[Thyroid carcinoma in children and adolescents]

Area of Science:

• Oncology
• Pediatrics
• Endocrinology

Context:

• Thyroid cancer in patients under 21 years old accounts for approximately 10% of all thyroid cancers.
• This demographic represents 3% of all cancers diagnosed in children and adolescents.
• Female predominance is observed, with a 2:1 ratio compared to males.

Purpose:

• To characterize thyroid cancer in pediatric patients.
• To compare its features and prognosis with adult cases.
• To highlight genetic factors and treatment modalities.

Summary:

• Pediatric thyroid cancers are predominantly papillary (90%), often bilateral, multifocal, and larger than adult tumors.
• Increased frequency of capsule invasion and lymphatic/pulmonary metastases is noted in children.
• Genetic alterations like RET/PTC, RAS, and BRAF are commonly implicated in pediatric thyroid carcinogenesis.
• Cervical adenomegaly is frequent but not a poor prognostic indicator.
• Diagnostic tools include ultrasound and fine needle aspiration biopsy.
• Preferred treatment involves surgery (thyroidectomy, ganglionary excision) followed by radioiodine therapy and L-thyroxine suppression for TSH control.
• Plasma thyroglobulin monitoring aids in detecting residual disease.

Impact:

• Understanding these differences is crucial for accurate diagnosis and tailored treatment strategies in pediatric thyroid cancer.
• The generally better long-term prognosis in children underscores the importance of early and effective intervention.
• Research into radiation sensitivity and genetic factors may lead to improved therapeutic approaches.