Surgery has good prognosis for thyroid cancer. But how can one avoid scars?

Ms. Kim, a stay-at-home mom in her 50s, was recently diagnosed with early-stage thyroid cancer. She was relieved to hear that thyroid cancer has a high recovery rate if treated early. However, she was told that the surgery would require a horizontal incision in the front of her neck, which could leave a scar like a neck wrinkle or change her voice. Not wanting to be scarred for life, Kim wondered if there was another option, and heard about endoscopic surgery, which allows thyroid cancer to be removed through the inside of the mouth.

Thyroid cancer is one of the most common cancers. According to the National Cancer Center's 2021 National Cancer Registry statistics, thyroid cancer has been the number one cancer for three years in a row, with an incidence rate of 68.6 per 100,000 people. That points to the dominant prevalence of thyroid fever regardless of sex.

Thyroid cancer has a good prognosis compared to other cancers, with a survival rate of 98 percent if operated on in the early stages. The main treatment for thyroid cancer is thyroidectomy. However, the thyroid gland is located in the front of the neck, which makes the scar more visible. After thyroid surgery, patients often cover the scar with a scarf or shawl.

The thyroid gland is located in the thyroid cartilage that protrudes from the front of the neck, about two to three centimeters below the uvula. A lump on the thyroid gland is called a thyroid nodule. Thyroid nodules are common enough to be detected on an ultrasound scan in 30 percent of cases. Most of the time, they don't cause any symptoms and are discovered by chance during an ultrasound examination. However, if the nodule suddenly grows larger, or if there’s pressure in the neck, voice changes, or shortness of breath, it’s time for an ultrasound and a fine-needle aspiration test to check for thyroid cancer.

Some 5-10 percent of people with thyroid nodules are diagnosed with thyroid cancer. When thyroid cancer is diagnosed, the first step is to differentiate the type of cancer. There are four main types of thyroid cancer -- papillary, follicular, medullary, undifferentiated, and anaplastic. Most thyroid cancers are papillary and follicular.

Papillary thyroid cancer (PTC), which accounts for 75-80 percent of all thyroid cancers, is a cancer in which tumors grow in clusters. It is very slow to progress. The 10-year survival rate is over 90 percent, and most people can return to normal life without problems after treatment. Follicular cancer, which accounts for 20 percent of all thyroid cancers, also has a good prognosis due to slow cancer cell growth.

In contrast, medullary, undifferentiated, and anaplastic cancers are rare, accounting for 0.2 to 1 percent of thyroid cancers. However, they have a poor prognosis due to metastasis and rapid cancer cell growth. Undifferentiated cancer is especially dangerous, being classified as stage 4 upon diagnosis.

The main treatment for thyroid cancer is surgery. The extent of surgery and the treatment method can vary depending on the patient’s condition. In general, there are two types of surgery -- total thyroidectomy, in which the entire thyroid gland is removed, and lobectomy, in which only the lobe with the tumor is removed.

Depending on the patient's condition, a subtotal resection, in which part of the thyroid gland is left intact, or a cervical lymphadenectomy, in which the surrounding lymph nodes are removed. After surgery, radioactive iodine treatment may be added. The course of treatment is determined after a thorough examination and consultation with a thyroid specialist before surgery.

There are two main types of thyroid cancer surgery: open and endoscopic. The traditional neck dissection, which involves a four- to five-centimeter incision in the skin under the uvula, is a long-standing procedure. It can be done for any stage of cancer, but it has a significant disadvantage; it leaves a scar on the front of the neck.

Endoscopic resection is a surgical procedure that can solve many patients' problems. This surgery involves making small incisions (less than one centimeter) in the armpit and areola on both sides and inserting an endoscope to access the lesion. It reduces the scarring burden and does not affect breastfeeding and breast cancer screening.

Recently, transoral endoscopic surgery has also gained attention as a scarless surgery method designed to leave no scars. It is performed by inserting an endoscope through three small incisions in the mucous membrane between the lower gum and the lips. The oral mucosa heals quickly and leaves little scarring afterward.

There are no scars on the skin, so patients can shower immediately after surgery. Patient satisfaction is high because there is less risk of skin adhesions and less pain. However, not all thyroid cancer patients are candidates for endoscopic resection. It depends on the location and size of the cancer and the risk of metastasis.

"The smaller the size of the cancer and the lower the risk of metastasis, the higher the chances of endoscopic surgery and the better the prognosis," said Yoon Yeo-gyu, director of the Thyroid Center at St. Peter’s Hospital Gangnam. "The scope of surgery and whether or not to apply the surgical method can vary depending on the patient's condition, so it is recommended to find and consult a specialist experienced in thyroid surgery and treatment."