MOLECULAR EXAMINATIONS
Thyroid Cancer
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Thyroid Gland
Thyroid cancer begins in the thyroid gland, which is located in the front of the neck just below the voice box. The thyroid gland is part of the endocrine system, which regulates hormones in the body. The thyroid gland absorbs iodine from the bloodstream to produce thyroid hormones, which regulate a person’s metabolism.
A normal thyroid gland has 2 lobes, joined by a narrow strip of tissue called the isthmus. A healthy thyroid gland is barely palpable, meaning it is difficult to find by touch. If a tumor develops in the thyroid, it may be felt as a lump in the neck. A swollen or enlarged thyroid gland is called a goiter, which can be caused when a person does not have enough iodine in their body. Most people get enough iodine from salt, so goiters in these conditions are caused by other reasons.
Thyroid Cancer Types
There are 5 main types of thyroid cancer:
Papillary Thyroid Cancer (PTC).
Papillary thyroid cancer develops from follicular cells and is usually slow-growing. It is the most common type of thyroid cancer. It is usually found in 1 lobe. Only 10% to 20% of papillary thyroid cancers occur in both lobes. Papillary thyroid cancer can often spread to the lymph nodes (metastasis).
Follicular Thyroid Cancer.
Follicular cancer also develops from follicular cells and is usually slow-growing. It is less common than papillary thyroid cancer. Follicular thyroid cancer rarely spreads to the lymph nodes.
Overall, papillary and follicular thyroid cancer account for approximately 95% of all thyroid cancer types.
Hurthle cell cancer.
Hurthle cell cancer arises from a specific type of follicular cell. Hurthle cell cancer is much more likely to metastasize to the lymph nodes than other thyroid cancers.
Medullary Thyroid Cancer (MTC).
MTC develops from C cells and is sometimes the result of a genetic syndrome called multiple endocrine neoplasia type 2 (MEN2). MTC accounts for about 3% of all thyroid cancers. About 25% of all MTC is hereditary. This means that family members of the patient will have the possibility of a similar diagnosis. Genetic testing for the RET proto-oncogene can confirm whether family members also have familial/hereditary MTC.
Anaplastic thyroid cancer.
This type is rare, accounting for about 1% of thyroid cancers. It is a fast-growing, poorly differentiated thyroid cancer that can start from another type of thyroid cancer or from a benign thyroid tumor. Because this type of thyroid cancer grows quickly, it is more difficult to treat successfully.
The tool that doctors use to stage thyroid cancer is the TNM system. Doctors use the results from the histological examination (pTNM) and scans (CT scan, MRI, etc.) to answer the questions:
Tumor (T tumor): How big is the primary tumor? Where is it located?
Lymph node (N-node): Has the tumor metastasized to the lymph nodes? If so, where and in how many lymph nodes?
Metastasis (M-metastasis): Has cancer metastasized to other parts of the body? If so, where and to what extent?
The results are combined to determine the stage of cancer for each person individual. For thyroid cancer, there are 5 stages: stage 0 (zero) and stages I to IV (1 to 4).
Staging can be clinical or pathologic. Clinical staging is based on the results of tests before surgery, which may include a physical examination and imaging tests. Pathologic staging is based on the histologic examination of a tissue sample or organ removed during surgery or a biopsy . In general, pathologic staging provides the most information for determining a patient’s prognosis .
It is common for people with thyroid cancer to have few or no symptoms. Thyroid cancers are often diagnosed by a routine examination of the throat during a general physical examination. They are also unintentionally discovered by X-rays or other imaging techniques performed for other reasons. People with thyroid cancer may have the following symptoms or signs:
ometimes, people with thyroid cancer don’t have any of these changes. Or, the cause of a symptom may be a different medical condition that isn’t cancer.
- A swelling, projection on the front of the neck, near Adam’s apple
- Hoarseness
- Swollen lymph nodes in the neck
- Difficulty in swallowing
- Difficulty in breathing
- Neck pain
- Cough that persists and is not due to a cold
- If you are concerned about any changes you are experiencing, contact your clinician
These symptoms may be due to thyroid cancer or other thyroid problems, such as a goiter, or a condition unrelated to the thyroid, such as an infection.
For most types of cancer, a biopsy is the only sure way for a doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for histological examination in a pathological laboratory. If the biopsy is not possible, your doctor may suggest other tests to help the diagnosis.
Your doctor will look at these factors when choosing a diagnostic test:
- The type of cancer suspected
- Your symptoms
- Your age and general health
- The results of previous medical examinations
This section describes options for diagnosing thyroid cancer. Not all of the tests listed below are used for everyone.
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- Physical examination
- Blood tests (thyroid hormone test
- Ultrasound of the thyroid gland, CT scan, Radioisotopes, PET scan
- Biopsy
is the removal of a small amount of tissue for microscopic examination (histological examination). Only a biopsy can make a clear diagnosis. It is the standard way to determine if a nodule is cancerous or benign. During this procedure, the doctor removes the cells from the nodule which are then examined by a cytopathologist. The cytopathologist is the doctor who specializes in cell analysis (while the pathologist specializes in tissue analysis) to diagnose diseases. This biopsy is often conducted with the help of ultrasound.
A biopsy for thyroid nodules will be performed in 1 of these 2 ways:
- Fine needle aspiration biopsy (FNAB).This procedure is usually performed in a doctor’s office or clinic. It is an important diagnostic step to determine if a thyroid nodule is benign or cancerous. The doctor inserts a thin needle into the nodule and removes the cells and a little fluid. The procedure can be repeated 2 or 3 times to take samples from different areas of the nodule. In Microdiagnostic Pathologists & Cytologists who specialize in interpreting laboratory tests and evaluating cells, tissues and organs, they work together for the final diagnosis. The test may be positive, which means, there are cancerous cells, or negative, which means that there are no cancerous cells. The test may also be unspecified, which means it is not clear if there is cancer.
- Surgical biopsy.If the needle aspiration biopsy does not give a clear result (unspecified), the doctor may suggest a biopsy in which the nodule and possibly the thyroid lobe should be surgically removed. Removal of the nodule alone is usually not recommended due to the possibility of removing the possible malignancy without sufficient surgical margins, which is the area of the tissue around the nodule.
- Molecular examination of the nodule sample. Your doctor may recommend that a molecular test should be performed on a sample in order to identify specific genes, proteins, and other factors unique to the tumor. Genetic analysis of your thyroid nodule may help us understand the risk of thyroid cancer being cancerous.
- A biopsy
is the removal of a small amount of tissue for examination under a microscope (histological examination). Only a biopsy can make a clear diagnosis. It is the standard way to determine whether a nodule is cancerous or benign. During this procedure, the doctor removes cells from the nodule, which are then examined by a cytologist. A cytologist is a doctor who specializes in analyzing cells (while a pathologist specializes in analyzing tissues) to diagnose diseases. This biopsy is often done with the help of ultrasound. A biopsy for thyroid nodules will be done in 1 of 2 ways: -Fine needle aspiration (FNAB). This procedure is usually performed in a doctor’s office or clinic. It is an important diagnostic step in determining whether a thyroid nodule is benign or cancerous. The doctor inserts a thin needle into the nodule and removes cells and a little fluid. The procedure may be repeated 2 or 3 times to take samples from different areas of the nodule. In Microdiagnostics, pathologists & cytologists who specialize in interpreting laboratory tests and evaluating cells, tissues and organs work together to make a final diagnosis. The test may be positive, meaning that cancer cells are present, or negative, meaning that there are no cancer cells. The test may also be indeterminate, meaning that it is not clear whether cancer is present. -Surgical biopsy. If the needle aspiration biopsy does not give a clear result (indeterminate), the doctor may suggest a biopsy in which the nodule and possibly the thyroid lobe will need to be removed surgically. Removing the nodule alone is usually not recommended, due to the possibility of removing the potential malignancy without adequate surgical margins, which is the area of tissue around the nodule.</li< - Molecular testing of the nodule sample. Your doctor may recommend molecular testing of a sample to identify specific genes, proteins, and other factors unique to the tumor. Genetic analysis of your thyroid nodule can allow us to understand the risk of your thyroid nodule being cancerous.
A risk factor is anything that increases a person’s chances of developing cancer. Although risk factors are often associated with the development of cancer, most of them do not directly cause cancer. Some people with many risk factors never develop cancer, while others without known risk factors develop it.
Knowing the risk factors and discussing them with your doctor can help you make more informed choices about your lifestyle and health care.
The following factors may increase a person’s risk of developing thyroid cancer:
Gender.
Women are diagnosed with 3 out of every 4 cases of thyroid cancer.
Age.
Thyroid cancer can occur at any age, but about 2/3 of all cases occur in people aged from 20 to 55 years old. Reconstructive thyroid cancer is usually diagnosed after the age of 60. Infants (10 months and older) and adolescents may develop myeloid thyroid carcinoma (MTC), especially if they carry the RET proto-oncogenic mutation.
Genetics.
Some types of thyroid cancer are linked to genetics. Below are some key facts about thyroid cancer, genes, and family history. If you are interested in learning more about your personal genetic risk of developing cancer, read this article about hereditary cancer.
A mutated RET oncogene, which can be passed from parent to child, can cause myeloid thyroid carcinoma (MTC). This does not mean that everyone with a mutated RET oncogene will develop cancer. Blood tests and molecular tests can detect the gene. Once the mutated RET oncogene is detected, your doctor may recommend surgery to remove the thyroid gland before cancer develops. People with myeloid MTC myeloid carcinoma are encouraged to have molecular tests to see if there is a mutation in the RET proto-oncogene. If so, you will be recommended genetic testing by parents, siblings, and children.
A family history of MTC increases a person’s risk. People with MEN2 syndrome are also at risk of developing other types of cancer.
A family history of precancerous polyps in the colon, also called the large intestine, increases the risk of developing thyroid cancer.
Radiation exposure.
Exposure to moderate levels of radiation to the head and neck can increase the risk of thyroid cancer. Such sources of exposure include:
Actinotherapy for Hodgkin’s lymphoma or other forms of lymphoma in the head and the neck.
Exposure to radioactive iodine is also called I-131 or RAI, especially in childhood.
Exposure to ionizing radiation,
Low iodine diet. Iodine is needed for normal thyroid function.
Race.
White people and Asian people are more likely to develop thyroid cancer, but this disease can affect a person of any race or nationality.
Breast cancer.
A recent study showed that breast cancer survivors may have a higher risk of developing thyroid cancer, especially in the first 5 years after they’ve been diagnosed, and those diagnosed with breast cancer at a younger age. This finding is still being investigated by researchers.
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Frequently Asked Questions (FAQ)
Your clinician has performed a fine needle aspiration (FNAB) to take cells from the nodule(s) in your thyroid to see if the nodule(s) is/are benign or cancerous. If the cytology result is indeterminate, then PredictArray Thyroid can help to understand whether the nodule is benign or not. The test checks for the presence of mutations in specific genes.
The tests are performed on the surgical specimen (paraffin cubes) or the biopsy material (paraffin cube) from which your histological examination was performed or on the aspiration material (FNAB, EBUS) from which your cytological examination was performed. In our fully integrated Laboratory, the pathologist selects the most appropriate & representative paraffin cube, ensuring that the most appropriate sample will be used for the tests. Qualitative and quantitative parameters are checked.
In case your sample is not already in the Microdiagnostics archive, please contact us immediately so that we can arrange for its safe and rapid transport to our laboratory. You will also need to quickly and easily complete the Consent Form.
Most of the time, the sample material we are called upon to handle is small because it has resulted from a minimally invasive method (needle biopsy, fluid aspiration, paraffin block with minimal material).
In our laboratory, Pathologists check in a timely manner whether the material to be examined is sufficient. If so, then a management algorithm is followed, with the aim of achieving the performance of multiple tests on the material (Immunohistochemistry, real-time PCR, NGS) in order to fully check the molecular profile of your tumor (proteins, genes, histological Grading).
In this case, and once sample enrichment manipulations have been exhausted, we contact your clinician to discuss alternative approaches in order to obtain the desired information to select the optimal treatment for you. Some examples:
- Performing an alternative test (e.g. Immunohistochemistry instead of PCR, or choosing Next Generation Sequencing (NGS))
- Performing Immunohistochemistry instead of FISH (Fluorescent In Situ Hybridization) and tubulin
- Possible blood sampling instead of tissue testing (liquid biopsy)
- Possible option to take a new biopsy or puncture
Contact us at 2310 23 22 72 and we will immediately assist you in quickly transporting the sample to our laboratory.
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One of the primary concerns of Microdiagnostics is the protection of your personal data as well as the strict observance of the conditions for the protection of your genetic material and medical results.
In full compliance with the General Data Protection Regulation (GDPR), we ensure that any test conducted is done with your knowledge and consent and we do not communicate results over the phone.