Therapy

Abstract

As mentioned earlier therapeutic nihilism and very aggressive therapy programs were practised in cases of thyroid cancer, then histological typing of such tumors modified these approaches (Gemsenjäger 1978), so that in rather “benign” and extremely aggressive neoplasms only a minimal therapy was suggested by some authors (Taylor, Al-Wattar 1980) while other authors recommended that any type of thyroid cancer should be treated as radically as other malignancies (Clark 1982) — namely by “Stahl und Strahl” (=surgery and radiation) — and recently chemotherapy has been added to this active approach (Shimaoka 1980). When — in the following chapter — the author’s opinion is presented (which was acquired during 21/2 decades while handling a rather large number of thyroid cancer patients) it should be pointed out that with all the pecularities of this type of malignancy, with on-going research concerning pathogenesis and pathophysiology of these tumors (see earlier chapters) the statements made are to be seen as an “ad-hoc”-judgement of the potentials of various therapeutic strategies. Those will depend not only on scientific data, but also on a variety of factors (socio-economic, cultural, health policy) that differ very much from country to country. The primary aim, however, of any doctor confronted with the possibility of thyroid cancer in a patient must be to do everything in his power to cure a potentially fatal and terrible disease. Priorities world-wide therefore cannot only be “prescribed” in the manner of general text-books. If — e.g. — no ¹³¹I-therapy and no appropriate facilities for efficient radiotherapy are available, the responsibility will mainly rest on the surgeon’s capacity, which — in turn — may be restricted by local problems regarding appropriate anesthesia, hygiene, blood supply etc.