الفهرس 
Anatomical ConsiderationsOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
In 2014, an estimated 62,980 individuals, predominately women, will be diagnosed with thyroid carcinoma. from 2006 to 2010, the incidence of thyroid cancer increased at an annual rate of 5.4% in men and 6.5% in women. Papillary thyroid cancer is the most common endocrine malignancy and accounts for the majority of cancers of the thyroid gland. The incidence of papillary thyroid cancer is rapidly increasing.
Microscopically, papillary carcinomas share certain features. The neoplastic papillae contain a central core of fibrovascular (occasionally just fibrous) tissue lined by one or occasionally several layers of cells with crowded oval nuclei. The tumors invade lymphatics leading to multifocal lesions and to regional node metastases.
The most frequent presentation of papillary thyroid cancer is a palpable thyroid nodule, cervical lymphadenopathy, or incidental detection on imaging. Locally advanced disease can present with hoarseness or voice alteration.
FNA biopsy is recommended for solid hypoe-choic nodules greater than 1 cm in largest dimension, mixed solid/cystic nodules greater than 2 cm, and microcentimeter nodules with suspect ultrasound features, such as micro-calcifications and irregular borders.
A combination of thyroidectomy and therapeutic neck dissection is unanimously approved for neck lymph node-positive patients, but for neck lymph node-negative patients, combining prophylactic neck dissection (PND) and thyroidectomy is controversial. Radioactive iodine therapy is for selective irradiation of thyroid remnants, microscopic DTC or other non resectable or incompletely resectable DTC, or both purposes.
The treatment develops rapidly in these decades. Conventional thyroidectomy has been a mature, safe, and efficacious treatment for differentiated thyroid cancer for the past few decades, but one incisional scar left in the anterior lower neck cannot be avoided. The evolutionary development of laparoscopic surgery satisfies the esthetic demand, recovery, and limited trauma in nearly all fields of surgical disciplines, including the treatment of differentiated thyroid cancer.
Although reports thus far have been encouraging regarding the oncologic soundness of some alternative approaches for small, low-risk, well-differentiated thyroid cancers, longer follow-up periods and greater experience may be needed before definite inclusional criteria for malignant disease are set. Preoperative discussion regarding the possibility of open conversion and reoperation is imperative. Careful patient selection is paramount, and for the appropriate and committed patient, these innovative techniques provide a benefit not offered by conventional approaches.
The prognosis of papillary thyroid cancer is related to age, sex, and stage. In general, if the cancer does not extend beyond the capsule of the gland, life expectancy is minimally affected. Prognosis is better in female patients and in patients younger than 40 years. The survival rate is at least 95% with appropriate treatments. Regional lymph node metastases are extremely common (50% or more) at initial presentation of usual papillary cancer. This feature does not apparently adversely affect long-term prognosis especially in patients under age 45 years at diagnosis