Thyroid Cancer in Nepal:

Nepal is a developing nation and has witnessed various natural calamities in recent past but currently is tied in the fetters of cancer; an ailment with less hope. Thyroid cancer has been on a sharp rise in Nepal from past certain years and due to limited treatment options, people suffer complications, which are treatable. It is seen that every year 1000  to 2000 new thyroid cancer patients are diagnosed in Nepal and although presence of new diagnostic technology is evident but curative measures and successful surgery rates are doubtful due to lack of medical advancement and affordability.

Thyroid Gland:

Before analysing the thyroid cancer, let us study some brief about Thyroid gland. Thyroid gland is a vital organ with a major role in the good metabolism and hence good development of the human body. It helps to regulate other body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream.

Thyroid gland is located at the front of the neck, under the voice box. It has a butterfly-shape: The two side lobes lie against and around the windpipe (trachea), and are connected at the front by a narrow strip of tissue.

In need of more energy by body, thyroid glands produce more hormones. Like, during pregnancy the thyroid gland produces more hormones.

Thyroid Cancer:

What is Thyroid cancer?

Thyroid Cancer falls in category of Head and Neck Cancer. Thyroid cancer is a rare type of cancer that affects the thyroid gland which is a small gland at the base of the neck that produces hormones like T3 (triiodothyronine) and T4 (thyroxine). T3 and T4 regulate your body’s temperature, metabolism and heart rate. Thyroid Cancer most likely affects Females than male population. Thyroid cancer can occur in any age group, although it is most common after age 30, and its aggressiveness increases significantly in older patients.

Symptoms of thyroid cancer can include:

  • A painless lump or swelling in the front of the neck can be one prime symptom though not every lump is cancerous.
  • swollen glands in the neck
  • unexplained hoarseness that doesn’t get better after a few weeks
  • a sore throat that doesn’t get better
  • difficulty swallowing

 

Types of thyroid cancer:

There are four main types of thyroid cancer:

  • Papillary carcinoma
  • Follicular carcinoma
  • Medullary thyroid carcinoma- unlike the other types, it can run in families
  • Anaplastic thyroid carcinoma – the rarest and most serious type
  • Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers. They tend to be easier to treat than the other types.

Causes of thyroid cancer:

It is not usually clear what causes this, but there are a number of things that can increase the risk of getting Thyroid Cancer.  It has been observed that Thyroid cancer occurs when a change to the DNA in the cells in the thyroid causes them to grow uncontrollably and produce a lump.

Other thyroid conditions, such as an inflamed thyroid (thyroiditis) or goitre – but not an overactive thyroid or underactive thyroid, a family history of thyroid cancer, radiation exposure in childhood – such as radiotherapy, obesity, a bowel condition called familial adenomatous polyposis (FAP)

acromegaly – a rare condition where the body produces too much growth hormone

Diagnosis:

  • Thyroid cancer is usually diagnosed by sticking a needle into a thyroid nodule (FNAC test)or removal of a worrisome thyroid nodule by a surgeon.
  • The thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign (95% to 99% of all nodules that are biopsied are benign) or malignant (less than 1% of all nodules, and about 1% to 5% of nodules that are biopsied).
  • The pathologist decides the type of thyroid cancer: papillary, follicular, mixed papillary-follicular, medullary, or anaplastic.

Treatments for thyroid cancer

  • Surgery – to remove part or all of the thyroid
  • Radioactive iodine treatment – you swallow a radioactive substance that travels through your blood and kills the cancer cells.
  • For advanced or recurrent cancers External radiotherapy and or chemotherapy is required:
  • External radiotherapy – a machine is used to direct beams of radiation at the cancer cells to kill them
  • Chemotherapy and targeted therapies – medications used to kill cancer cells

Benefits of Scarless Thyroid and Parathyroid Removal

From past many years, thyroid removal surgery has been performed by making a two-inch or longer opening in the neck. That leaves a permanent, obvious scar that is difficult to conceal. In recent years, we have witnessed major medical advancement with inclusion of advanced methods and technology for supporting the surgeries that are minimally invasive and highly efficient.

ROBOTIC THYROID SCARLESS SURGERY:

It is an innovative option to patients with abnormal thyroid or parathyroid glands, which are located in the front of the neck, an inch or two below the chin.  .

Robotic thyroidectomy—a minimally invasive surgical technique to remove all or part of the thyroid—was developed by doctors in South Korea, Seoul.

Robotic thyroidectomy is, in fact, a major step in thyroid surgery. As Dr. Mudit says, “This made sense that robotic thyroidectomy would be the next step in thyroid surgery, especially for those who don’t want a neck scar.”

How It Works ?

Robotic thyroidectomy eliminates the visible neck scar by accessing the thyroid gland through an incision behind the earlobe . This is called an retroauricular approach. That incision is 5-7cm long, but it’s hidden in the hairline. This technique has been adopted from plastic surgeon performing facelift procedure for cosmetic enhancement.

Robotic thyroidectomy is done using the daVinci Surgical System, a system that’s been used in many other robot-assisted surgeries with much success. The daVinci system has:

  • Four robotic hands: These are called EndoWrist instruments, and they do work just like hands. They can grab things, twist, and turn—and they’re incredibly small. The robotic hands allow the surgeon to make very precise movements.
  • 3D camera: This is a high-definition camera that gives the surgeon a 3D image of the thyroid. He or she can zoom in and get an even more detailed look; the camera includes magnification of 10x.
  • Console: The surgeon sits at the console, where he or she controls the four robotic hands and sees images from the 3D camera.

The four robotic hands and the 3D camera are inserted through the incisions. The surgeon can then accurately remove part or all of the thyroid, depending on what the patient needs.

As a reassurance, the daVinci robot is completely under the control of the surgeon. The robotic hands cannot move on their own; they must be told what to do by the surgeon. The daVinci Surgery System also cannot be programmed; the surgeon must be there giving input and making decisions during the surgery.

Advantages of Robotic Thyroidectomy

  • No incision in the neck
  • Better identification of critical structures: Due to the magnified 3D view, it is easier to identify critical structures, such as the recurrent laryngeal nerve (the nerve that goes to your voice box) and parathyroid glands.

The recovery time for robotic thyroidectomy is almost about the same as it is for open —a patient usually spends one-3 day in the hospital following the surgery.

Disadvantages of Robotic Thyroidectomy

The only disadvantages  sees in robotic thyroidectomy right now is that it can’t be used on every patient.

Who Can Have a Robotic Thyroidectomy?

Right now, robotic thryoidectomies work best for patients who:

  • Have not undergone previous neck surgery
  • Have  nodules less than 5cm

Conclusion

The biggest benefit is, of course, the lack of a scar on the neck. . Cosmetically speaking, a robotic thyroidectomy is a huge step forward in thyroid surgery.

And beyond the cosmetic benefits, robotic thyroidectomy is a fascinating advance in how surgeons can treat thyroid patients. It enables surgeons to do endoscopic procedures with more precision because the robotic hands have dexterity similar to, if not better than, human hands.

The surgeon performs the procedure using the latest robotic arm which is controlled by the surgeon from a console and allows for greater precision and magnification to reduce complications. This novel approach leaves no visible scar.

This recent surgical technique is a boon for cancer patients in Nepal as India has highly advanced methods for cancer treatment and the costs of treatment is affordable along with good prognosis and same socio-cultural atmosphere in both the neighbouring countries. This method is highly recommended as it takes less time to heal as well as has high success rate.