Rakovina štítnej žľazy

10.7.2012 , Jakub Šulta

rakovina-stitne-zlazy.jpg - kopie
rakovina-stitne-zlazy.jpg - kopie
Rakovina je podľa niektorých pomerne častá, podľa iných naopak vzácna. Pravdou však zostáva, že zhubný nádor štítnej žľazy postihuje jedného na desať tisíc obyvateľov. Dnes patrí medzi dobre liečiteľné choroby, ktoré majú veľmi dobrú prognózu. Predovšetkým preto, že najčastejšou formou je nezhubný nádor zvaný adenóm. Zhubná forma rakoviny štítnej žľazy zvyčajne nemá žiadne prejavy a jej hlavnou nevýhodou sú metastázy.

Rakovina štítnej žľazy

Rakovina štítnej žľazy je laické označenie pre nádor štítnej žľazy. Správne by sme však mali termín rakovina vyhradiť iba pre karcinóm štítnej žľazy, čo je zhubný nádor. Medzi hlavné rizikové faktory patrí ionizujúce žiarenie, ktoré je nebezpečné predovšetkým v mladšom veku. Ďalej genetické dispozície, autoimunitné zápaly či nedostatok jódu alebo porucha tvorby hormónov štítnej žľazy.

Štítna žľaza

Štítna žľaza je orgán nachádzajúci sa na prednej strane krku. Je uložená pred priedušnicou a pod štítnou chrupavkou. Hlavnou úlohou štítnej žľazy je tvorba hormónov trijódtyronin (T3) a tyroxínu (T4), ktoré sa uplatňujú v mnohých procesoch nášho organizmu a kalcitonínu ktorý znižuje hladinu vápnika v krvi. Zjednodušene povedané, štítna žľaza hovorí iným orgánom čo majú robiť.

Čo je rakovina?

Rakovina, presnejšie povedané nádor je porucha buniek, ktoré sa v dôsledku svojho poškodenia začnú nekontrolovateľne deliť a rásť. Nádory delíme na zhubné (malígne) a nezhubné (benígne). Nezhubné nádory väčšinou rastú pomaly, nepoškodzujú okolité tkanivá a nezakladajú metastázy čiže druhotné nádorové ložiská. Naopak zhubné nádory rastú agresívne, prerastajú do okolitých tkanív a zakladajú metastázy, ktoré sú najčastejšou príčinou úmrtia.

Nezhubná rakovina štítnej žľazy

Nezhubné nádory štítnej žľazy sú oveľa častejšie, ako zhubné nádory, ktoré tvoria približne 1% zo všetkých malígnych nádorov. Samotná hranica medzi benígnymi a malígnymi nádormi však nie je úplne jasná. Najčastejším nezhubným nádorom je adenóm.

Adenóm

Adenóm štítnej žľazy je nezhubný nádor, ktorý sa môže vyskytovať samostatne alebo vo väčšom množstve, čo označujeme ako nodózna struma. Niekedy sa stretávame s termínom uzol, ktorý je súhrnným označením všetkých nádorových i nenádorových útvarov štítnej žľazy. Adenóm štítnej žľazy postihuje predovšetkým ženy, najčastejšie vo veku nad 40 rokov. Všeobecne rozdeľujeme uzly na tzv. studené a horúce. Studené uzly nevykazujú jódový metabolizmus a nemajú endokrinologické prejavy. Veľmi často bývajú zhubného charakteru, napr. karcinóm. Horúce uzly naopak vykazujú zvýšený metabolizmus jódu. Veľmi často u nich dochádza k zvýšenej produkcii hormónov (hypertyreóze) a následným zmenám v krvnom obraze. Predstaviteľom horúceho uzla je tiež adenóm. V niektorých prípadoch hrozí aj jeho zvrat v malígnu formu.

Zhubná rakovina štítnej žľazy

Zhubné nádory štítnej žľazy sa vyskytujú skôr zriedkavo, v SR je ročne zachytených asi 800 prípadov. Bohužiaľ v posledných rokoch má toto číslo tendenciu mierne narastať. Nezanedbateľný vplyv na vznik tohto ochorenia má ožiarenie krku či radiácia vo vzduchu (napr. po výbuchu atómovej bomby).

Karcinóm štítnej žľazy

Rakovina čiže karcinóm štítnej žľazy postihne približne 1 z 10 000 obyvateľov. Väčšina karcinómov štítnej žľazy nemá žiadne výrazné prejavy. Často je možné nahmatať tuhý útvar v prednej časti krku tzv. uzol štítnej žľazy, väčšinou však nebolestivý bez preukázania vplyvu na organizmus. Výhodou karcinómu štítnej žľazy je skutočnosť, že metastázuje iba v 3%, čo nám dáva veľmi dobrú šancu na vyliečenie. Cieľové orgány pre vznik týchto druhotných nádorových ložísk sú väčšinou krčné uzliny, pľúca a kosti.

Diagnostika rakoviny štítnej žľazy

Pri diagnostike rakoviny štítnej žľazy musíme najprv vyšetriť funkciu štítnej žľazy pomocou biochémie. Biochemické vyšetrenie najčastejšie vykonávame odberom krvi, ktorá nám poskytuje dôležité informácie o stave organizmu a jeho orgánov. Sonografické vyšetrené spresní veľkosť uzla prípadne štítnej žľazy a dovolí nám skontrolovať okolie. V prípade nálezu uzla vykonáme odber tkaniva tenkou ihlou tzv. biopsiu, ktorá objasní či sa jedná o nádorový či nenádorový útvar a odhalí jeho biologickú aktivitu, či je zhubný alebo nezhubný. Spresnenie konkrétneho nádoru nám určuje liečbu i prognózu ochorenia.

Liečba rakoviny štítnej žľazy

Liečba rakoviny štítnej žľazy sa odvíja od charakteru ochorenia, ktorý určuje postup aj prognózu.

Adenóm

Pokiaľ sa jedná o adenóm sú základným medikamentom v terapii tyreostatiká čiže lieky tlmiace aktivitu štítnej žľazy. Cieľom je normalizovať funkciu žľazy a potom zvoliť liečbu definitívnu. Tyreostatiká môžu mať rad nežiaducich účinkov ako začervenanie tváre, svrbenie kože alebo zvýšenú teplotu. Chirurgická liečba (tyreoidektómia) je najčastejším definitívnym riešením adenómu. U pacientov sa neodstraňuje väčšinou celá žľaza, ale iba postihnutý lalok. Nevýhodou chirurgického zákroku je riziko poranenia vratného nervu (nervus laryngeus recurrens), čo vedie k čiastočnej alebo úplnej strate hlasu či dýchacím ťažkostiam. Na skúsených pracoviskách je však riziko týchto komplikácií iba okolo 1% výkonov. Liečba rádioaktívnym jódom je podávaná dospelým pacientom u ktorých je vysoké riziko chirurgického výkonu. K optimalizácii funkcie dochádza najčastejšie za 2-6 mesiacov po aplikácii. Prognóza adenómov je veľmi dobrá, ale je potrebné ich dôkladne liečiť. Neliečený adenóm je život ohrozujúcim ochorením.

Karcinóm

Základom v liečbe karcinómu štítnej žľazy je úplné odstránenie žľazy tzv. totálna tyreoidektómia (TTE). Ďalší postup v liečbe závisí predovšetkým od druhu karcinómu. Najčastejší papilárny karcinóm (80%) dobre akumuluje jód, preto používame približne 6 až 8 týždňov po odstránení žľazy rádiojód, ktorý preukáže prípadné vzdialené metastázy. Liečba rádiojódom spočíva v naviazaní rádioaktívneho jódu na bunky štítnej žľazy, ktoré jód z krvi vychytávajú a ich následnom usmrtení. Používame ho predovšetkým na odstránenie zvyškov žľazy po TTE, kedy u približne 95% pacientov sú zvyšky preukázané. U iných nádorov, ktoré napríklad nekumulujú jód používame rádioterapiu čiže vonkajšie ožiarenie. Problematika liečby karcinómov štítnej žľazy je veľmi obsiahla a vždy záleží od mnohých faktorov, ktoré rozhodnú o postupe v liečbe.

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