O câncer da tireóide pode ser considerado o mais comum da região da cabeça e pescoço e é três vezes mais freqüente no sexo feminino. Nos EUA, a doença corresponde a 3% de todos os cânceres que atingem o sexo feminino. No Brasil correspondeu a 1,3% de todos os casos de câncer matriculados no INCA de 1994 a 1998, e a 6,4% de todos os cânceres da cabeça e pescoço.
Os carcinomas diferenciados são os mais freqüentes. Dentre eles existem o carcinoma papilífero, o carcinoma folicular e o carcinoma de células de Hürthle. Entre os carcinomas pouco diferenciados temos carcinomas medulares e os carcinomas indiferenciados.
Sintomas
A presença de um nódulo na tireóide, região anterior baixa do pescoço, normalmente não é indicação da presença de um câncer. Entretanto, a ocorrência de nódulo tireoidiano em pacientes com história de irradiação prévia do pescoço ou história familiar de câncer da tireóide, é mais suspeito. Da mesma forma, a presença de nódulo tireoidiano, associado à presença de linfonodomegalia cervical (gânglios linfáticos aumentados no pescoço) e/ou ao sintoma de rouquidão, pode ser indicação de um tumor maligno na tireóide.
Fatores de Risco
A história de irradiação do pescoço, mesmo em baixas doses, assim como a ocorrência de câncer da tireóide na família, podem ser considerados fatores de risco para o câncer da tireóide.
Tratamento
O tratamento do câncer da tireóide é cirúrgico. A tireoidectomia total ou parcial (em casos indicados) é o tratamento de escolha.
O tratamento dos carcinomas bem diferenciados (carcinoma papilífero e carcinoma folicular) depende dos fatores de risco, que indicarão a extensão da cirurgia e a necessidade da complementação terapêutica com o iodo radioativo. Já os outros tumores malignos da tireóide, deverão ser tratados com a tireoidectomia total.
Em casos de tumores que apresentem disseminação para gânglios linfáticos cervicais, o tratamento do tumor primário deve ser associado ao esvaziamento cervical seletivo (retirada dos gânglios linfáticos relacionados). A complementação terapêutica com o iodo radioativo deve ser sempre utilizada em pacientes com carcinomas bem diferenciados, considerados de alto risco e submetidos a tireoidectomia total.
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