甲状腺癌,医学英语翻译词汇词典考试,在线翻译

ThyroidCancers

Therearefourgeneraltypesofthyroidcancer:papillary（includingmixedpapillary-follicular）,follicular,medullary（solid,withamyloidstruma）,andundifferentiatedandanaplastic（rare）.Mostthyroidnodulesarebenign,andthyroidcancersgenerallyarenothighlymalignantandarecompatiblewithnormallifeexpectancyiftreatedproperly.

甲状腺癌一般有4种类型：乳头状（包括乳头－滤泡混合型癌）、滤泡状、髓样（实体，伴淀粉样甲状腺肿）和未分化及间变细胞癌（罕见）。多数甲状腺结节为良性。甲状腺癌一般也非极度恶性，如果治疗得当，患者可以达到正常寿命。

Usually,eitherthepatientorthephysiciannoticesanotherwisesymptomlesslumpintheneck.Rarely,metastasesfromasmallthyroidcancermayleadtopresentingcomplaintsduetolymphnodeenlargement,pulmonarysymptoms,oradestructivebonelesion.

通常，病人或医生会注意到颈部有一个并无其他症状的肿块。小甲状腺癌转移可能导致一些因淋巴结增大、肺部症状或破坏性骨损所致的症状，但这种情况较罕见。

Thesuspicionofcancerisincreasedbythefollowingfactors:（1）age（youngpatientsaremoresusceptible）;（2）sex,ifthepatientisaman（morewomenhavethyroidcancerbyaratioof2:1,butwomenhavemorethyroiddiseasebyaratioofabout8:1;thus,amanwithanoduleshouldberegardedwithgreatersuspicion）;（3）asolitarynodule（multinodularlesionsareusuallybenignunlessthereisadominantcoldnodulebythyroidscan）;（4）acoldnoduleonthyroidisotopicscanning（hotnodulesareseldomcancerous）;（5）ahistoryofradiationexposuretothehead,neck,orchest,especiallyininfancyandchildhood（eg,foranenlargedthymusorenlargedtonsils,acne,orlymphoma）;（6）radiographicevidenceoffine,stippledpsammomatouscalcification（papillarycarcinoma）ordense,homogeneouscalcification（medullarycarcinoma）;（7）recentorrapidenlargement;and（8）stony-hardconsistency.Needleaspirationbiopsyisthebestdiagnosticapproachtodistinguishbenignfrommalignantnodulesprovidingthataskilledbiopsierandcytologistareavailable.

下列因素可增加癌的可疑性：（1）年龄（年轻病人更易患癌）；（2）性别,如果病人为男性（女性与男性的甲状腺癌比为2：1，但女性更多的是得甲状腺病，约为8:1，因此，男性有甲状腺结节时应考虑癌的可能性更大）；（3）孤立小结（多结节病变一般为良性，除非甲状腺扫描时呈明显的冷结节）；（4）甲状腺同位素扫描时发现冷结节（热结节很少表现为癌）；（5）有过头、颈、胸放射接触史,尤其是婴儿和儿童期（例如，因胸腺增大或扁桃体肿大、痤疮或淋巴瘤等）；（6）X线片见细、斑点状、沙粒样钙化（乳头状癌）或致密、匀质钙化（髓样癌）；（7）最近增大或快速增大；（8）质地石头样坚硬。如拥有技术熟练的活检技术员和细胞学家，针吸活检便是区别淋巴瘤良性与恶性的最佳诊断方法。

PAPILLARYCARCINOMA

Papillarycarcinomaisthemostcommonthyroidcancer（60to70%ofallthyroidcancers）.Femalesareaffectedtwotothreetimesmoreoftenthanmales.Itismorefrequentintheyoung,butismoremalignantintheelderly.Itismorecommoninpatientswithahistoryofradiationexposureandspreadsviathelymphaticsystem.Lateralaberrantthyroidrestsmaybefoundthatareactuallyoccultmetastaseswithabenignhistologicappearance.Thesewell-differentiatedcancersmaybeTSH-dependentandmaydevelopingoiterssecondarytoHashimoto'sthyroiditis.Manypapillarycarcinomascontainfollicularelements,butthisdoesnotalterthebasicbiologyofthetumor.

乳头状癌是最常见的甲状腺癌（占全部甲状腺癌的60%~70%）。女性病人是男性病人的2-3倍。年轻人较常见，但老年人恶性率更高。有照射史病人较常见，癌细胞可经淋巴系统扩散。可以发现一侧迷走性甲状腺残余，实际上这是带有良性组织表观的癌的隐性转移。.这些高分化癌属TSH（促甲状腺激素）依赖型，可以在继发于桥本甲状腺炎的甲状腺肿中发展。许多乳头状癌含有滤泡成分，但这并不改变肿瘤的基本生物学特征。

Treatmentforsmall（<1.5cm）encapsulatedtumorslocalizedtoonelobeisusuallylobectomyandisthmectomy,althoughsomeexpertsrecommendmoreextensivethyroidsurgicaltreatment.ThyroidhormoneinTSHsuppressivedosesisgiventominimizechancesofregrowthortoregressanymicroscopicremnantsofpapillarycarcinoma;surgicaltreatmentisalmostalwayscurative.Large（>1.5cm）ordiffuselyspreadingtumorsoftenrequiretotalornear-totalthyroidectomywithpostoperativeradioiodinescansandsubsequentablationofresidualthyroidtissuewithappropriatelylargedosesof131Iadministeredwhenthepatientishypothyroid.Alternatively,recombinantTSH（notyetavailable）canbeadministeredfor2dayspriorto131Iforthediagnosticscantodetectresidualthyroidtissueorcancer,thusavoidingtheneedtoletthepatientbecomehypothyroidpriortothediagnosticscan.Repeattreatmentmayberequiredevery6to12motoachieveablationoftheremainingthyroidtissue.TSHsuppressivedosesofL-thyroxinearegivenaftertreatment,andmeasurementofserumthyroglobulinisusefulindetectingrecurrentorpersistentdisease.

对局限于一叶的包裹性小肿瘤（<1.5cm）,通常作叶切除和峡部切除，但有些专家建议进行更广泛的甲状腺外科治疗。TSH抑制剂量甲状腺激素用于减少癌的再生或使显微镜镜检下的乳头状癌残余出现萎缩；外科治疗几乎总是可以治愈它。大的（＞1.5cm）或弥漫扩散性肿瘤常需行甲状腺全切或次全切伴术后放射性碘扫描和后续甲状腺残余组织切除伴适当的大剂量131I（放射性碘）（如果病人甲状腺功能减退）。还有一种方法是在射碘前先予2天重组TSH（目前无货），为诊断扫描作准备，以探查残余的甲状腺组织或癌，这样就可避免在诊断性扫描前病人出现甲状腺功能减退。每6－12个月进行一次重复治疗，以确保残余甲状腺组织的清除。治疗后应服用TSH抑制剂量的L－T4。血清甲状腺球蛋白测定有助于发现疾病的复发或持续。

FOLLICULARCARCINOMA

Follicularcarcinomaaccountsforabout15%ofthyroidcancersandismorecommonintheelderly.Itismoremalignantthanpapillarycarcinoma,spreadinghematogenouslywithdistantmetastases.Italsoisoccasionallyassociatedwithahistoryofradiationexposureandoccursmorefrequentlyinfemalesthaninmales.

滤泡状癌约占甲状腺癌的15%，老年人较常见。其恶性率高于乳头状癌，可沿血道向远处转移。偶尔也与放射线接触有关，女性得病率高于男性。

Treatmentforfollicularcarcinomaofanysizerequiresnear-totalthyroidectomywithpostoperativeradioiodineablationofresidualthyroidtissueasintreatmentforpapillarycarcinoma.Metastasesappeartobemoreamenabletoradioiodinetherapythanthoseofpapillarycarcinoma.TSHsuppressivedosesofL-thyroxineandserumthyroglobulinmeasurementsshouldbefollowed.医学.全在.线www.med126.com

滤泡状癌的治疗，不论大小，均需行次全切伴术后残余甲状腺组织射碘清除，这一点与乳头状癌治疗相同，射碘治疗转移效果较乳头状癌更佳。术后应使用TSH抑制剂量L－T4，并进行血清甲状腺球蛋白测定。

ANAPLASTICCARCINOMA

Anaplasticcarcinomaaccountsfor10%orlessofthyroidcancersandoccursmostlyinelderlypatientsandinwomenslightlymorethaninmen.Thetumorischaracterizedbyrapidandpainfulenlargement,andabout80%ofpatientsdiewithin1yrofdiagnosis.Rapidenlargementofthethyroidglandmayalsosuggestthyroidlymphoma,particularlyiffoundinassociationwithhighlevelsofthyroidperoxidaseantibodiesandHashimoto'sthyroiditis.

未分化癌在甲状腺癌中所占比例为≤10%，大多发生在老年人，女性略多于男性。其特征为肿瘤的快速、疼痛性增大，约80%病人在确诊后1年内死亡。甲状腺迅速增大亦可提示甲状腺淋巴瘤，特别是在伴有高水平甲状腺过氧化酶抗体和桥本甲状腺炎时。

MEDULLARYCARCINOMA

Medullary（solid）carcinomamayoccurassporadic（usuallyunilateral）orasfamilial（frequentlybilateral）,transmittedasanautosomaldominanttrait.Pathologicallythereisaproliferationofparafollicularcells（Ccells）thatproduceexcessiveamountsofcalcitonin,ahormonethatcanlowerserumCaandphosphate（PO4）,butthatisrarelypresentinsufficientlyhighconcentrationstoalterserumCaandPO4levels.TherearealsocharacteristicamyloiddepositsthatstainwithCongored.

髓样（实体）癌可以是散发性（通常单侧）也可以是家族性（常为双侧），常染色体显性遗传。病理学显示有滤泡旁细胞（C细胞）的增生，产生过量降钙素。该激素可降低血清钙和磷酸盐（PO4），但该激素很少能达到可以改变血清钙和磷酸盐（PO4）水平的浓度。同时有特征性刚果红染色的淀粉样沉着物。

SymptomsandSigns

Theusualpresentationisthatofanasymptomaticthyroidnodule,althoughmanycasesarenowdiagnosedduringroutinescreeningofaffectedkindredswithmultipleendocrineneoplasiatypeIIAorIIBbeforeapalpabletumordevelops.医学全.在线网.站.提供

通常表现为无症状甲状腺结节，虽然很多病例在肿瘤扪及前就可通过多内分泌肿瘤IIA或IIB血缘关系的常规检查得到确诊。

Medullarycarcinomamayhaveadramaticbiochemicalpresentationwhenassociatedwithectopicproductionofotherhormonesorpeptides,suchasACTH,vasoactiveintestinalpolypeptide,prostaglandins,kallikreins,andserotonin.ThistumorisacomponentofSipple'ssyndrome,whichischaracterizedbymedullarycarcinomaofthethyroid,pheochromocytoma,andhyperparathyroidism.Allthreedisordersarenotalwaysfoundinthesamepatient.Pheochromocytomaispresentin50to75%;hyperparathyroidism,in50%.Additionalfindingsnotregularlyassociatedwiththissyndromeincludedisordersoftheneuralectoderm,includingmucosalneuromas;megacolon;pectusexcavatum;poorlydevelopedmusculature;andmarfanoidappearance,withlongarmsandfingers.Whentheseassociatedconditionsoccur,thesyndromeisclassifiedasmultipleendocrineneoplasia,typeIIB;hyperparathyroidismisnotpresentinthissubset.

当伴有其他激素或肽异位分泌时，如促肾上腺皮质激素（ACTH）、血管活性肠多肽、前列腺素、血管舒缓素、血清素等，髓样癌就可能出现戏剧性生化改变。该肿瘤是赛普尔综合症组成之一，其特征是甲状腺髓样癌、嗜铬细胞瘤和甲状旁腺功能亢进。这三种病症不会出现于同一病人，嗜铬细胞瘤的出现率为50－75%，甲状旁腺功能亢进为50%。该综合症的其他非常见伴发症包括神经外胚层疾病，如神经粘膜瘤；巨结肠；漏斗胸；肌肉组织发育不全；马方样外表伴长臂长指。当出现这些伴发症时，该综合症就被归类为多内分泌肿瘤IIB。在该分组中不存在甲状旁腺功能亢进。

Metastasesspreadviathelymphaticsystemtocervicalandmediastinalnodes,butsometimestoliver,lungs,andboneaswell.

病灶通过淋巴系统转移到颈和纵隔淋巴结，有时也可能转移到肝、肺和骨。

Long-termsurvivaliscommoninpatientswithmedullarycarcinomaandmultipleendocrineneoplasia,typeIIA,with>2/3ofaffectedpatientsaliveat10yr.Medullarycarcinomaofthesporadictypecarriesaworseprognosis.

髓样癌及多发性内分泌瘤IIA病人长期存活是常见的，2/3以上病人可存活10年。散发性髓样癌预后较差。

Isotopicscansdemonstrateanonfunctioning（cold）nodulethatdoesnotconcentrateradioiodine.X-raysmayshowadense,homogenous,conglomeratecalcification.Thebesttestformedullarycarcinomaisthepresenceofanelevatedserumcalcitoninlevel,sinceonlyrarelyisthelevelnormal.Achallengewithcalcium（15mg/kgIVover4h）orpentagastrin（0.5µg/kgIVin5sec）provokesexcessivesecretionofcalcitonin.Precisefiguresforcalcitoninlevelsvaryamonglaboratories.

同位素扫描显示无功能（冷）节，它不能浓集射碘。X线可显示致密、匀质、团块状钙化。髓样癌检实的最佳结果是发现血清降钙素水平增高，因为该值很少正常。钙（15mg/kgIV滴注4h）或五肽胃泌素（0.5µg/kgIV5秒钟内推注）激发可刺激降钙素的过度分泌。降钙素确度因实验室而异。

Hereditarymedullarycarcinomacannowbediagnosedbydetectingsomaticpointmutationsintheretproto-oncogeneonchromosome10,whicharepresentinalmostallofthesepatients.

遗传性髓样癌目前可通过10号染色体上”RET”原癌基因体点突变检查得以确诊，几乎所有此类病人都有这种情况。

Totalthyroidectomyisindicated,evenifbilateralinvolvementisnotobvious.Lymphnodesarealsodissected.Ifhyperparathyroidismispresent,removalofhyperplasticoradenomatousparathyroidsisrequired.Ifpheochromocytomaoccurs,itisusuallybilateral;therefore,ananteriorabdominalapproachispreferredfortheoperation.Pheochromocytomasshouldbeidentifiedandremovedbeforethyroidectomybecauseofthedangerofprovokinghypertensivecrisisduringtheoperation.

即使双侧累及不明显，也需行甲状腺全切。并行淋巴结清除。如存在甲状旁腺功能亢进，就需行甲状旁腺增生或腺瘤切除。如有嗜铬细胞瘤，通常为双侧性，最好行前腹腔开腹法。因术中有促发高血压危象可能，在施行甲状腺切除前应先确诊嗜铬细胞瘤。

Becauseofthefamilialincidenceofmedullarycarcinoma,itisimportanttoscreenrelativesbychromosomalanalysistodetectmutationsintheretproto-oncogeneandtoperiodicallydeterminethebasalandstimulatedlevelsofserumcalcitonin.Relativesinwhomanelevatedcalcitoninlevelwithoutapalpablethyroidabnormalityisdetectedshouldundergothyroidectomy,sincethereisagreaterchanceofcureatthisstage.Someexpertsrecommendsurgicaltreatmentinrelativeswhohavenormalbasalandstimulatedserumcalcitoninbutwhohavetheretproto-oncogenemutation.

髓样癌呈家族性，因此，对亲属进行染色体分析筛选，探测其RET原癌基因突变情况，定期测定其基础和激发的降钙素水平，这一点很重要。对于降钙素水平升高，但未扪及甲状腺异常的亲属，应行甲状腺切除，因为该阶段的治愈机率更高。有些专家建议，对基础和激发降钙素正常，但有RET原癌基因突变的亲属应行外科治疗。

UNDIFFERENTIATEDTHYROIDCANCER

未分化甲状腺癌

Thisisaparticularlyvirulentformofthyroidcarcinoma.Itoccursintheelderlyandhasavariablepathology,includingspindle,squamous,andanaplasticcells.Althoughtheprognosisispoor,arecentapproachhasbeenadvocatedconsistingofchemotherapyandradiationbeforethyroidectomyandanothercourseaftersurgicaltreatment.Thisapproachhasresultedinsomeprolongedremissions.

本病为最恶性的甲状腺癌，见于老年人，病理各异，包括纺锤状、鳞状和未分化细胞。虽然预后差，但最近有人主张在甲状腺切除前先做化疗和放疗，术后再做一个疗程。这种方法可使缓解期延长。

RADIATION-INDUCEDTHYROIDCANCER

放射诱导的甲状腺癌

Relativelysmalldosesofradiationduringinfancyandchildhoodincreasetheriskofdevelopingbenignandmalignantthyroidneoplasms.Athyroidabnormalitymaydevelopabout5yrafterexposure,butthepatientremainsatincreasedriskforatleast30to40yrafterexposure.Probablynomorethan1/3ofthoseirradiateddevelopathyroidneoplasm;mostarebenign.However,about7%oftheirradiatedgroupdevelopthyroidcarcinoma;mostarepapillaryormixedfollicular-papillaryandaregenerallyslow-growingandrelativelynonaggressive.Thetumorsarefrequentlymulticentric,andathyroidscandoesnotalwaysreflectareasofinvolvement.Microscopicfociofcanceroftenhavebeenobservedinareasconsideredclinicallynormal.

婴儿和儿童期相对小剂量照射增加良性和恶性甲状腺瘤危险。照射后5年可能出现甲状腺异常，至少在接触放射线后30~40年间，病人仍处于肿瘤多危期。大概不到1/3的放射病人会得甲状腺瘤，大多为良性。不过，约7%病人会得甲状腺癌，多数为乳头状癌或滤泡－乳头混合型癌，一般生长缓慢，相对无侵犯性。肿瘤呈多中心，甲状腺扫描并不总能显示病变部位。显微镜所显示的癌灶通常见于临床认为正常的区域。