Prospective management of nodal metastases in differentiated thyroid cancer

Article Abstract:

Cancers that are differentiated (resembling normal tissue) tend to be less aggressive than those that are not as well differentiated. There is lack of agreement regarding the best treatment for differentiated thyroid cancer. Because previous studies have concluded that metastasis (cancer spread) to the lymph nodes does not influence patient survival, this factor has not been considered in making a prognosis. Some surgeons remove only palpable lymph nodes, and others recommend modified neck dissection with prophylactic (preventive) lymph node removal. A review was undertaken of 227 patients with differentiated thyroid cancer to determine the significance of lymph node metastasis. There were 70 patients (31 percent) with lymph node metastasis; 14 (20 percent) were palpable prior to surgery, and the remainder identified by routine sampling at the time of surgery. The average follow-up period was eight years, ranging from 2 to 28 years. Tumor recurrence occurred in 13 of these 70 patients (19 percent), compared with three recurrences (2 percent) among the 157 patients without nodal disease. Of the 68 patients treated by modified neck dissection, 63 also received radioactive iodine therapy. Of these 63 patients, there were 10 recurrences (16 percent), compared with three recurrences (42 percent) in the seven patients who did not receive radioactive iodine therapy. Overall, four patients (2 percent) died of thyroid cancer; all had lymph node metastasis. Metastasis to the cervical (neck) lymph nodes was associated with a high incidence of recurrence and distant metastasis. These results indicate that lymph node involvement is a marker for more aggressive cancer. Modified neck dissection is recommended for cervical lymph node metastasis, along with radioactive iodine therapy, when indicated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Lymph nodes, Thyroid cancer, Lymph node excision

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Early pharyngolaryngeal carcinomas with palpable nodes

Article Abstract:

The combination of small primary cancer with associated lymph node invasion (metastasis) has a poor prognosis, and the optimal treatment has not yet been agreed upon. Cancer of the pharyngolaryngeal area (area between the hyoid bone at the base of the tongue and the esophagus) with nodal involvement may be treated in very different manners. A study was undertaken of 313 patients with T1 or T2 cancer of the pharyngolaryngeal area with palpable lymph nodes, using three different treatment protocols. T1 and T2 refer to the stages of cancer, indicating progressive increase in tumor size and involvement; a T1 the tumor is small, but has encroached on the basement layer of the tissue; a T2 tumor is larger and more deeply involved. The treatment protocols were: P1, complete removal of cervical lymph nodes and postoperative radiotherapy; P2, partial pharyngolaryngeal surgery, as well as complete removal of cervical nodes and postoperative radiotherapy; and P3, radiotherapy only. The average patient age was 58 years, and all but one patient was male. The average interval between the initial symptom and medical evaluation was 3.5 months. The most frequently used treatment protocol was P3, radiotherapy only, (62 percent); 21 percent of patients underwent the P1 protocol; 17 percent received the P2 protocol. Average survival was 19 months for patients treated by methods P1 and P2, and 16 months for the P3 treated patients. The type of treatment did not significantly influence survival; overall survival averaged 18 months. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer metastasis, Head and neck cancer

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Speaking jejunum after laryngopharyngectomy with neoglottic and neopharyngeal reconstruction

Article Abstract:

Restoring normal voice and swallowing functions after the removal of the pharynx and larynx (laryngopharyngectomy) for treatment of cancer are troublesome problems. A method which uses intestinal tissue from the jejunum (part of the small intestine) to restore these functions is described. Three patients underwent abdominal surgery after a laryngopharyngectomy so that a part of the jejunum could be removed and used in the reconstruction of the throat; a loop of the intestinal tissue was placed so that breathing would not interfere with swallowing. All three patients were able to swallow despite occasional fluid leaks. Two patients were able to speak clearly. It appears that intestinal tissue may be used to restore normal speech and swallowing functions after laryngopharyngectomy without the use of mechanical devices. Serious considerations, however, include the risks of graft necrosis (deterioration of the transplanted tissue) and intestinal obstruction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Complications and side effects, Cancer, Flaps (Surgery), Surgical flaps, Jejunum, Laryngectomy

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