分化良好的甲狀腺癌的治療管理

Management of Well Differentiated Thyroid Cancers (WDTC)

甲狀腺癌是最常見的內分泌惡性腫瘤，在台灣的癌登資料顯示，自1998-2008年甲狀腺癌的發生率迅速增加到每10 萬人口有4.74~8.69 人的發生率。許多文獻已有一致的看法，即分化良好的甲狀腺癌只有在腫瘤大於4 公分或具癌症的病理特徵，如硬化、高柱狀、島狀等、患者年齡45 歲以上、淋巴結或遠處轉移，才是影響預後不良的因素。這些高危險的病人需要外科切除手術，甚至中央部位淋巴結的摘除。相反的如果腫瘤小於1 公分，則是5 年內的轉移機會只有1.7%，可以考慮先不手術而只要觀察其是否變大。至於預後的分子診斷或標靶治療則仍在發展中，尚未有定論，有待後續研究。

Thyroid cancer is the most common endocrine malignancy. According to the annual report of Cancer Registry of Taiwan, the incidence has increased to 8.69 per 100,000 people, as shown in Figure 1.In the United States, the incidence of thyroid cancer has almost doubled since 1973, and is now the most rapidly increasing cancer in females and second most rapidly increasing cancer in males1. This increase can’t be explained by the increasing screening use of image studies such as ltrasonography, because all stages of the cancer at diagnosis have increased in a similar manner, not just the early ones [1,2.]