甲状腺髓样癌诊治难点及对策

Difficulties and countermeasures in the diagnosis and treatment of medullary thyroid carcinoma

甲状腺髓样癌预后较差,早期易发生转移。遗传性和散发性髓样癌具有不同临床特征和预后。超声、CT、MRI、骨显像具有特定的诊断价值。降钙素具有诊断特异性,而癌胚抗原有助于评估病情进展。无论遗传性还是散发性髓样癌,均应重视后续的基因检测。遗传性和散发性髓样癌需制定不同的手术策略。颈部局部复发转移的病人应积极手术治疗。晚期进展性髓样癌可进行姑息性手术、外放射治疗或采用酪氨酸激酶抑制剂的全身性治疗。术后监测降钙素和癌胚抗原的倍增时间评估复发和转移。

Prognosis of medullary thyroid carcinoma(MTC)is worse,and occurrence of early metastasis is easy.Hereditary and sporadic MTC have different clinical characteristics and prognosis.The diagnostic value of ultrasound,CT,MRI and bone scintigraphy is special.Calcitonin(Ctn)is found to have diagnostic specificity,while carcinoembryonic antigen(CEA)is useful for evaluating disease progression.Whether hereditary or sporadic MTC,surgeons should pay attention to the subsequent genetic detection.Different surgical strategies are required for hereditary and sporadic MTC.Active surgery is necessary for patients with regional recurrence and nodal metastasis.Advanced progressive MTC could be treated by palliative surgery,external radiotherapy or systemic treatment with the tyrosine kinase inhibitor.Measurement of doubling times of serum Ctn and CEA can evaluate recurrence and metastasis after surgery.