Features of thyroid cancer in children and adolescents living in areas contaminated with radionuclides

Thyroid cancer is a relatively rare form of cancer. At the same time, the urgency of the problem of studying this disease in children and adolescents is due to the increase in the incidence of this pathology as a result of the accident at the Chernobyl nuclear power plant. At the same time, it should be noted that the thyroid gland is the most sensitive organ to radiation. However, it was not possible to accurately assess the contribution of the radiogenic factor to the development of thyroid cancer due to the lack of individual accumulated doses. The most polluted, due to the accident at the Chernobyl nuclear power plant, in the Russian Federation is the Bryansk region.

The study presents a comprehensive analysis of the clinical course of 51 cases of thyroid cancer in children and adolescents (mean age 11.3 years) who were treated in the period from 2000 to 2002 in medical institutions of the Bryansk region. Among the patients: boys – 8 (15.7%), girls – 43 (84.3%). The ratio of males and females at this age with thyroid cancer is 1: 5.4.

According to the histological type, the study found only highly differentiated forms of thyroid cancer – papillary cancer in 48 (94.1%), follicular – in 3 (5.9%) patients. All tumors were morphologically verified.

Most often, children complained of a palpable tumor in the neck area – 16 people (31.4%), weakness and weight loss – 5 people (9.8%), an increase in lymph nodes – 5 people (9.8%), for signs of thyroiditis – 1 person (1.9%) and for discomfort in the neck area – 8 people (15.7%). During a preventive examination of the population, the tumor was detected in 18 people (35.3%).

Ultrasound examination revealed nodular goiter in 6 patients (11.8%); one (1.9%) had a cyst and thyroiditis; 8 (15.7%) – suspected cancer; 3 (5.9%) have an adenoma. It should be noted that two people (3.9%) were diagnosed with adenoma and goiter at the same time on ultrasound, and one (1.9%) had goiter and suspected cancer.

Puncture biopsy under ultrasound control was performed in 40 patients (78.5%), one without ultrasound control (1.9%). Puncture biopsy was not performed in 10 (19.6%) people. Based on the results of puncture biopsy, cancer was diagnosed in 26 (63.4%) cases, in all other cases, non-oncological diseases were diagnosed, such as dysplasia of the follicular epithelium – in 1 (2.4%), follicular tumor – in 5 (12.2 %), autoimmune thyroiditis – in 8 (19.5%), adenoma – in 8 (19.5%), cyst – in 1 (2.4%) person.

Surgical treatment consisted of: hemithyroidectomy – 22 (43.2%) cases, thyroidectomy – in 27 (52.9%), isthmusectomy – in 2 (3.9%) patients. In addition, 27 (52.9%) patients additionally underwent removal of cervical lymph nodes, 3 (5.9%) – fascial-sheath excision of the neck tissue, and one (1.9%) – a Kraille operation. At the moment, one (1.9%) patient has died from other diseases. All other patients (98.1%) are alive.

Thus, in patients with nodular thyroid pathology, regardless of age, a puncture biopsy must be present in the examination plan, the use of which will make it possible to diagnose thyroid cancer in a timely manner. Thyroid cancer in childhood and adolescence is characterized by highly differentiated histological forms. The long-term 3-year results of thyroid cancer treatment in children and adolescents in the study group did not depend on the volume of the operation performed. The prognosis of thyroid cancer in children, according to our study, is favorable.

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