To achieve the main objective of their study which was to determine the demographic, clinical and pathological characteristics of MTC the authors embarked on a study in Portugal south region. They used a database from Portuguese south regional cancer registry which held information on patients submitted to genetic testing. Their criterion was based on a histological diagnosis of MTC. The CT simulation and RET mutation analysis were among the tactics used to retrieve helpful information on the study. Later they defined the tumor stage according to tumor-node-metastasis (TNM) classification and grouped patient on different stages. Biochemical cure (BC) following surgery was considered when CT levels measured 3-6 months after surgery were lower than the reference value. After some period if no traces of disease were present and high level of CT, locoregional or distant metastasis reappears the disease was concluded to have recurred. Patients were grouped based on their status at the last follow-up as capitulated to MTC.
From their study of 140 patients enrolled 62% were diagnosed with MTC while the remaining were referred to Portuguese institute of oncology Francisco Gentil hospitals following first surgical intervention performed elsewhere. They found that female patients were largely hit by the disease with those suffering from FMTC being significantly younger than those with sporadic MTC. Some of the causes leading to a diagnosis of MTC in patients not detected by screening were the presence of nodules, increased serum CT levels, increased serum carcinoembryonic levels and operation cases for larynx carcinoma. Among those not detected by screening 34% of them did not exhibit a preparative suspicion of MTC since FNAC were either negative for NTC or not requested and therefore CT determination was not performed. It was evident that survival rate was high to those cases reported early enough. After further analysis, they observed that patient who underwent surgery some prognostic factors affected their survival chances, which includes age, stage at diagnosis and absence of BC. However, those patients detected by genetic or pentgastrin screening age was no longer a major determinate for survival while multivariate analysis revealed that only absence of BC had a negative impact on prognosis.
The authors were convinced that MTC among the present patients remained stable throughout the year. However, a high proportion of advanced cases is evident probably due to the absence of routine serum CT determination in the management of thyroid nodules. Other authors had previously resolved that MTC was mainly reviewed in advanced stages of the stages and was mainly familial. However, from their study, the authors found that only a few percentage of the cases was ancestral which indicates a prevalence significantly lower than that reported by other authors. Nevertheless, the authors were in agreement with other literature that patients detected by genetic screening were diagnosed at a younger age than sporadic cases. The authors were convinced that only prognostic factor exerting a significant impact on survival was postoperative CT. However, the influence of other prognostic factors such as age should be assessed carefully especially with the high number of hereditary MTC cases.
The learning outcome of the article involves identifying MTCs which was found that majority cases of these diseases are detected in the advanced stages. One can conclude that CT determination is more sensitive in diagnosing these types of carcinoma than FNAC. Thou the epidemic is constantly increasing across the world it is clear that the annual incidence of the tumor can remain stable throughout. It is encouraging to learn that once someone is subjected to primary surgery treatment of BC is achieved any relapse of MTC is rarely observed. Lastly one can learn that when MTC is noticed early enough especially at for young people one is easily treated and the chance of the disease recurring is minimal.
Cupisti, Kenko, Achim Wolf, Andreas Raffel, Matthias Schott, Daniel Miersch, Qin Yang, Claus F. Eisenberger, Hans D. Roher, and Wolfram T. Knoefel. 2007. "Long-Term Clinical and Biochemical Follow-Up in Medullary Thyroid Carcinoma". Annals of Surgery 246 (5): 815-821. doi:10.1097/sla.0b013e31813e66b9.
Evans, Douglas B., Jason B. Fleming, Jeffrey E. Lee, Gilbert Cote, and Robert F. Gagel. 1999. "The Surgical Treatment of Medullary Thyroid Carcinoma". Seminars in Surgical Oncology 16 (1): 50-63. Doi: 10.1002/ (sici) 1098-2388(199901/02)16:1<50: aid-ssu9>3.0.co; 2-6.
Gharib, H., E. Papini, R. Paschke, D. S. Duick, R. Valcavi, L. Hegedus, and P. Vitti. 2010. "American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules: Executive Summary of Recommendations". Journal of Endocrinological Investigation 33 (5): 287-291. Doi: 10.1007/bf03346587.
Hajje, G., I. Borget, S. Leboulleux, C. Chougnet, A. Al Ghuzlan, H. Mirghani, C. Caramella, D. Hartl, M. Schlumberger, and E. Baudin. 2012. "Early Changes In Carcinoembryonic Antigen But Not In Calcitonin Levels Are Correlated With The Progression-Free Survival In Medullary Thyroid Carcinoma Patients Treated With Cytotoxic Chemotherapy". European Journal of Endocrinology 168 (2): 113-118. Doi: 10.1530/eje-12-0771.
Pezzi, Todd A., Vlad C. Sandulache, Christopher M. Pezzi, Ashley E. Turkeltaub, Lei Feng, Maria E. Cabanillas, Michelle D. Williams, and Stephen Y. Lai. 2016. "Treatment and Survival of Patients with Insular Thyroid Carcinoma: 508 Cases from the National Cancer Data Base". Head Neck 38 (6): 906-912. doi:10.1002/hed.24342.
Schott, M. 2011. "Prognostic Factors Of Disease-Free Survival After Thyroidectomy In 170 Young Patients With A RET Germline Mutation: A Multicenter Study Of The Groupe Francais D'etude Des Tumeurs Endocrines". Yearbook of Endocrinology 2011: 130-131. doi:10.1016/j.yend.2011.06.011.
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