Clinical presentation and outcome patterns of thyroid cancer
THE CONTEXT
Thyroid cancers commonly present with a thyroid swelling, but nodal disease, nerve involvement and tumour consistency provide additional clinical clues.
Incidence and outcomes
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The passage reports an annual incidence of about 0.8 per million and a female-to-male ratio of 3:1.
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Papillary thyroid carcinoma incidence is increasing rapidly worldwide, mainly because imaging detects previously occult disease.
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Despite increasing incidence, mortality rates are described as static, with overall 5-year survival exceeding 80%.
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Anaplastic carcinoma predicts a poor outcome, whereas differentiated carcinomas generally have excellent outcomes.
Presentation and examination
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Thyroid swelling is the most common presenting symptom. Enlarged cervical lymph nodes may be the presentation of papillary thyroid carcinoma.
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Small papillary tumours may be impalpable even when lymphatic metastases are present.
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Anaplastic cancers are usually hard, irregular and infiltrating.
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Differentiated carcinoma may feel suspiciously firm and irregular, but is often indistinguishable from a benign swelling.
Features suggesting local involvement
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RLN paralysis is very suggestive of locally advanced disease.
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Pain, often referred to the ear, suggests nerve involvement by an infiltrating tumour.