“I’ve been diagnosed with cancer and they’ve proposed nothing.” It’s a phrase that makes you swoon: why don’t you do anything? Even then, watch and wait it’s a new way Deal with cancer.
of English watch and wait hey active surveillance, involves closely monitoring tumor growth in each patient, without providing any surgical intervention or any treatment. It is currently being used with patients with thyroid, prostate and lymphoma cancers.
case of papillary cancer
Naturally, this option is not valid for any type of cancer. With regard to thyroid cancer, it can only be applied to so-called low-risk papillary carcinoma or microcarcinoma. But what are its features? and why can watch and wait With this form of the disease?
Papillary cancer occurs most commonly in those that affect the thyroid gland, and the number of diagnoses increases every year. It is not yet known why. One explanation is improvements in imaging techniques, which are able to detect small tumors (less than 1 cm), called microcarcinomas. And where do papillary come from?
In general, thyroid cancer is divided into two groups, depending on its state of cell differentiation, or what is similar, how disorganized and uncontrolled the cells making it are. Then, there are differentiated tumors, such as papillary or follicular carcinoma; and undifferentiated, such as poorly differentiated or anaplastic. The latter are very aggressive, with short survival and without effective treatment.
In a healthy thyroid, the cells are arranged in spheroids. Inside, thyroglobulin accumulates, a protein needed to produce thyroid hormones (T3 and T4), which help regulate the body’s metabolism and growth. Papillary carcinoma cells form long finger-like papillae, hence their name.
In general, papillary carcinoma has a good prognosis, although in some cases it can progress and become invasive. It is treated surgically, removing part or all of the thyroid, and/or with radioactive iodine.
In the second assumption, therapy works as follows. Thyroid cells need to take up iodine to produce thyroglobulin and thyroid hormones. By maintaining a certain cellular structure, papillary carcinoma still has the ability to capture this mineral, and if it is radioactive, tumor cells die by integrating it.
Small and not very aggressive tumors
Previously, microcarcinomas went unnoticed because of their small size – some were discovered postmortem – and because they did not present symptoms. This suggests that the disease was not actually progressing and the person was living normally. Although more microcarcinomas are now being diagnosed, the mortality rate has not increased.
With this in mind, follow-up studies of papillary microcarcinoma patients were conducted first in Japan and Korea, and in recent years in the US. In most patients, the tumor did not change in size over time. Sometimes it would even shorten and disappear on its own. It only increased in a small percentage of individuals, but it did so slowly.
In other words, most people diagnosed with papillary microcarcinoma are probably receiving unnecessary treatment. Keep in mind that surgery always involves risk, and in this case the laryngeal nerve or vocal cords can be damaged. Later on, a hormonal supplement is needed for life.
And when it comes to radioactive iodine therapy, not only do the tumor cells die, but they also grow healthy. The watch-and-wait option doesn’t seem like such a bad idea. But what is involved?
so watch and wait
First, candidates must have a papillary tumor of less than 1.5 cm, without invasion of lymph nodes in the neck. They cannot have other types of diseases and are preferably above 60 years of age. Young, it seems, are not consistent during follow-up, and tumors show slow growth in patients over the age of six decades.
Follow-up involves having an ultrasound test every 6 months for the first two years and then annually. Decisions are made as the tumor develops.
But patients need to balance feelings of concern about letting cancer run its course against the risk of side effects and complications from treatment. Once the patient is diagnosed and considered low risk, they are given the option of having surgery or watching and waiting.
There are three types of patients: those who prefer to be treated and have immediate surgery, those who start with surveillance and then, even without changes in the tumor, choose to treat it, and those who tolerate . Having cancer is a huge psychological burden, and not everyone experiences it in the same way.
America is many years ahead of us: the watch-and-wait option is still being explored in Europe. But are we ready?