Thyroid cancer in Yemen

OBJECTIVE: To evaluate the characteristics of thyroid cancer (TC) patients in regard to demographic distribution, histological variants, mode of presentation and modalities of diagnosis and treatment.

METHODS: We retrospectively audited the records of 97 consecutive cases with histologically proved thyroid cancer between 1997 and 2001 presenting to the Kuwait University Hospital, Sana'a, Yemen.

RESULTS: Patients with TC in this study comprise 17.7% of goiter patients who were admitted at the same period. Females constituted 89.7% (n=87), and males 10.3% (n=10). The average age of diagnosis was 38.4 years. More than two thirds were at the age of <40. Among patients with goiter, the percentage of carcinoma was higher in the following groups, males (37.9% versus 16.6%, p=0.028), patients aged >47 (25.8% versus 12.6%, p=0.001), patients with enlarged lymph nodes (9.3% versus 3.8%, p=0.020), and patients with recurrent disease after being operated for a presumably benign disease (8.2% versus 2.9%, p=0.012). The average period since patients noticed the swelling until seeking medical help was 4 years. Most patients (90%) came from highland areas. Multinodular swelling was the most common clinical finding (43.3%), and hoarseness was the most common symptom (17.5%). In histopathological examination, papillary carcinoma accounted for 93.8% of the cases and papillary microcarcinoma was found in 10 cases (10.3%). The papillary/follicular carcinoma ratio was 22:1. Hormone assay and ultrasonic imaging were the most commonly used investigations. Sub total thyroidectomy was the most common procedure used in treatment (39%).

CONCLUSION: Not all histological variants of TC are represented in this study. Papillary carcinoma formed the bulk of TC cases. Salt iodization program might have an effect on the incidence of thyroid malignancy, and on the papillary/follicular carcinoma ratio. Better level of expertise is needed in the field of fine needle aspiration and ultrasonography. A consensus has to be reached, which is based on our environment and capabilities, where TC has to be managed aggressively by experienced surgeons. Yemen is in real need of a national cancer registry to assess the problem on a national level.