“I was diagnosed with cancer and they suggest not doing anything.” It’s a phrase that makes you dizzy: how come you’re not doing anything? However, watch and wait it’s a new way to treatment crab. in English watch and wait or active monitoring, consists in intensively monitoring the evolution of the tumor in each patient without performing any surgical intervention or providing any treatment. It is currently used in patients with thyroid cancer, prostate cancer and lymphoma.
The case of papillary cancer
Naturally, this option is not valid for any type of cancer. Regarding thyroid cancer, it can only be used for so-called low-risk papillary carcinoma or microcarcinoma. But what are its characteristics? And why can only watch and wait with this form of the disease?
Papillary cancer is the most common of those affecting the thyroid gland, with the number of diagnoses increasing every year. It is not yet known why. One explanation is the improvement of imaging techniques capable of localizing small tumors (under 1 cm), which are called microcarcinomas. And where does papillary come from?
Generally, thyroid cancer is divided into two groups depending on the state of cell differentiation, or, what is the same, how disorganized and uncontrolled the cells that form 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 low survival rates and no effective treatment.
In a healthy thyroid gland, the cells are organized into spheres. Inside, thyroglobulin accumulates, a protein needed to generate thyroid hormones (T3 and T4), which help control the body’s metabolism and growth. Papillary carcinoma cells form papillae, like elongated fingers, hence their name.
In general, papillary carcinoma has a good prognosis, although in some cases it can progress and become aggressive. It is treated with surgery to remove part or all of the thyroid gland and/or with radioactive iodine.
In the second assumption, the therapy works as follows. Thyroid cells must take up iodine to produce thyroglobulin and thyroid hormones. Maintaining a certain cellular structure, the papillary carcinoma still has the capacity to capture this mineral, and if it is radioactive, the 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 showed no symptoms. This suggested that the disease was not actually progressing and the person was living a normal life. Although more microcarcinomas are now being diagnosed, the death rate has not increased.
With this in mind, follow-up studies of patients with papillary microcarcinoma were conducted, first in Japan and Korea, and in recent years in the United States. In the majority of patients, the tumor did not change in size over time. Sometimes it even diminished and disappeared on its own. It grows in only a small percentage of individuals, but it does so slowly.
In other words, the majority of people diagnosed with papillary microcarcinoma receive probably unnecessary treatment. Keep in mind that surgery always involves risk and in this case, the laryngeal nerve or vocal cords may be damaged. Then lifelong hormone supplementation is necessary.
And as for radioactive iodine therapy, not only tumor cells die, but also healthy ones. The watch and wait option doesn’t seem like such a bad idea. But what does it consist of?
So watch and wait
First, applicants must have a papillary tumor smaller than 1.5 cm, with no neck lymph node invasion. They cannot have other types of diseases and preferably over 60 years of age. Young people seem to tend to be inconsistent during follow-up, and tumors in patients older than six decades tend to show slow growth.
Follow-up consists of performing an ultrasound examination every 6 months for the first two years and then annually. Decisions are made as the tumor progresses. But patients have to balance feelings of concern about letting the cancer grow, versus the risk of side effects and complications from treatment. Once a patient is diagnosed and deemed low risk, they are given the option to undergo surgery or watch and wait.
There are three types of patients: those who prefer to be treated and immediately operated, those who start with observation and then, even without changes in the tumor, prefer to treat it, and those who persevere. Cancer carries a great psychological burden and not everyone experiences it in the same way. The US is a few years ahead: the watch-and-wait option is still being explored in Europe. But are we prepared?
Maria Elena Rodriguez Garcia-Rendueles
Principal Investigator: Thyroid Cancer, IMDEA FOOD
Article originally published on The Conversation