武汉甲康医院杨育峰教授科普：都说甲状腺癌是“懒癌”，能够躺平吗？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">近年来，随着甲状腺彩超体检的普及，我国甲状腺癌的发病率<span style="color: black;">显著</span><span style="color: black;">提升</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">关于甲状腺癌</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲状腺癌，是一种头颈部最<span style="color: black;">平常</span>的、起源于甲状腺滤泡上皮或滤泡旁上皮细胞的恶性肿瘤，约占全身恶性肿瘤的1%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q0.itc.cn/images01/20240521/ce7940199ee543719215a2a6cdca6ba0.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病因尚未完全<span style="color: black;">知道</span>，<span style="color: black;">日前</span>认为与以下<span style="color: black;">原因</span><span style="color: black;">相关</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">● 高碘或缺碘<span style="color: black;">膳食</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">● 放射线接触史</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">● 雌激素</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">● 遗传<span style="color: black;">原因</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">● 甲状腺<span style="color: black;">疾患</span>（结节性甲状腺肿、甲亢、甲状腺腺瘤、慢性淋巴细胞性甲状腺炎等）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女性发病率<span style="color: black;">显著</span>高于男性，比例为2~4：1。任何年龄都可发病，多见于青壮年。<span style="color: black;">因为</span>大部分甲状腺癌病程发展较慢，恶性程度较低，预后良好，5年<span style="color: black;">存活</span>率高达97%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，常被<span style="color: black;">叫作</span>为“懒癌”或“幸福癌”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">甲癌是懒癌，<span style="color: black;">能够</span>躺平吗？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲状腺癌有乳头状癌、滤泡状癌、髓样癌和未分化癌四种类型。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">01</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">乳头状癌</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是最<span style="color: black;">平常</span>的类型，发病率约为80%~90%，<span style="color: black;">通常</span>多见于30~45岁的女性。以淋巴转移为主，局限在甲状腺内，肿瘤生长缓慢，恶性程度较低，预后较好。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">02</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">滤泡状癌</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">发病率约为2%~10%，任何年龄均可发病，以中老年人<span style="color: black;">占多数</span>，高峰期在50岁<span style="color: black;">上下</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以血行转移为主，可侵犯甲状腺临近组织或经血道远处转移，但生长缓慢，恶性程度中等，预后较好。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">03</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">髓样癌</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">出现</span>率约为1%~5%，中老年人比例较高，约50%的<span style="color: black;">病人</span>是家族遗传。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">易从淋巴及血液转移，会产生降钙素，有低血钙的表现，还会并发其它内分泌瘤（如肾上腺瘤、副甲状腺瘤等）。中度恶性，手术治疗为主，预后效果<span style="color: black;">通常</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q7.itc.cn/images01/20240521/f82ae78494cf4dbab3a93eca0db33a9f.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">提示：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">髓样癌在超声下，边界清楚，易被误诊为良性癌，可做降钙素<span style="color: black;">检测</span>来<span style="color: black;">帮忙</span>确诊其良恶性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">因<span style="color: black;">拥有</span>家族遗传性，<span style="color: black;">倘若</span><span style="color: black;">检测</span>出甲状腺髓样癌，<span style="color: black;">意见</span>其他家庭成员<span style="color: black;">亦</span>做降钙素<span style="color: black;">检测</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">04</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">未分化型甲状腺癌</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最严重的甲状腺癌类型，较为少见，<span style="color: black;">出现</span>率约为1.0%~7.5%，好发于70岁以上男性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">常<span style="color: black;">出现</span>淋巴、血液转移。高度恶性，浸润广泛、病程短、转移快、死亡率高，中位<span style="color: black;">存活</span>期（有且<span style="color: black;">仅有</span>50%的<span style="color: black;">病人</span><span style="color: black;">能够</span>活过这个时间）仅有7~10个月。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大<span style="color: black;">都数</span>就诊时，<span style="color: black;">已经是</span>晚期。存活率差，其5年<span style="color: black;">存活</span>率<span style="color: black;">小于</span>10%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q6.itc.cn/images01/20240521/29d3e7090fa340ac87beb86ae0882217.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，并非所有的甲状腺癌都是“懒癌”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">严格<span style="color: black;">来讲</span>，人们所说的“懒癌”其实<span style="color: black;">指的是</span>分化型甲状腺癌。甲状腺癌<span style="color: black;">能够</span>很“温柔”，<span style="color: black;">亦</span><span style="color: black;">能够</span>很“凶险”，<span style="color: black;">必要</span><span style="color: black;">导致</span><span style="color: black;">注意</span>，<span style="color: black;">茫然</span>的“躺平”并不可取。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">甲癌常有<span style="color: black;">那些</span>症状？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲 状腺癌<span style="color: black;">初期</span>大多<span style="color: black;">没</span>症状，<span style="color: black;">大都是</span>在体检时<span style="color: black;">经过</span>超声<span style="color: black;">检测</span>被<span style="color: black;">发掘</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">典型的临床表现：</strong>前下颈部肿块，质地硬，可随吞咽上下移动，<span style="color: black;">通常</span>不伴<span style="color: black;">病痛</span>等不适。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">晚期会<span style="color: black;">显现</span>的症状：</strong>声音嘶哑、<span style="color: black;">呼气</span>困难、吞咽梗阻感、耳朵肩部枕部<span style="color: black;">病痛</span>等症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">科研</span><span style="color: black;">表示</span>，分化型甲状腺癌在规范治疗后，10年存活率达93%，30年存活率超过90%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q6.itc.cn/images01/20240521/a6efc2dd8d8045b495820c9832db1e74.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">提示：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">无</span>得到<span style="color: black;">即时</span>治疗，会侵犯到“咽喉要道”的其他器官，如气管、食道和颈部<span style="color: black;">要紧</span>的血管、神经等，<span style="color: black;">亦</span>会<span style="color: black;">显现</span>肺、骨等远处器官的转移，临床上<span style="color: black;">亦</span>有<span style="color: black;">必定</span>的死亡率。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此</span>，即使体检中<span style="color: black;">发掘</span>的甲状腺结节被疑似“懒癌”，<span style="color: black;">亦</span>要足够<span style="color: black;">注意</span>，积极<span style="color: black;">遵循</span>专业<span style="color: black;">大夫</span>的意见。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">显现</span>以下症状要<span style="color: black;">警觉</span>！</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"> 01</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">颈部<span style="color: black;">显现</span>肿块</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">颈部<span style="color: black;">显现</span>一个或多个<span style="color: black;">没</span>痛性肿块或结节，<span style="color: black;">一般</span>在体检时被<span style="color: black;">发掘</span>，<span style="color: black;">病人</span>可能会感觉颈部有异物感或肿胀感。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">02</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">压迫症状</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随着肿瘤的增大，可能会对<span style="color: black;">周边</span>组织和器官产生压迫，<span style="color: black;">位置于</span>“咽喉要道”的气管、食管、神经等被压迫会相应<span style="color: black;">显现</span><span style="color: black;">呼气</span>困难、吞咽困难、声音嘶哑等症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">03</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">颈部淋巴结肿大</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲癌可能侵犯颈部淋巴结，<span style="color: black;">引起</span>淋巴结肿大。肿大的淋巴结<span style="color: black;">一般</span><span style="color: black;">没</span>痛，质地较硬。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q4.itc.cn/images01/20240521/965677300e2e4a58839ea8558e5156cc.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">04</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">甲状腺功能<span style="color: black;">反常</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">部分甲状腺癌<span style="color: black;">病人</span>可能<span style="color: black;">显现</span>甲状腺功能亢进或<span style="color: black;">衰退</span>的症状，如心悸、多汗、体重减轻、疲劳等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">05</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">转移症状</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲状腺癌晚期可能<span style="color: black;">出现</span>远处转移，如转移到肺、骨骼、肝脏等器官，<span style="color: black;">引起</span><span style="color: black;">显现</span>相应的症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">甲状腺癌<span style="color: black;">怎样</span>防治？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"> 01</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">远离致病因</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">经常接触电离辐射、雌激素、<span style="color: black;">肥壮</span>、压力过大、生活作息不规律等都会<span style="color: black;">增多</span>患甲状腺癌的<span style="color: black;">危害</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，要远离电离辐射、<span style="color: black;">警觉</span>含雌激素类的<span style="color: black;">打扮</span>品、保健品、养成良好的<span style="color: black;">膳食</span>习惯、适度运动、<span style="color: black;">掌控</span>体重、保持<span style="color: black;">阳光</span>的<span style="color: black;">心情</span>等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">02</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">正确摄入碘</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘摄入量过高或过低均与甲状腺<span style="color: black;">疾患</span><span style="color: black;">相关</span>。<span style="color: black;">倘若</span>尿碘超标，应<span style="color: black;">重视</span>减少摄入碘盐、含碘<span style="color: black;">食品</span>（如海鲜）；<span style="color: black;">倘若</span>尿碘偏低，则可适当多摄入含碘<span style="color: black;">食品</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q8.itc.cn/images01/20240521/c91543eed1d14e99ac25f71f31bff299.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">03</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">定时</span>体检</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">意见</span><span style="color: black;">定时</span>检查，最好<span style="color: black;">选择</span>超声波<span style="color: black;">检测</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尤其是高危人群：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">① 童年期有头颈部放射线照射史或放射性接触史的人群；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">② 有甲状腺<span style="color: black;">疾患</span>家族史者；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③ 年龄＞35岁，<span style="color: black;">尤其</span>是更年期女性；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">④ 甲状腺功能<span style="color: black;">显现</span><span style="color: black;">反常</span>者。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重视</span>：<span style="color: black;">女性</span>怀孕前应<span style="color: black;">检测</span>甲状腺功能，待甲状腺激素水平调至正常后再怀孕。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">小贴士：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">发掘</span>甲状腺癌，需<span style="color: black;">导致</span><span style="color: black;">注意</span>，<span style="color: black;">茫然</span>“躺平”只会错过最佳的治疗<span style="color: black;">机会</span>。<span style="color: black;">定时</span>体检、<span style="color: black;">即时</span><span style="color: black;">看病</span>以及遵循专科<span style="color: black;">大夫</span>的治疗<span style="color: black;">意见</span>都非常<span style="color: black;">要紧</span>，<span style="color: black;">不可</span>用“躺平”的态度对待可能并不懒的“懒癌”。<a style="color: black;"><span style="color: black;">返回<span style="color: black;">外链论坛：http://www.fok120.com/</span>，查看<span style="color: black;">更加多</span></span></a></p>
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