Referring to thyroid cancer as if it were a single disease is an oversimplification that increasingly fails to reflect what we now know about the condition. The term encompasses tumors with different biological characteristics, degrees of aggressiveness, prognoses and treatment requirements.

This distinction is particularly important because it influences one of the key decisions following diagnosis: how the patient should be treated and what role surgery should play in each individual case.

"A few years ago, we tended to consider thyroid cancer in a much more uniform way. Today, we know that it comprises a group of tumors with different behaviors and that, therefore, they should not all be treated in the same way," explains Dr. César Canales Bedoya, Head of the Department of General and Digestive Surgery at Hospital Ruber Internacional, part of Grupo Quirónsalud.

Advances in fields such as molecular biology, genetics, pathology, fine-needle aspiration (FNA), high-resolution ultrasound and other imaging techniques have made it possible to characterize thyroid lesions with far greater precision.

This has led to a significant change in the way the disease is approached: it is no longer simply a matter of determining whether or not a tumor is present, but of identifying what type of tumor it is and, as far as possible, anticipating how it may behave.

"Understanding the biology of the tumor is now just as important as the surgery itself. The more information we have before making a decision, the better we can tailor treatment to each patient," Dr. Canales emphasizes.

Not all thyroid cancers have the same level of aggressiveness

There are significant differences among tumors originating in the thyroid gland.

Differentiated thyroid carcinomas are the most common and generally have a better prognosis. In contrast, there are more aggressive tumors, such as certain poorly differentiated carcinomas, as well as much less common but particularly aggressive tumors, such as anaplastic thyroid carcinoma.

Medullary thyroid cancer also needs to be considered. It has a different biological origin and therefore requires a specific diagnostic and therapeutic approach.

Furthermore, a malignant lesion located in the thyroid does not necessarily originate in the gland itself. Other possibilities that must be considered include metastases from tumors originating in other organs or lymphomas involving the thyroid.

"Knowing exactly what type of tumor we are treating is essential. The word ‘cancer’ may be the same, but the behavior of the disease, its treatment and its prognosis can be very different," the specialist explains.

Detecting smaller lesions does not necessarily mean performing more surgery

Improvements in diagnostic techniques now make it possible to identify increasingly small thyroid lesions. However, greater diagnostic capability should not automatically result in more surgical procedures.

On the contrary, more accurate characterization makes it possible to better select the patients who genuinely need surgical treatment and to avoid procedures that are unlikely to provide them with a meaningful benefit.

"The aim is not to operate more simply because we are able to diagnose more. It is to operate better. We need to identify which patients require surgery and tailor the extent of the procedure to the specific characteristics of both the tumor and the patient," explains the Head of the Department of General and Digestive Surgery.

This individualized approach is particularly relevant in a disease that encompasses tumors with very different patterns of progression.

"If we have a clear understanding of the nature and aggressiveness of the lesion, we can avoid unnecessary surgery in certain patients while, at the same time, acting quickly when we are dealing with a tumor whose behavior requires immediate treatment," he adds.

FNA and ultrasound help provide a better understanding of the nodule

An important part of this process begins before the patient enters the operating room.

High-resolution ultrasound makes it possible to examine the characteristics of the thyroid gland and any lesions within it. When indicated, fine-needle aspiration (FNA) allows cells to be obtained from the nodule for analysis, providing valuable information to help establish a diagnosis.

These techniques are complemented by advances in pathology, genetics and molecular biology, which are enabling increasingly precise characterization of certain tumors.

Together, these tools help build a kind of "profile" of the lesion, which is essential when subsequently deciding on the most appropriate therapeutic strategy.

"Surgery begins long before the operating room. A sound indication for surgery depends on an accurate prior diagnosis. Knowing exactly what we are treating allows us to plan the procedure more effectively and provide patients with more precise expectations regarding their disease," says Dr. Canales Bedoya.

Early diagnosis remains essential

The possibility of individualizing treatment does not make early diagnosis any less important. On the contrary, identifying tumors at an early stage remains an important factor in achieving good outcomes.

However, the next step is to correctly interpret what has been detected.

An accurate diagnosis makes it possible to determine the degree of aggressiveness, select the most appropriate treatment, plan follow-up and provide a more precise assessment of the prognosis.

Progress, therefore, does not lie solely in the availability of new surgical techniques, but also in our increasing ability to determine which treatment each individual patient actually needs.

From diagnosis to treatment: a multidisciplinary decision

This growing complexity also explains why thyroid cancer requires a multidisciplinary approach.

The Department of General and Digestive Surgery and its Endocrine Surgery Section at Hospital Ruber Internacional, headed by Dr. César Canales, work closely with specialists in Endocrinology, Pathology, Radiology and Oncology, with additional support from the laboratory.

"Today, it would be difficult to view the treatment of thyroid cancer as a decision made by a single specialist in isolation. We need to integrate clinical, radiological and pathological information and, when appropriate, molecular data in order to make the best possible decision for each patient," he explains.

For Dr. Canales, this paradigm shift can be summarized in one idea: moving from treating a diagnosis to treating the specific tumor of a specific individual.

"The better we understand the tumor, the more precise we can be in its treatment. This means reducing unnecessary procedures whenever possible while acting immediately when the characteristics of the disease require it. Personalization is one of the major advances we are currently seeing in thyroid cancer," he concludes.