What Questions Should I Ask My Doctor
If you have thyroid cancer, you may want to ask your healthcare provider:
- Why did I get thyroid cancer?
- What type of thyroid cancer do I have?
- Has the cancer spread outside of the thyroid gland?
- What is the best treatment for this type of thyroid cancer?
- What are the treatment risks and side effects?
- Will I need thyroid replacement hormone therapy?
- Is my family at risk for developing this type of thyroid cancer? If so, should we get genetic tests?
- Can I get thyroid cancer again?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Receiving a cancer diagnosis is unsettling, regardless of the type. Fortunately, most thyroid cancers respond extremely well to treatment. Your healthcare provider can discuss the best treatment option for the type of thyroid cancer you have. After treatment, you may need to take synthetic thyroid hormones for life. These hormones support vital body functions. They usually dont cause any significant side effects, but youll have regular checkups to monitor your health.
Last reviewed by a Cleveland Clinic medical professional on 08/13/2020.
Treatment For Patients With Dtc Bm
The prognosis of DTC patients is relatively good after receiving appropriate treatment, depending on the individual situation. Nevertheless, patients with DTC BM generally have worse prognoses . Early diagnosis and prompt and effective treatment have important influences on prognosis. Treatments for patients with DTC BM include 131I therapy, surgical resection, local EBRT, systemic bisphosphonate therapy and molecular targeting therapy, as well as TSH-suppressive therapy . Even with so many therapeutic measures, the 10-year survival rate remains low, and the efficacy of the abovementioned therapeutic measures remains controversial.
In addition to the treatment described above, Orita et al. retrospectively studied 22 patients with DTC BM who underwent zoledronic acid therapy and performed a subsequent prospective study suggesting that zoledronic acid was a safe, well-tolerated and effective treatment for palliation in DTC BM patients. No patients were treated with zoledronic acid in the present study; therefore, we cannot evaluate its efficacy. Radiofrequency ablation reduced pain from thyroid cancer with BM, and cryotherapy is another technique for the treatment of BM from thyroid cancer; nevertheless, their effectiveness is controversial and requires further study.
The Vicious Cycle Of Osteolytic Bone Metastases
Bone is unique, in that it is a large repository of immobilized growth factors , and calcium. Perhaps unexpectedly, osteolysis is triggered principally by tumor-stimulated osteoclast differentiation and activation – rather than by replacement of bone by tumor per se . Tumor-associated macrophages and metastatic cancer cells often overexpress osteoclast-inducing factors to prompt bone resorption/osteolysis, this osteolysis in turn, leads to the release of active matrix-embedded cytokines/growth factors, like TGF and IGFs , thereby promoting tumor growth in bone in a vicious cycle .
Primary and metastatic tumors are frequently heterogeneous , with metastases often clonally distinct from their primary tumors and sometimes better suited to preferential adhesion and metastasis formation at specific anatomical sites. The ability of tumor cells to recruit blood supply is critical to the development of macrometastases; >80% of DTC OMs are located in the axial skeleton red marrow – where blood flow is highest, with vertebrae , pelvis , ribs , and femur representing the most common sites of metastases . Bone also contains niches wherein vascular sinusoids lacking basement membranes are permissive of invasion . Moreover, cancer subclonal cells that exchange biological information with bone are best able to establish OMs via disrupting a normally tightly regulated process called coupling linking bone resorption to bone formation .
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After Surgery: Radioactive Iodine And Long
Almost all people who had surgery for papillary thyroid cancer will need to see a doctor for many years to have exams and certain blood tests to make sure the cancer has been cured, and to detect any return of the cancer as soon as possible should it return. Many people with papillary thyroid cancer will need to take radioactive iodine to help cure the cancer. We have several very important pages on these topics.
ThyroidCancer.com is an educational service of the Clayman Thyroid Center, the world’s leading thyroid cancer surgery center.
Low Survival Rates Observed For Specific Thyroid Cancers Following Bone Metastasis
Bone offers a haven for tumor cell growth following cancer metastases this haven is eventually compromised, however, due to pathological changes, compression of the spinal cord, bone surgery or irradiation as treatment and ultimately an increased risk of death.
Researchers at the University of Michigan Comprehensive Cancer Center conducted the largest-known study on bone metastases in thyroid cancer. The team discovered that the highest rate of cancer-related bone lesions and an overall increased risk in death were in patients with follicular and medullary thyroid cancer.
We know that metastases are bad. But patients in our study who had bone metastases had a worse survival rate compared to patients who had metastases at other distant sites, stated study author Megan Haymart . This suggests that bone metastases are a uniquely poor prognostic indicator.
Palak Choksi , lead author on the study highlighted, however, that patients with local or regional thyroid cancer but exhibit no metastases, have excellent prognoses.
Only about 8% of patients in the study had either a bone metastasis or skeletal-related event such as a cancer-related bone fracture, Haymart commented.
Earlier studies investigating bone metastases and differentiated thyroid cancers were largely from single institutions that enrolled patients and had significantly smaller sample sizes.
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Malar Bone Metastasis Revealing A Papillary Thyroid Carcinoma
1Department of Nuclear Medicine, Salah Azaiez Institut, University El Manar II, 1006 Tunis, Tunisia
2Department of Immunohistocytology, Salah Azaiez Institut, University El Manar II, 1006 Tunis, Tunisia
3Department of Otorinolaryngology, Salah Azaiez Institut, University El Manar II, 1006 Tunis, Tunisia
Papillary thyroid carcinoma is the most common form of differentiated thyroid carcinoma. It is generally confined to the neck with or without spread to regional lymph nodes. Metastatic thyroid carcinomas are uncommon and mainly include lung and bone. Metastases involving oral and maxillofacial region are extremely rare. We described a case of malar metastasis revealing a follicular variant of papillary thyroid carcinoma, presenting with pain and swelling of the left cheek in a 67-years-old female patient with an unspecified histological left lobo-isthmectomy medical history. To our knowledge, this is the first recorded instance of a malar metastasis from a follicular variant of papillary thyroid carcinoma.
2. Case Report
In November 2008, a 67-years-old female was referred to our hospital with the complaint of a slow-growing painless swelling of 6 months duration on her left cheek. She had a medical history of left lobo-isthmectomy of the thyroid gland, seven years ago, with unspecified histology.
Assigning A Cancer Stage
Cancer stages are typically assigned a Roman numeral and are determined by the TNM testing and other factors.4 The system is used mostly to describe cancers with solid tumors, such as breast, lung, or colon cancer. TNM stands for:;
- Size of tumor and spread into nearby tissue
- Spread of cancer to nearby lymph nodes
- Metastasis, the spread of cancer to other areas of the body
Stage I: The earliest cancer stage is when a tumor has not grown deeply into nearby tissues and has not yet spread to lymph nodes or other areas of the body. In some cases, cancer staging may be described as in situ which means in place and is technically Stage 0. This early stage is the most curable and usually treated by removing the tumor with surgery.
Stage II and III: These progressive stages indicate larger tumors that have grown more deeply into the tissues and may have spread to the lymph nodes, but may not yet have reached other areas of the body.;
Stage IV: This stage is determined to be the most advanced or metastatic cancer, which means it has spread throughout the body, to the lymph nodes, and beyond.
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Cancer In Nearby Lymph Nodes
Sometimes cancer is found in lymph nodes that are near to where the cancer started. For example, breast cancer cells may travel to lymph nodes in the armpit or above the collar bone .
If a surgeon removes a primary cancer, they often remove some of the nearby lymph nodes. The lymph nodes are examined to see if there are any cancer cells in them.
The risk of the cancer coming back may be higher if the nearby lymph nodes contain cancer cells. Your doctors may suggest you have more;treatment;after surgery to reduce the risk.
Cancer in lymph nodes that are further away is called;secondary cancer. Cancer found in nearby lymph nodes is usually treated differently to cancer in lymph nodes that are further away from the primary cancer.
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Discovery Of Pathogenic And Driver Mutations In Thyroid Cancer
The first evidence to conclusively link genomic alterations to TC came with the appreciation that MTC occurs in a heritable form linked to gain-of-function germ line mutations in RET . RET is a transmembrane receptor protein kinase, signaling through downstream pathways including the mitogen activated protein kinase cascade involving RAS/RAF/MEK/ERK. Activated/mutated RET thus drives pro-proliferative signaling and is thought to represent the dominant MTC driver in the majority of patients, realizing that mutated HRAS alternatively drives a minority of MTCs. Because RET requires ATP as a substrate to phosphorylate and thus activate downstream proteins, the hypothesis arose that RET activity might be blocked by small molecule ATP decoys that block downstream signal transduction. Two multi- and RET-kinase inhibitors are now approved for treatment of advanced MTC, two additional ATP mimics are approved in DTC and a combination therapy is presently approved for BRAFV600E mutated ATC based on limited data , with additional and more selective RET inhibitors now in clinical trial in MTC.
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Secondary Cancer In Distant Lymph Nodes
Cancer cells can break away from the primary cancer and travel through the lymphatic system to lymph nodes further away from where the cancer started. These are known as distant lymph nodes. If cancer cells settle in the distant lymph nodes, it is known as;secondary or metastatic cancer.
When the cancer cells in the distant lymph nodes are examined under a microscope, they look like cells from the primary cancer. For example, when a lung cancer has spread to distant lymph nodes, the cancer cells look like lung cancer cells.
The aim of;treatment;in this situation is usually to destroy as many cancer cells as possible. This can help control the cancer.
What Are The Types Of Thyroid Cancer
Thyroid cancer is classified based on the type of cells from which the cancer grows. Thyroid cancer types include:
- Papillary: Up to 80% of all thyroid cancers are papillary. This cancer type grows slowly. Although papillary thyroid cancer often spreads to lymph nodes in the neck, the disease responds very well to treatment. Papillary thyroid cancer is highly curable and rarely fatal.
- Follicular: Follicular thyroid cancer accounts for up to 15% of thyroid cancer diagnoses. This cancer is more likely to spread to bones and organs, like the lungs. Metastatic cancer can be more challenging to treat.
- Medullary: About 2% of thyroid cancers are medullary. A quarter of people with medullary thyroid cancer have a family history of the disease. A faulty gene may be to blame.
- Anaplastic: This aggressive thyroid cancer is the hardest type to treat. It can grow quickly and often spreads into surrounding tissue and other parts of the body. This rare cancer type accounts for about 2% of thyroid cancer diagnoses.
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Testing Lymph Nodes For Cancer
A swollen lymph node can be felt with your fingertips and sometimes, and if large enough, can be seen. However, there are other areas of the body where lymph nodes are more difficult to find and dont present symptoms on the surface. The only way to confirm a cancer diagnosis in the lymph nodes is through a biopsy.;
A biopsy is performed by using a long, thin needle to remove part of the lymph nodes or lymphatic tissue and reviewing it under a microscope to see if there are cancerous cells. The number of cancer cells will determine the course of treatment. There are additional tests to also determine how far cancer has spread and the cancer stage. All of this plays a part in the type, frequency, and outlook of treatment.;
If you are wondering, is cancer of the lymph nodes terminal, understand that cancer spreadto the lymph nodes does not automatically determine which stage its in.3 Typically, if its traveled far from its originating tumor source, it could indicate a later stage, though there are several tests that can be performed to get a clearer picture. These include:
Not all of these tests are necessary to confirm cancer staging, but they each help deliver more information to make an accurate diagnosis. Furthermore, cancer staging is assigned at the time of diagnosis but can be restaged following treatment. This is based on if cancer has stopped its growth or metastasized to other areas of the body.
What Is Thyroid Cancer
Thyroid cancer is a type of cancer that starts in the thyroid gland. It happens when cells in the thyroid grow out of control and crowd out normal cells.
Thyroid cancer cells can spread to other parts of the body such as the lungs and the bone and grow there. When cancer cells do this, its called metastasis. But the type of cancer is based on the type of cells it started from.
So even if thyroid cancer spreads to the lung , its still called thyroid cancer, not called lung cancer.
Ask your doctor to use this picture to show you where your cancer is.
Adaptive Approaches Physical And Occupational Medicine
Debility even in the absence of pain from OMs also requires palliation, often best addressed via physical and occupational medicine specialists. Restoration of function through rehabilitation should also be sought whenever possible, else adaptive approaches used, such as braces or adaptive equipment used to best advantage.
Papillary Thyroid Cancer Quick Facts:
- Peak onset ages 30 through 50
- Females more common than males by 3 to 1 ratio
- Prognosis directly related to tumor size
- Accounts for 85% of thyroid cancers
- Can be caused by radiation or x-ray exposure
- Spread to lymph nodes of the neck present in up to 50% of cases
- Distant spread is very rare
- Overall cure rate very high
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The Papillary Thyroid Cancer Tnm Staging System
A staging system is a standard way to sum up how large a cancer is and how far it has spread.
The most common system used to describe the stages of thyroid cancer is the American Joint Committee on Cancer TNM system. The TNM system is based on 3 key pieces of information:
- T indicates the size of the main tumor and whether it has grown into nearby areas.
- N describes the extent of spread to nearby lymph nodes. Lymph nodes are bean-shaped collections of immune system cells to which cancers often spread first. Cells from thyroid cancers can travel to lymph nodes in the neck and chest areas.
- M indicates whether the cancer has spread to other organs of the body.
Numbers or letters appear after T, N, and M to provide more details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means a category can’t be assessed because the information is not available.
T categories for papillary thyroid cancer
TX: Primary tumor cannot be assessed.T0: No evidence of primary tumor.T1: The tumor is 2 cm across or smaller and has not grown out of the thyroid.
- T1a: The tumor is 1 cm across or smaller and has not grown outside the thyroid.
- T1b: The tumor is larger than 1 cm but not larger than 2 cm across and has not grown outside of the thyroid.
N categories for papillary thyroid cancer
M categories for thyroid cancer
About The Lymph Nodes
The lymphatic system helps protect us from infection and disease. It also drains lymph fluid from the tissues of the body, before returning it to the blood.
The lymphatic system is made up of fine tubes called lymphatic vessels. They connect to groups of lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.
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What Is The Progression Of Papillary Thyroid Carcinoma If Left Untreated
If neglected, any thyroid cancer may result in symptoms because of compression and/or infiltration of the cancer mass into the surrounding tissues, and the cancer may metastasize to lung and bone. Metastases, in descending order of frequency, are most common in the neck lymph nodes and lung, followed by the bone, brain, liver, and other sites. Metastatic potential seems to be a function of the primary tumor size. Metastases in the absence of thyroid pathology in the physical examination findings are rare in patients with microscopic papillary carcinoma .
What To Expect When Having A Pet Scan
In preparing for;a PET scan, a radioactive substance is injected into the blood. The amount of radioactivity used is low. Because cancer cells in the body generally utilize sugar as their energy source to grow, they absorb more of the sugar than normal cells.
This test can be very useful for physicians to make a diagnosis of papillary thyroid cancer that has:
- Come back following prior surgery
- Spread to other sites in the body
- Diagnosed as papillary thyroid cancer but didn’t take up radioactive iodine
The PET/CT scan for a diagnosis of papillary thyroid cancer combines images of both PET and CT scans at the same time. This is because PET images alone are not very detailed. The computer shows the relative amount of radioactivity in a particular area and where the sugar is localized, appearing red or hot. The combination of these two images lets the doctor compare an abnormal area on the PET scan with its detailed appearance and location on the CT scan.
PET/CT scanning is not always positive in patients with a diagnosis of papillary thyroid cancer.
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