The incidence of thyroid cancer in children has been increasing steadily. The present incidence rate stands at 0.54 per 100,000 children. It commonly affects young children and teenage girls. The main factors responsible for the development of this cancer are exposure to radiation, both environmental and diagnostic and exposure to alkylating agents. In certain cases, it can be hereditary and occur as a result of RET mutation or RET/PTC rearrangement.
According to a report published in the latest issue of the Seminars in Pediatric Surgery, the main course of treatment for thyroid cancer in children remains surgery. In certain cases, it is to be followed by radioactive iodine. Experts advise total or near total resection of the thyroid gland accompanied by modified neck dissection in order to remove regional lymph nodes as the preferred mode of treatment in most cases. This type of surgery is advocated as it removes the entire tumor along with any microscopic foci of cancer which may be present in the contra-lateral lobe. Once the entire thyroid gland has been removed, administration of radioactive iodine can kill the remaining cancer cells present elsewhere. Apart from this, the levels of serum thyroglobulin can be monitored after the complete resection of thyroid gland in order to detect recurrence of the tumor.
Not all patients require complete removal of the lymph glands. The radiological and clinical stage of the disease is important in deciding the extent of neck dissection. In patients with advanced size of the tumor without clinically palpable lymph nodes, a prophylactic dissection of the central compartment of the neck would suffice. According to certain experts, if the basal calcitonin level in the preoperative stage is normal, then the patient does not requires lymph node dissection.
Radioactive iodine is recommended in all children with papillary thyroid cancer with distant metastasis. Apart from surgery, several new methods of treating pediatric thyroid cancer like therapies targeting signaling pathways, angiogenesis inhibitors, immune-modulators, and gene therapy, etc. are also being researched.
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