Diagnosis and Treatment of Patients with
Thyroid Cancer in Yemen during the
National war 2017-2021
Amani Saleh Hadi1*, Gamal Abdul Hamid2
1Specialist of Clinical Oncology and Nuclear Medicine National Oncology Center, Yemen
2National Oncology center Aden, Faculty of medicine & Health Science, Yemen
Submission: March 17, 2023; Published: April 04, 2023
*Corresponding Address: Amani Saleh Hadi Saeed, M.B., B.CH. M.Sc., Specialist of Clinical Oncology and Nuclear Medicine National Oncology Center, Yemen
How to cite this article: Amani Saleh H, Gamal Abdul H. Diagnosis and Treatment of Patients with Thyroid Cancer in Yemen during the National war
2017-2021. Canc Therapy & Oncol Int J. 2023; 23(4): 556117. DOI:10.19080/CTOIJ.2023.23.556117
Thyroid cancer is the most common malignancy of the endocrine system, representing 3.8% of all new cancer cases in the United States and is the ninth most common cancer overall. The American Cancer Society estimates that 62,450 people in the United States will be diagnosed with thyroid cancer in 2015, and 1950 deaths will result from the disease.
Objective: To review the current approach to the diagnosis and treatment of patients with thyroid cancer during the war period.
Method and result: One hundred and Fifty-five patients with thyroid malignancy were seen at the National Oncology Center, Aden during the period 2017-2021 were studied. Thyroid cancer showed that the median age of diagnosis was 43 years with a high incidence of the disease between the ages of 30 and 60 years. Thyroid cancer was common amongst females (118) than males (38) with 3.1:1 ratio. There were 123 (78.8%) papillary thyroid cancer, 21 (13.5%) follicular thyroid cancer and 7 (4.5%) anaplastic cell typecases.
Conclusion: Our results suggest that thyroid cancer continuous presenting alarming challenge with an increasing the prevalence in females. Papillary carcinoma is the most common type among Yemeni populations. Further epidemiological studies are required in policy strategies for control and prevention strategies of thyroid cancer in Yemen. The prognosis and treatment of thyroid cancer depend on the tumor type and its stage at the time of diagnosis. Early diagnosis and appropriate treatment can improve prognosis and reduce mortality
Thyroid cancer with an estimate of about 3.0% of new cases
was the ninth cancer for incidence and the most common type of
cancer of the endocrine system in 2020, globally . About 230,000
new cases of thyroid cancer were estimated in 2012 among
women and 70,000 among men, with an age-standardized (world
population) rate of 6.10/100,000 women and 1.90/100,000 men
Papillary thyroid cancer (PTC) is the most common subtype
of thyroid cancer and is considered to be well-differentiated.
Papillary carcinoma of the thyroid is usually an indolent tumor
with a good survival prognosis especially when small and limited
to the thyroid gland. The increasing mortality rates among patients
with advanced-stage PTC suggest that for patients with these
high-risk tumors, there should be renewed focus on aggressive
transdisciplinary management that includes surgery, adjuvant
radioactive iodine, and, when indicated for the 5–10% of patients
who develop progressive disease, systemic therapy. While there
is continued debate about the appropriate extent of surgery for
low-risk tumors, total thyroidectomy and adjuvant radioactive
iodine are indicated for high-risk disease . The risk factors of
PTC include genetic mutation and environmental exposure .
The role of Notch signaling in PTC is not clearly defined,
as it has been discordantly reported as both oncogenic and
tumor suppressive. In 2011, Park et al. analyzed tissues from
patients with PTC and found that the IHC expression of the
Notch1 receptor correlated with the increased presence of nodal metastases, extrathyroidal extension, and greater tumor size. However, they found no correlation between the presence of the
Notch3 receptor and clinic-pathological factors . Those with
Bethesda III either underwent surgery or were followed up with
repeat FNA. Some patients with Bethesda II or I opted for surgery
either because of pressure symptoms in the neck, the large size
of a goiter or hyperthyroidism. For those who underwent surgery
and had a thyroid tumor, the World Health Organization (WHO)
2017 classification was used to classify thyroid tumors . The
results of the Global Cancer Incidence, Mortality, and Prevalence
(GLOBOCAN) 2020 study showed that thyroid cancer in Turkey
and Iran with 13,682 and 4,114 incident numbers among women
had the highest values in the Eastern Mediterranean Region (EMR
. The economic cost of overdiagnosis in a thyroid cancer patient
can range from hundreds to thousands of dollars, depending on
the extent of the examinations performed and the complexity of
the intervention and follow-up .
All statistical analyses were performed using IBM SPSS
statistics (version 23). The results of the descriptive analysis of the
epidemiological data were presented as frequencies, percentages
and mean ± standard deviation for normally distributed data and
median ± interquartile range for non-normally distributed data.
One hundred and Fifty-five patients with thyroid malignancy
were seen at The National Oncology Center, Aden during the period
2017-2021 were studied Table 6. Thyroid cancer showed that the
median age of diagnosis was 43 years with a high incidence of the
disease between the ages of 30- and 60-years Table 1. Thyroid
cancer was common amongst females (118) than males (38) with
3.1:1 ratio Tables 2,3 and 4. There were 123 (78.8%) papillary
thyroid cancer, 21 (13.5%) follicular thyroid cancer and 7 (4.5%)
anaplastic cell type cases Table 5.
Over the past 3 decades, there has been a dramatic increase
in the number of people diagnosed with thyroid cancer, which
may be attributable to the wide use of imaging studies, including
ultrasounds, computed tomography, magnetic resonance imaging,
and positron emission tomography scans that incidentally detect
The heterogenous clinical presentations and genetic profiles of
thyroid cancer can make this disease complex in nature. The term
“thyroid cancer” encompasses a range of subtypes that originate
from different cell types within the thyroid- namely follicular
thyrocytes and the parafollicular C-cells. Across the various
thyroid cancer subtypes, the degree of cellular differentiation has
a strong influence on disease progression, treatment strategies,
and overall patient survival [9-11].
Salt iodization was introduced in Yemen in 1995 and was, at
that time, supposed to cover 22–60% of the households. Whether
this is still the case is unknown; this may in Yemen in 2015 with
increased bombing in many areas of the country. This could be a
source of environmental carcinogens causing an increase in the
rate of thyroid be a factor causing an increase in the percentage
of patients with follicular thyroid cancer (FTC). The war started
cancer, including an increase in the risk of FTC; this has to be
further studied, but environmental pollutants have been linked
to an increase in thyroid cancer [12,13]. Abdulmughni YA, et al.
 Not all histological variants of thyroid cancer 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
Thyroid cancer is divided into several main types, with
papillary thyroid cancer being the most common. The treatment
options for patients with thyroid cancer include the surgical
removal of the entire thyroid gland (total thyroidectomy),
radioactive iodine therapy, and molecular-targeted therapies with
tyrosine kinase inhibitors. During the war in Yemen in the last 8
years the nuclear medicine completely closed and patients have
two choices; to do thyroidectomy in Yemen then travel abroad
for further evaluation and treatment or travel and do every thin
Our results suggest that thyroid cancer continuous presenting
alarming challenge with an increasing the prevalence in females.
Papillary carcinoma is the most common type among Yemeni
populations. Further epidemiological studies are required in
policy strategies for control and prevention strategies of thyroid
cancer in Yemen. The prognosis and treatment of thyroid cancer
depend on the tumor type and its stage at the time of diagnosis.
Early diagnosis and appropriate treatment can improve prognosis
and reduce mortality.