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Thyroid disease is defined as a condition of malfunction of thyroid.
Thyroid disease: Thyroid CancerThyroid cancer is a condition in which the cells in the thyroid gland have become cancerous.
Types of thyroid cancer
The most common types of thyroid cancer include
1. Papillary thyroid cancer
Papillary thyroid cancer, the most common type of thyroid cancer with high proclivity for recurrence or persistence found in patients with BRAF(a protein, involved in directing cell growth) mutation(1), makes up about 80 percent of all thyroid cancers. The cancer tends to develop in the women age group between 30-40 and grows slowly. Papillary thyroid cancer can be cured if diagnosed early.
2. Follicular thyroid cancer
Follicular thyroid cancer, a slowly grew cancer with peak onset between ages 40 to 60, and second most common thyroid cancer, makes up about 15 percent of all cases with mostly in women over 50 years of age(2). Follicular thyroid cancer can be treated successful, if diagnosed early, depending to site of metastasis, histology, and iodine avidity of the metastasis(3).
3. Medullary thyroid cancer
Medullary thyroid cancer, third most common thyroid cancer made up about 5 percent of all cases(4), arises from thyroid hormone producing cells with abnormally high levels of calcitonin(6). Medullary thyroid cancer tends to grow slowly but can spread to distant parts of the body, if not treated early, depending to interdisciplinary communication, and patient education and encouragement of enhance compliance and safety, etc.(5).
4. Anaplastic thyroid cancer
Anaplastic thyroid cancer the rare case of thyroid cancer, makes up less than 2 percent of all cases(7). The cancer cells tend to grow and spread very quickly responsible for the majority of death from all thyroid cancers and have a median survival of 6 months(7). Anaplastic thyroid cancer is deadly, with only 10% of survival rate, and median survival of 3 to 5 months(8) after it is diagnosed.
1. Lump in the neck(9)(10)(11)
Due to uncontrollable cells growth and only 5% of this lumps are found to be cancerous.
2. Enlarged lymph node(12)(14)
Cancer has invaded the lymph nodes and its surrounding
3. Change of voice(13)
Hoarseness or difficulty speaking in a normal voice as the tumor has affected the voice-box region.
4. Pain or discomfort in the throat or neck(15)(16).
5. Problem of swallowing(17)
As a result of tumor has affected the esophagus or of enlarged lymph node
6. Difficult breathing(18)
Cancer may have invaded the lung or may affect either the upper or lower of respiratory track or due to enlarged lymph node
7. Other local compressive symptoms, such as dysphagia, dysphonia, stridor, neck tenderness and dyspnea(19)
B. Causes and risk factors
Risk of thyroid cancer increases with age(20).
Women are twice at risk to develop thyroid cancer than men(20).
In US, according to statistic, Caucasians are at greater risk than African Americans to develop thyroid cancer(21). Women in ethnic Asian/Pacific Islander and Hispanic origin are associated to higher risk of thyroid cancer(21).
5. Exposure to radiation(22)(23)
People who exposed to the radiation therapy at a young age for treatment of certain cancer are at higher risk to develop thyroid cancer at later age(24).
6. Family history(25)
Increased risk of thyroid cancer if your direct family has a history of thyroid cancer(26).
7. Chronic goiter(27)
Risk of thyroid cancer increased if you have a history of enlargement of the thyroid gland.
8. Exposure to certain chemical agents(28)(29)
In a study by Copenhagen researchers, the effect of chemicals such as polychlorinated biphenyls and dioxins on the thyroid. is associated with the of correlation between chemicals and increased TSH cause of an increased opportunity for mutations and the development of cancer.
9. Low level of iodine
People with life-long iodine deficiency are more likely to develop thyroid cancer(30)(31).
People born with mutation in the RET proto-oncogene are at risk in developing medullary thyroid cancer (MTC)(32)(33).
C. Diagnosis and tests
After family history and careful physical examination, If you have a family history of medullary thyroid cancer, blood test for calcitoninis is necessary
1. Blood test
The blood is to determine the levels of calcitoninis. Elevation of calcitoninis may be a sign of thyroid cancer(34).
2. Thyroid scan(35)
With the inject of asotope, your doctor can view the images capture and classify them, according the amount asotope of absorption by the thyroid gland. If the gland is actively taking up the isotope, ultrasound will show whether the abnormality is a cyst or not. Thyroid biopsy may be required to further assessment.
3. Thyroid biopsy(36)
In thyroid biopsy, a sample of the effected area is taken by a thin needle instrument (thin needle aspirate) under local anesthesia and examined by a pathologist under microscopy to view the type and stage of the cancer.
4. CT Scan (computerized tomography)(37)(38)
A CT scan generates is a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes.
The Grades of Thyroid cancer are depending to the tendency of spreading. Low grade cancers(39) in most cases, usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise(40)(41).
Thyroid cancer is classified as 5 stages
1. Stage 0
If the cancerous cell have not penetrated in deeper tissue but in the surface of the thyroid lining.
In stage I, The cancerous cells are no longer in the surface but have invaded into deep thyroid lining, but still completely inside the thyroid gland.
a.1. Stage IA1:
The spreading is not less than 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2: The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b. Stage IB:
The cancer in this stage have invaded the connective tissue, & less than 5mm (1/5 inch).
b.1. Stage IB1:
Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:
Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (1/5 inch)
3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the thyroid gland.
4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the thyroid gland
5. Stage IV
In this stage, cancerous cells has spread to the tissues immediately outside of the thyroid gland, other distant parts of the body.
G.1. What to avoid
1. Potassium Iodide
Potassium Iodide (KI) is one of the drug used to absorb radioactive iodine cause of thyroid disease and cancer. Today it has been used worldwide to prevent thyroid cancer in people who are exposed to radioactive iodides(43)(44).
2. Avoid exposure to radiation(22)(23)
People who exposed to the radiation therapy at a young age to treat certain cancer are at higher risk to develop thyroid cancer at later age. Extra precaution to prevent exposure the thyroid gland when X ray is taken.
3. Avoid Iodine deficiency(30)(31)
Increase Iodine intake from diet to prevent iodine deficiency cause of thyroid cancer.
4. Avoid certain chemical agents(28)(29)
Chemicals such as polychlorinated biphenyls and dioxins can increase risks of thyroid cancer
5. Lose weight
In an article published in the journal Cancer Epidemiology, Biomarkers and Prevention the meta-study indicated that the risk of thyroid cancer increases for obese men at roughly the same rate as it does for women(45), but in men over the age of 45 years and women under 45 years, a BMI in the obesity range was linked to a lower incidence of malignancy(46).
5. Avoid chlorine and fluoride(47)
Chlorine and fluoride are chemically related to iodine and they can block iodine receptors
1. Cruciferous vegetables(48)
Cruciferous vegetables such as cauliflower, broccoli, cabbage, etc. beside containing high amount of antioxidants, it also contains high amount phytonutrients which have shown to prevent the onset and halt the progression of certain cancers. Unfortunately, according to National Cancer Center, intake of Cruciferous vegetables is associated with risk of thyroid cancer(49).
2. Green tea
Epigallocatechin gallate found in green tea, showed to reduce thyroid cell motility and migration associated with modulation in the expression of several proteins involved in cell adhesion and reorganization of actin proteins(50).
Garlic consumption is associated to reduced risk of common cancers, according an analysis of several case-controlled studies in Europe. Diallyl sulfide, a phytochemical found in garlic showed to induces growth inhibition and apoptosis of anaplastic thyroid cancer cells by mitochondrial signaling pathway(51), with functions of cell regulatory and signaling events, in the responses of cells multiplication, communication, cell proliferation and death(52).
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibits apoptosis, in inducing cell death. Unfortunately, high consumption of tomatoes (> 200/year) was associated with an elevated risk of > 2.5 for malignant tumor(53)
5. Organic Soy
G.3. Nutritional supplements
1. Free radicals scavengers
Vitamin A, C, E are free radical scavengers enhanced the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth(56). According to Fujita Health University School of Medicine, patients tissues with papillary carcinoma and follicular adenoma were found to contain significantly higher concentrations of xanthine oxidase (XOD) and gluthathione peroxidase (GSH-PX), in comparison to those in the normal thyroid tissues(57)
2. Modified citrus pectin
Strong evidences in studies found that Modified citrus pectin may help block the growth and metastasis of solid tumors(58)(59).
Selenium may haves a protective effect on various stages of cancer(60). In a study in large groups of people, researchers found that in areas of the world where selenium levels in the soil are high, death rates from cancer are significantly lower than in areas where selenium levels are low(61). According to Weill Medical College of Cornell University, selenium inhibits thyroid cancer cell proliferation through upregulation of family of gene (GADD)responsible for growth arrest DNA damage(62).
H.1. In conventional medicine
Treatment of thyroid cancer not only depends on the stage, grade but also ages of the patient. Thyroid cancer occurs in older people tend to be aggressive, while in young adulthood and adolescence are curative.
The objective of the surgery is to cure, especial in the younger age group. If the cancer is a slow-grow and in the early stage, in most case after the thyroid gland was removed, patient will need to take thyroxine tablets for the rest of his/her life. According to Northwast University, total thyroidectomy showed to lower recurrence rates and improved survival compared with lobectomy(63). If the cancer has spread to the nearby lymph nodes, the lymph nodes are also removed in the same surgery.
If your blood indicates that you have an elevation of calcitoninis, an inherited medullary thyroid cancer, then surgery may be only treatment(64).
2. Radioactive Iodine
Radioactive iodine usually is also used to treat hyperthyroidism(65). In case of thyroid cancer, treatment of radioactive iodine showed to improve the survivors rate through reduction of its spreading(66). The use of radioactive therapy must follow certain guideline(67).
Since it is highly radioactive, avoid exposing radioactivity to your family members or other people are absolutely necessary. There are some instructions that you must follow for the first 5 days after your treatment(68).
a. Drink plenty of fluids.
b. Avoid contact with children and pregnant women.
c. Sleep in your own room.
d. Use separate towels, face cloths, and sheets.
e. Wash above and your personal clothing separately for 5 days
For more information of http://www.eanm.org/publications/guidelines/gl_radio_ther_259_883.pdf
a. Radiation may be used for stages II, III, and IV to kill any cancer cells remaining in the body, after surgery. By using high-energy x-rays or other types of radiation(70)(71), radiation therapy kills the cancer cells and keep them from growing or regrowing.
b. Side effects
b.2. Chest pain
b.3. Heart problem
b.4. Short of breath
b.5. Skin discoloration or pinkness, irritation.
In elder, and if the cancer has spread, chemotherapy may be recommended. Combination of chemotherapy after treatment of radiotherapy(72) or surgery and intensive radiotherapy have resulted in long-term survival in patients in most cases of invasive thyroid cancer,(73).
Chemotherapy is most used to treat with advance stage of cancer combined with radio therapy(74), as cancer has spread to a distant parts of the body, by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells(75).
b. Side effects
b.3. Hair loss
b.6. Mouth sores taste and smell changes
H.2. Herbal medicine
Antioxidant, antiproliferative, and immunostimulatory found in aloe may be next potential herbal medicine for treatment of cancers(76) due to its chemical compounds, such as acemannan(77), and di(2-ethylhexyl)phthalate (DEHP)(78)(79) in immunomodulating and anticancer effects.
Absinthe is also known as Wormwood, a distilled, highly alcoholic beverage flowers extracted from leaves of the herb Artemisia absinthium. According to studies, wormwood maybe used as a promising potential treatment for cancer treatment(80)(81).
Fenugreek is used both as a herb (the leaves) and as a spice (the seed), genus Trigonella, belonging to family Fabaceae. Studies have shown that fenugreek exhibits chemopreventive properties against certain cancers(82)(83)(84).
4. Devil's Claw
The extract of Harpagophytum procumbens, in vitro demonstrated anticancer effects against several cancer cell lines(85)(86) and has been reported to be effective in the treatment of lymphoma cancer, according to a study conducted by K. S. Wilson, M.D., published in the journal "Current Oncology" in August 2009.
Celandine is a herbaceous perennial plant, genus Chelidonium, belonging to the family Papaveraceae, native to Europe and western Asia and introduced widely in North America. According to studies, the herb has demonstrated cytotoxicity activity as a natural resource for treatment potential antitumor agents(87.) Ukrain (Ukrain is an anticancer drug based on the extract of Celandine), in a systematic review of randomised clinical trials, showed a potential as an anticancer drug(88)(89)(90)
H.3. Traditional Chinese medicine
1. Pu Kong Yin (Dandelion Root)
According to numbers of studies(91)(92)(93), dandelion root extract showed to exhibit its anti cancer effects in some cancer cell lines.
In drug-resistant human melanoma cells, dandelion root extract induced apoptosis of chemoresistant melanoma, without toxicity to healthy cells(94).
2. Qing hao
Qing hao, also known as wormwood, a Chinese folk medicine may be used as a promising potential treatment for cancer(80)(81).
3. Jie Geng
Aponins in Jie Geng showed to exhibit a very significantly augment of the cytotoxicity of immunotoxins and other targeted toxins directed against human cancer cells(95)(96)(97).
4. Gan Cao
Gan Cao is also known as Licorice root. The herbs showed to inhibit progression of certain cancer cell lines(98)(99)(100). In-vitro, saponins in Gan Cao stimulates the immune system and inhibits Epstein-Barr virus expression and possess anti-cancer activities(101).
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