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Guideline of diagnosis and treatment of thyroid tubercle and become divided thyroid cancer
By admin | July 18, 2008
(Add on March 9, 2006 the 21st edition) of differentiation thyroid cancer follow the patient that visits patient of pair of become divided thyroid cancer to follow the target that seek for a long time to have a relapse to the likelihood namely for a long time to undertake be monitoringed closely, so that discover recrudescent focus of a disease as early as possible, inchoate check gives recrudescent kitchen to conduce to pair of patients carrying out effective treatment. The size with exist continuously according to patient pathological changes along with the content that visit or have a relapse dangerous each are not identical. American cancer combines committee (AJCC)/ international resists cancerous union (UICC)TNM in installment although can forecast dead danger of the patient, but the recrudesce that cannot forecast tumor is dangerous. Should evaluate patient prognosis and treat plan certainly, it is dangerous to be about to press recrudesce degree is patient cent 3 levels:Low danger patient: Lei Taoist sacrificial ceremony asks qualitative Chuo acute communicable diseases? of garden of of ψ of hole of flood dragon of kang of establish of core of Zhu Hui of Li of ≡ of Ban of laborious of of the Gui that cast aside ⑶ is all macroscopical tumour already all was excised, tumor did not invade local organization and not tall the pathology that encroachs a gender is behaved or attack blood vessel. If use 131I, so in the first time undertake iodine scans radiating all over after the operation (when RxWBS) , absorb without 131I outside thyroid bed. The patient highs in: Lei Taoist sacrificial ceremony asks qualitative Jia? to macroscopical tumour invades the parenchyma other thyroid gland, or tumor has the pathology that encroachs a gender is behaved or invade blood-vessel. Tall danger patient: Lei Taoist sacrificial ceremony asks qualitative Jia? to macroscopical tumour invades circumjacent organization, tumor excision is not complete, far is transferred, or keep clear of in thyroid leftover focus of a disease there is iodine to absorb outside thyroid bed is being seen when 131I of the travel after art scans. Accepting thyroid gland is cut completely or in the patient of close complete resection, the person that have following and all requirement at the same time is the condition that do not have disease namely: What brandish writes? of ぞ of storehouse of Qiu of herd of Bao of Bi Shi carve to do not have existence tumour is video learn evidence (when the whole body after art scans, recently when diagnostic sex scanning and cervical and supersonic examination, ) all is absorbed without iodine beyond thyroid bed, below the condition that violates sexual antibody in lack, be restrained with TSH and all cannot detect during stimulation thyroid globulin (Tg)(graph 1) . Detect the important method that serum Tg level is a kind of remain that monitor or move focus of a disease, its have high sensitivity and particularity to thyroid cancer, especially be expert at thyroid gland cuts method completely and after purify remains pathological changes. Hormone of thyroid gland of out of service or with recombine model hormone of person hurried thyroid gland (after RhTSH) undertakes stimulating, this detected susceptibility is highest. Detect during restraining TSH to secrete with thyroid hormone Tg cannot check goes out a few rudimental tumour. Be done not have after cure or only when a few normal thyroid organizations remain, diagnostic sex RxWBS is the most useful along with seek a means. After radioactivity iodine is treated, the sensitivity of RxWBS is reduced somewhat, accordingly, clinical during kitchen, thyroid without remaining tumour element is restrained cannot check gives Tg and the low danger patient with cervical and supersonic electronegative examination need not go RxWBS. Cervical and supersonic examination is to detect patient of differentiation thyroid cancer is cervical the tall sensitive method of move. Have not detect below TSH stimulation even sometimes when serum Tg, cervical and supersonic already but check gives move kitchen. The curative effect that restrains cure to thyroid element currently is put open to question. Research makes clear, thyroid hormone restrains cure to be able to reduce thyroid cancer patient to be followed for a long time during visitting the occurence rate of large and clinical undesirable incident, but with Zun Xuan thyroid element (LT4) controls thyroid optimal rate still unknown. As taller as TSH level (the photograph when ≥ 1 MU/L) is compared, restrain TSH(≤ 0.05 MU/L) to be able to make continuously of the patient live without recrudesce time is lengthened. In much more variable analysis, the inhibition of TSH the independence that degree is tumor recrudesce forecasts an element. And another large research makes clear, disease in installment, the independence that patient age and the condition that 131I treats all are disease prognosis forecasts an element, and TSH controls rate is not. If be in,follow during visitting, discover tumor changes kitchen range, 131I is treated normally of no help. To invading the upper respiratory tract is mixed on the tumour of enteron, the proposal chooses operation cure to add auxiliary cure [131I and (or) body external exposure puts cure (EBRT)] . The patient’s lapse to decides at, whether excise tumor kitchen thoroughly and retain a patient relevant physiology function, and whether can from what be invaded by simple table tracheal or come off on esophagus tumor. Invade tracheal deep-seated organization when tumor (if invade tubal antrum directly) when, need a tracheal resection or resection of pharynx ministry esophagus. The patient that heals to having law should go traumatic and lesser cure, use tracheal support to such patient or travel tracheotomy is ameliorable their life quality. Choke to having or the patient of haemoptysis symptom, can effecting a radical cure operation or laser of the travel before appeasement is treated are treated. Although 131I treats a lot of pair of patients to have distinct curative effect, but have not decide its are optimal remedial dosage. The method that 131I treats has 3 kinds: Zhuo Yue complains pool ② of bright? fearing acute communicable diseases is able to bear or endure through the radiation of blood and body the radiation that suffers quantity and especially mensurable tumour is able to bear or endure upper limit getting an amount treats dosage; ③ certainly move of far to having department or other and special situation () of exhaustion of the function that be like kidney, or the patient that needs RhTSH stimulation really, should use dosage titration. Still had compared the lapse to after using these methods without research now. In the process that treats thyroid cancer, the use of radioactivity iodine is more and more extensive, doctors must understand the long-term risk with use iodic radioactivity better, be like this therapy effect to salivary gland, the long-term effect that the reproductive system of the male that reachs its to be able to cure thyroid cancer to sufferring from and female produces, and the danger of the disease such as tumour of path of bowel of tumour of parotid gland of remedial succeed hair, stomach, cystic tumour and colonic cancer. Use RhTSH cannot restrain move kitchen not only, quicken tumor possibly instead to transfer the growth of kitchen. Below the circumstance that does not damage iodine to absorb a function, lithium can restrain thyroid gland to release iodine, accordingly, can make 131I remain in normal thyroid organization and tumor cell. Have research discovery, lithium can make tumor transfers the 131I radiative dosage that gathers in kitchen to increase 2 times on average, and former the rate that these tumour release iodine is rapidder. If issueing check to give Tg without exciting circumstance, or the Tg>2 Ng/ml below the circumstance that is being stimulated, should go cervical reach bosom to become like the examination, be like cervical and supersonic with bosom layer (CT of 5~7 Mm) helix, search tumor to change kitchen range. Although vein inject iodic agent conduces to the move kitchen of resolution tumour, but if plan to carry out radioactivity iodine inside a few months after the examination,treat, should avoid to undertake strengthening scanning with iodine. If scanning result shows negative, criterion operation cure may cure a disease, but radioactivity iodine of sex of go by check also should consider to treat after art (100~200 MCi) . The research that in the light of terminal iodine patient of counteractive become divided thyroid cancer has changing cure is very few. Much softer more right amount than the star (every 3 weeks of use 60~75 Mg/m2) are effective to the patient of 40% above (majority may stabilize illness) effectively for the part, but the duration of its action is not affirmatory. The operation that in looking into this guideline, introduces and radioactivity iodic therapeutics are medicable patient of most become divided thyroid cancer, but the tumor that has a few patient can grow quickly, transfer extensively, endanger life even, to these the patient can take experimental therapy. The understanding that reachs cytology to send ill mechanism to thyroid cancer element currently is ceaseless and thorough, a variety of target already were entered to remedial method clinical evaluate level, these therapeutics include: Plant ⒁ of Chu of epiphysis of Bao of Nao of horsefly of せ of of ⑸ of Jie of of gourd ladle ┗ is planted cook of ⒚ of of law of cattail benzyl knocks at Gu to criticize sb’s faults frankly dash forward Mou Wen Pin takes? (full text to be over)
Topics: cure for cancer |