carcinoma, which accounts for 20% of all thyroid cancers, likewise has a good prognosis because the cancer cells grow slowly.
By contrast, medullary, poorly differentiated and anaplastic carcinoma are rare, accounting for only 0.2-1% of all thyroid cancers, but they carry a poor prognosis because they metastasize and grow quickly. Anaplastic carcinoma in particular is so high-risk that it is classified as stage 4 at the time of diagnosis.
◇Treatment of thyroid cancer
All thyroid cancer treatment is based on surgery, but the extent of surgery and the treatment method may vary somewhat with the patient's condition. By extent, surgery is generally divided into ‘total thyroidectomy’, which removes the entire thyroid, and ‘lobectomy’, which removes only the lobe containing the tumor. In some cases, ‘subtotal thyroidectomy’, which leaves part of the thyroid, or ‘neck dissection’, which also removes surrounding lymph nodes, is performed.
Once the extent of surgery is determined, the surgical approach is decided. Thyroid cancer surgery falls broadly into two types: ‘open skin incision’ and ‘endoscopic surgery’. The cervical incision approach, performed through a 4-5 cm incision in the skin below the Adam's apple, is one of the traditional methods long in use; it can be performed regardless of how far the cancer has progressed, but has the drawback of leaving a scar on the front of the neck.
Endoscopic resection can resolve this concern. BABA (bilateral axillo-breast approach) endoscopic surgery is performed by making micro-incisions of less than 1 cm in both armpits and at the areolae and inserting an endoscope to reach the lesion. It not only reduces the burden of scarring but has no effect whatsoever on breastfeeding or breast cancer screening.
Going a step further, the recently devised ‘transoral endoscopic surgery’ is a ‘scarless technique’ designed to leave no scar at all: three micro-incisions are made in the mucosa between the lower gum and the lip, and an endoscope is inserted to perform the operation.
Director Yoon, Yeo Gyu explained, “The oral mucosa heals very quickly and leaves almost no scar once healed,” adding, “Because there is no skin wound, patients can shower immediately after surgery and return to daily life easily, and the risk of skin adhesion and the level of pain are relatively low, so patient satisfaction is very high.”
However, not every thyroid cancer patient can undergo endoscopic resection, because eligibility for endoscopic surgery depends on the location and size of the cancer and the risk of metastasis.
Director Yoon, Yeo Gyu stressed, “The smaller the cancer and the earlier the stage, with lower risk of metastasis, the more likely endoscopic surgery becomes, and the better the surgical prognosis.”