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Fortschritte in der diagnostik und therapie des C-zell-karzinoms der schilddrüse

Progress in the diagnostics and therapy of medullary thyroid carcinoma

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Summary

Between 1986 and 1989 172 patients were operated on thyroid cancer. Twenty-nine (17%) of them had a medullary carcinoma. In 20 of these patients (69%) the carcinoma occurred in a sporadic and in 9 (31%) patients in a familial form. Eighteen patients (62%) had to be operated because of tumor recurrence and in 4 of them additional surgery was necessary because of distant metastases. Due to tumor recurrence 7 patients underwent multiple operations during the above period. Adequate first operation was performed only in 6 patients (33%). Based on family screening a carcinoma was diagnosed in 4 patients in its occult stage. Diagnostic methods include biochemical and imaging methods. Calcitonin is the most sensitive tumor marker. Basal and stimulated serum calcitonin analysis provides a very efficient method to detect medullary carcinoma in early tumor stage and to treat the disease curatively. DNA-analysis improves early diagnosis of persons at risk.

Zusammenfassung

Von 1986 his 1989 werden 172 Patienten mit einem Schilddrüsenmalignom operiert, von den 29 (17%) ein C-Zell-Karzinom aufwiesen. Zwanzig dieser Patienten (69%) hatten die sporadische Tumorform und 9(31%) die familidre. Bei 18 Patienten (62%) mit einem C-Zell-Karzinom erfolgte die Operation wegen eines lokoregiondren Tumorrezidivs and bei 4 von diesen Patienten waren außerdem Eingriffe wegen Fernmetastasen erforderlich. In 7 Fällen fanden während des o.g. Zeitraumes wegen eines erneuten Tumorrezidivs oder Fernmetastasierung mehrere Reeingriffe statt. Eine addquate Erstoperation war nur bei 6 Patienten (33%) vorausgegangen. Bei 4 Patienten konnte der Tumor durch konsequentes Familien-screening bereits im prdklinischen Stadium diagnostiziert werden. Diagnostische MaBnahmen umfassen biochemische and bildgebende Verfahren. Calcitonin erweist sich als der sensibelste Tumorindikator. Durch Calcitoninbestimmung — basal und stimuliert —kann der Tumor im okkulten Stadium nachgewiesen und die Patienten durch eine friihzeitige Operation kurativ behandelt werden. Neue Aspekte in der Frühdiagnostik ergeben sich durch die DNS-Analyse.

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Authors and Affiliations

  1. Abteilung für Allgemeine and Unfallchirurgie, Heinrich-Heine-Universität, Moorenstraße 5, W-4000, Düsseldorf

    A. Frilling, P. E. Goretzki &  H.-D. Röher

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  1. A. Frilling
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  2. P. E. Goretzki
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  3. H.-D. Röher
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Frilling, A., Goretzki, P.E. & Röher, HD. Fortschritte in der diagnostik und therapie des C-zell-karzinoms der schilddrüse. Langenbecks Arch Chir 375, 333–339 (1990). https://doi.org/10.1007/BF00185215

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