ISSN: 1305-3876
Hakkında: Özel sayılar şeklinde yayınlanır.
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Medullary Thyroid Carcinoma
Dr. Çetin VURAL,a Dr. E. Ayça ÖZBAL KOÇ,a Dr. M. Mazhar ÇELİKOYARb
a1. KBB Kliniği, Şişli Etfal Eğitim ve Araştırma Hastanesi,
bKBB Kliniği, İstanbul Cerrahi Hastanesi, İSTANBUL
Medullary thyroid carcinoma originates from the C cells of the thyroid gland. Though most of them are sporadic, genetic forms can also be found. Genetic forms can be seen as part of syndromes MEN IIA and MEN IIB. The behaviour of the tumor is quite different from the differentiated cancers originating from the thyroid follicular cells which makes the diagnosis and treatment also different from differentiated tumors of the thyroid gland.
This tumor secretes calcitonin which makes its diagnosis and follow-up easier. The sporadic form can be seen as a thyroid nodule or a neck mass. Genetic forms differ from sporadic cases in the fact that they are often discovered by genetical assessments after diagnosis of medullary thyroid carcinoma in a family member.
Every patient diagnosed as medullary thyroid carcinoma must be evaluated for a RET mutation. If positive, all first degree relatives should also be screened.
Main treatment of the disease is surgery. In sporadic cases, central compartment and lateral neck dissections together with thyroidectomy is advised. In the cases of RET mutations, prophylactic surgery is needed even though medullary thyroid carcinoma may not be present at the time. Timing for the surgery should be done according to the type of the RET mutation. For this the “Codon related prophylactic thyroidectomy” concept has been developed. Radiotherapy and chemotherapy have a limited place in the management of advanced cases and new treatment modalities are being sought.Keywords: Carcinoma, medullary; RET proteinTurkiye Klinikleri J Surg Med Sci 2007, 3(49):35-40
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