Papillary carcinoma of thyroid, uterine and urothelial cells, prognosis and treatment.

Serous Papillary carcinoma Thyroid

Papillary carcinoma

Papillary carcinoma of the thyroid is a type of cancer that affects the anatomical structure and physiological function of the thyroid gland. Papillary carcinoma is derived from the epithelial tissue of the thyroid gland and constitutes 80-85% of the malignant thyroid tumours derived from epithelial tissue. Papillary carcinoma is primarily derived from the follicular cells of the thyroid gland. The important feature of this carcinoma is it is present in developed countries where iodine content is sufficient in their diet. Pathologically the tumour is characterized by macroscopic and microscopic changes in the thyroid gland. Gross changes includes the appearance of the cancer tissue itself it can be very minute present as an sub capsular scar usually white or to a huge tissue that has the potential to invade the neighbouring tissues which are in continuation with the thyroid gland. Gross cystic changes can also be seen along with areas of calcification sometimes ossification can also be visible due to excess calcium deposition. Microscopically changes includes the presence of the papillae, hence the name papillary carcinoma. There is variant cancer where along with cells having papillae there are also follicular pattern present this is known as mixed papillary follicular carcinoma, however this term is slowly being phased out as the consensus amongst researchers is that papillary carcinomas are characterized by presence of the follicular pattern. The metastasis of the papillary carcinoma is basically through the lymphatic channel thus the regional nodes are affected maximum. A new term micro carcinoma is being used now-a-days this means any papillary carcinoma less than the dimension of 1 cm it is referred as micro carcinoma.

Symptoms at which the patients present with this carcinoma are usually localized to the thyroid tissue.  They may present as hardened nodes in there neck sometimes painful. The patients might also complain hard lymph nodes present at the cervical region. The signs upon examination reveal that tumour will be approximately 2-2.5 cms big firm, very rarely pliable, fixed to the thyroid gland and moves on swallowing. On examination of the lymph nodes of the cervical region one can find hardened lymph node due to metastasis of the tumour through lymphatics.

Treatment of the papillary carcinoma is similar to treatment of any thyroid tumour. The survival chances is greater with papillary carcinonam as it is localized there is 90-95% of disease free long term survival in these patients. However the treatment of any thyroid tissue has sparked off an ongoing debate over which is a suitable patient for operative procedure, if operation is done how much to be done, should the entire tissue be taken out, should radiotherapy be followed. The most acceptable surgical protocol involves non metastasis thyroid papillary carcinoma which can be removed by and ipsilateral lobectomy that is taking out the affected lobe of the thyroid tissue. A subtotal thyroidectomy is a procedure where only 20% of the thyroid tissue is left; a near total thyroidectomy is a procedure where the amount of tissue left is just for support of the parathyroid tissue and a total throidectomy where the complete thyroid tissue is taken out.  Radiotherapy is done in case of metastasis is suspected along with the removal of the affected group of lymph nodes.