甲狀腺癌之新進展

Recent Advances in Thyroid Cancer

甲狀腺癌包括：乳突性及濾泡性甲狀腺癌、髓狀癌、未分化甲狀腺癌。甲狀癌治癒率很高。依據臺大醫院統計，五年生存率達87%。但是有些甲狀腺癌病人會發生再發性或甚至死亡，這些病人在第一次手術時就可估計出來。診斷上及治療上有固定的程序，此篇主要是寫台灣甲狀腺癌的現狀。從1960年到2000年，我們共收集1545個案例。依10年間隔區分，從1960年至1970年，我們發現早狀腺癌的標本平均體積為5.4 x 4.6 x 3.4公分；1991年至2000年，發現甲狀腺癌標本平均體積為診斷，呈現單一、堅硬且吞嚥時會動；這些症狀與良性腫瘤臨床症狀不容易分辨。診斷甲狀腺癌最可靠的工具是超音波檢查及細針穿刺細胞檢查。在臺大醫院五年生存率為87%，再發性有4.6%，遠隔轉移3.6%，癒後因子包括：病人的年齡、亞型、開刀時期腫瘤侵潤大小。甲狀腺癌最好的治療方法為開刀。而開刀主要目的是把腫瘤清除乾淨；反過來說，甲狀腺癌及有轉移頸部淋巴腺都要清除。大部分甲狀腺癌病人在手術後都需要給予碘-131治療。甲狀腺癌術後追蹤，主要目標是查甲狀腺素治療是否足夠，臨床上診斷是否有再發性或者遠隔轉移。依據臺大醫院經驗，甲狀腺癌再發性的現象在術後五年內會發生。甲狀腺癌的追蹤，包括：臨床檢查及超音波檢查、甲狀腺素是否適量、胸部X光、甲狀腺球蛋白定量及碘-131檢查。

Abstract: Thyroid cancer includes papillary and follicular, medullary and anaplastic types. These cancers are mostly curable with an 87% survival rate over 5 year in National Taiwan University Hospital. However, some patients are at high risk for recurrent disease or even death. Most of these patients can be identified at the time of the initial operation. This article describes recent trends in thyroid cancer in Taiwan. A total of 1545 cases of thyroid cancer treated in the recent four decades were divided by 10 years intervals. The mean size of find surgical specimen was 5.4x4.6x3.4cm between 1960-1970. It was reduced to 3.5x2.5x2.3cm in 1991-2000. The tumor size seems to influence the clinical syndromes and outcome. On physical examination, the cancer is usually single and firm, moves freely during swallowing, and is not so well distinguishable from a benign nodule. The ultrasonographic examination and fine-needle aspiration cytology are the most reliable tools for diagnosis. The overall 5-year survival rate for thyroid cancer is 87%. 4.6% of patients have local recurrent disease, 3.6% have distant metastasis. The prognostic indicators of recurrent disease and death are the patient’s age at diagnosis, histologic subtype and extent of the tumor. Initial treatment of thyroid cancer is surgery. The goal of surgery is to remove all tumor tissue in the neck. Therefore, the thyroid gland and affected cervical lymph nodes should be resected. Iodine-131 treatment is given postoperatively for most patients. The goals of follow-up after initial therapy are to maintain adequate thyroxine supplement and to detect any persistent or recurrent thyroid cancer periodically. Recurrences are usually detected within 5 years after the initial operation. Follow-up included clinical and ultrasonographic examinations, persistent adequate thyroxine supplement, chest x-ray, thyroglobuline examination, and iodine-131 up take for cancer detection.