How Does Age Matter Once You’ve Had Thyroid Cancer
To date, the the American Thyroid Association guidelines focus on three categories to calculate the risk that someone who has been treated for differentiated thyroid cancer will face recurrence.4 When assessing your risk of developing thyroid cancer again, the current ATA system classifies thyroid cancer status into low, intermediate or high risk for recurrence, taking into account the stage, whether the cancer is invasive, if neck lymph nodes are involved, as well as other factors.
This team of researchers drilled down further to look at whether age at the time of a patients diagnosis has any direct impact on the chance that thyroid cancer will come back. ;In particular, they looked at the association between age at diagnosis and rate of thyroid cancer recurrence and whether age has any influence on the accuracy of thyroid cancer reappearing based on the ATA diagnosis methods.1
To study the effect of age alone on risk of cancer recurrence, this team of researchers evaluated 1,603 patients with differentiated thyroid cancer. The patients had a median age of 49 years and a disease-free survival time of 44 months, meaning the chance of avoiding relapse of thyroid cancer was about four years for those at under age 50.1
The patients had undergone treatment at four different institutions and had undergone both thyroidectomy and radioiodine therapy. They were followed for at least one year after treatment. ;
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Doctor Visits And Follow
Your health care team will explain what tests you need and how often they should be done. Your schedule of doctor visits, exams, and tests will depend on the original extent of your cancer, the specific type of thyroid cancer you had, how it was treated, and other factors.
Papillary or follicular cancer: If you have had papillary or follicular cancer, and your thyroid gland has been completely removed or ablated, your doctors may consider at least one radioactive iodine scan after treatment, especially if you are at higher risk for recurrence. This is usually done about 6 to 12 months later. If the result is negative, you will generally not need further scans unless you have symptoms or other abnormal test results.
Your blood will also be tested regularly for TSH and thyroglobulin levels. Thyroglobulin is made by thyroid tissue, so after total thyroid removal and ablation it should be at very low levels or not be found in your blood at all. If the thyroglobulin level begins to rise, it might be a sign the cancer is coming back, and further testing will be done. This usually includes a radioactive iodine scan, and may include PET scans and other imaging tests.
For those with a low-risk, small papillary cancer that was treated by removing only one lobe of the thyroid, routine physical exams by your doctor, thyroid ultrasounds and thyroid blood tests are typical.
Long Term Monitoring And Treating Recurrent Or Persistent Disease
After your treatment, you will receive life-long monitoring. This is for two main reasons.
- First, long-term monitoring is important to make sure that your dose of thyroid hormone replacement is appropriate neither too low nor too high for your specific needs.
- Second, you will receive testing to find out if there is persistent disease or possible recurrence. Many people with differentiated thyroid cancer experience persistent disease or a recurrence, sometimes many years after the initial treatment. The prognosis for any person with a recurrence is better if it is discovered early. This is why life-long monitoring is important.
- The exact type of monitoring, and how often it takes place, depends on the size of the original tumor and whether the cancer had spread locally or distantly, as well as other factors.
- People free of disease receive less monitoring or testing than those with evidence of persistent disease.
- Also, testing is spread out and becomes less frequent when the patient becomes free of disease. You and your doctor should discuss a plan to fit your situation.
Monitoring will most likely include:
Also, for people in medium-risk or high-risk circumstances, long-term monitoring may sometimes include:
Treating Persistent or Recurrent Disease
If your testing shows persistent or recurrent disease, your treatment may include some or all of these treatments. Your treatment will be tailored to your own circumstances.
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Setting Limits: Lymph Node Removal & Thyroid Cancer
A new study seeks to establish a clinical guideline to quantify the risk of metastatic lymph nodes in thyroid cancer patients. The findings should go a long way to help ease the mind of the patientsand the physicians.
With thyroid cancer incidence on the rise, especially papillary thyroid cancer, surgical tumor resection is a critical component of the overall treatment plan, which might also include one or more of several adjuvant treatment options such as concomitant lymph node dissection.
The American Cancer Society notes that although an estimated 62,450 new cases of thyroid cancer will be diagnosed in the U.S. in 2016, fortunately, the death rate has not increased alongside incidence. Nevertheless, five-year survival rates for stage IV papillary thyroid cancer remain at only about 51%, and lymphovascular invasion is a key risk factor for occult, recurrent, or persistent disease.
With standards yet to be established regarding the number of LNs a surgeon might remove to help determine the existence of occult disease in addition to variations in clinical management thyroid cancer patients may be undergoing unnecessary or even inappropriate treatments that themselves carry risk for debilitating complications.
Signs Of Thyroid Cancer Recurrence
About 35 percent of individuals who have thyroid cancer experience a recurrence within 40 years of initial treatment, and two thirds of the recurrences occur 10 years after their treatment, according to the Thyroid Community. While a patient may show symptoms of a recurrence, oftentimes a patient may show no outward signs the cancer has returned.
Signs that thyroid cancer may include pain in the neck that may radiate up to the ears, coughing, trouble swallowing, breathing problems and hoarseness when talking.
Abnormal lumps or bumps under the skin can be a trouble sign. Patients may also notice swelling around or in the neck or in the lymph nodes. This occurs because the glands are so close to the skin.
Doctors can test thyroglobulin protein levels in the blood. After treatment, there should be no thyroglobulin present. Doctors may test at three month or 12 month intervals. If they see an increase in this protein, they may do further tests to determine whether the cancer has recurred. this protein is measured after your thyroid surgery to investigate if the cancer has returned.
Reasons for Return
Thyroid cancer can re-emerge if microscopic cancer cells spread beyond the thyroid before initial treatment. It can also recur if some pieces of thyroid tissue werent removed during surgery or cancer is in the bones, lungs or lymph nodes.
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Reason 2: Thyroid Cancer Survival Rates Are Great
Not all cancers are created equal.
Some types of cancer are more or less a death sentence.
Thyroid cancer is NOT one of them.
Your risk of dying from thyroid cancer is quite low.
One research study showed that survival rates among those who underwent thyroid cancer treatment were NOT significantly different from those who went untreated. The difference was a mere 2%.
Thyroid cancer survival in the United States: observational data from 1973 to 2005.
Papillary thyroid cancers of any size that are limited to the thyroid gland have favorable outcomes whether or not they are treated in the first year after diagnosis and whether they are treated by hemithyroidectomy or total thyroidectomy.
Whats more shocking is that of the tens of thousands of recorded cases, only 1.2% didnt receive immediate thyroid cancer treatment after diagnosis.
If survival rates are relatively the same
again, whats the big rush to undergo surgical thyroid treatment?
Yet, heres something that most fail to take into account
Second Cancers After Thyroid Cancer
Survivors of thyroid cancer can be affected by a number of health problems, but often their greatest concern is facing another cancer. Cancer that comes back after treatment it is called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer.
Unfortunately, being treated for cancer doesnt mean you cant get another. People who have had thyroid cancer can still get the same types of cancers that other people get. In fact, they might be as risk for certain types of cancer.
People who have or had thyroid cancer can get any type of second cancer, but they have an increased risk of developing:
Adrenal cancer risk is especially high in people who had the medullary type of thyroid cancer.
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If The Cancer Comes Back
If your cancer does come back at some point, your treatment options will depend on the where the cancer is, what treatments youve had before, and your current health and preferences. Treatment options might include surgery, radiation therapy, chemotherapy,;targeted therapy or some combination of these. For more on how recurrent cancer is treated, see Treatment of Thyroid Cancer, by Type and Stage.
For more general information on recurrence, see Understanding Recurrence.
Thyroid Cancer: How Age Affects Risk Of Recurrence
with Victor J. Bernet, MD, and Jonathon O. Russell, MD, FACS
So, you’ve been diagnosed with differentiated thyroid cancer and have had successful treatment. Thats great news. Yet, it would be well within reason, even expected, if you find yourself wonderingwhat is my risk of recurrenceat any point in the future?
Many factors influence the chance that you may experience a return or relapse of thyroid cancer. New data suggest that age alone appears to be an independent risk factor for predicting whether differentiated thyroid cancer, the most common kind, will reoccur,1 according to study findings published in the journal, Thyroid.
It seems that the older you are at the time of your initial diagnosis for differential thyroid cancer, the greater your risk of recurrence may be. That said, its important to understand that its not definite that the thyroid cancer will return, just an increased likelihood. Other factors, such as the stage of the cancer at diagnosis, still play a roleand the stage at diagnosis may soften the effects of increasing age,1 the researchers report.
How Common Is Thyroid Cancer
Thyroid cancer is a rare form of cancer, accounting for less than 1% of all cancer cases in the UK. Each year, around 2,700 people are diagnosed with thyroid cancer in the UK.
It’s most common in people aged 35 to 39 years and in those aged 70 years or over.
Women are 2;to 3;times more likely to develop thyroid cancer than men. It’s unclear why this is, but it may be;a result of;the hormonal changes associated with the female reproductive system.
Papillary Thyroid Cancer Complications
Even with radioactive iodine therapy and surgery, it’s still possible that papillary thyroid cancer , the cancer may recur. Recurrent thyroid cancer may occur yearseven decadesafter the initial treatment for the disease. Fortunately, though, recurrent thyroid cancer is treatable.
Patients with stages 1 or 2 thyroid cancer have an 85% chance of reaching complete remission after their initial cancer treatment. The 5-year survival rate is 80% for stage 1 patients and 55% for stage 2. Patients with stage 3 or 4 cancer have similar 5-year survival ratesbetween 15% and 35%.1
Thyroid cancer is treated, in part, by surgically removing all or part of the thyroid gland, a procedure known as a thyroidectomy. This is followed by radioactive iodine ablation of thyroid cells that may remain after this operation.
The most common sites where recurrent thyroid cancer appears are in the lymph nodes in your neck. Papillary thyroid cancer may also re-develop in other parts of the body, such as the bones and lungs.
- Thyroid Cancer: Complications. Mayo Clinic Health Information Web site. Available at: http://www.mayoclinic.com/health/thyroid-cancer/DS00492/DSECTION=complications. April 10, 2009. Accessed February 26, 2010.
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Reason 1: Thyroid Cancer Is Common And Often Harmless
Thyroid cancer rates have been on the rise.
Not because more people are developing thyroid cancer.
Its because more people than ever are being screened today. And the detection technologies used are now able to detect cancer that was previously undetectable.
Thyroid tumors are actually very common.
Several studies and reports have shown that thyroid cancer is commonly discovered during autopsies, and are unrelated to the cause of death.
Some studies report that thyroid cancer could be detectible in just about everyone, if they were able to look close enough and at the right time.
The truth is, like many cancers, thyroid cancer can spontaneously develop and disappear on its own. Your body is designed to fight cancer cells and often wins.
Unfortunately, we only think about the worse cases of cancer, when the body is already losing the battle.
Today, thyroid cancer rates have increased because were able to detect smaller and smaller thyroid tumors.
But, if left untreated , how many of these tumors would resolve on their own?
Many experts say that it happens much more than you might think.
So, whats the big rush to undergo surgical thyroid cancer treatment?
Survivability rates are great either way
A Surprising Scary Diagnosis
After that day, things happened at warp speed. My seasonal allergy symptoms and raspy voice turned out to be subtle signs that a mass was pressing against my trachea. A soft tissue neck ultrasound and fine needle biopsy soon revealed that I had a four-centimeter tumor covering the entire right lobe of my thyroid gland. It turned out to be a type of thyroid cancer called follicular variant of papillary carcinoma.
I never gave much thought to my thyroid. But amid all the testing and my cancer diagnosis, I learned just how important it is. This butterfly-shaped gland produces thyroid hormone , which regulates just about every function in the body, such as metabolism, heartbeat, temperature, mood, and other important processes. It reaches out to nearly every cell in the body.
“The most common type of thyroid cancer is papillary carcinoma,” says thyroid cancer specialist Eric Whitman, MD, medical director of Atlantic Health Cancer Care in Morristown, New Jersey. “Follicular variant is a subtype. Papillary and follicular thyroid cancers account for more than 90% of all thyroid cancers. They tend to grow very slowly.” While follicular thyroid cancers usually do not spread to the lymph nodes, like many other cancers do, they can move into other body areas, such as the lungs or bones.
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Lymph Node Assessment Model
In How Many Lymph Nodes Are Enough? Assessing the Adequacy of Lymph Node Yield for Papillary Thyroid Cancer, published in the Journal of Clinical Oncology, a team of researchers from the Duke Clinical Research Institute and the Duke Cancer Institute in Durham, North Carolina, including Julie A. Sosa, MD, MA and Terry Hyslop, PhD, set out to provide as definitive an answer as currently possible to the question posed in the title of their pioneering study.
Endocrinologists and their patients can make decisions about the need for other treatment based on good pathologic evidence. Knowing how many lymph nodes would need to be assessed to truly be certain of the risk of occult disease can help them with dynamic staging, adjuvant treatment choice, and intensity of follow-up. Terry Hyslop, PhD, Duke Clinical Research Institute, Duke Cancer Institute, Duke University, Durham, N.C.
What Causes Thyroid Cancer
In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition.
Risk factors for thyroid cancer include:
- having a benign thyroid condition
- having a family history of thyroid cancer
- having a bowel condition known as familial adenomatous polyposis
- acromegaly; a rare condition where the body produces too much growth hormone
- having a previous benign breast condition
- weight and height
Read more about the causes of thyroid cancer
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Does Change In Tsh Levels Indicate Return Of Thyroid Cancer
Thyroid cancer occurs when cancerous cells are detected in the tissues of the thyroid gland. A six monthly follow up care plan is advised after the culmination of the treatment for thyroid cancer.
This plan may include physical examinations and medical tests on a regular basis to monitor the recovery of the patient in the years to come. The reason being that in approximately 10 to 30 percent of thyroid cancer patients, recurrence or metastasis of the disease has been identified.
Of these patients, approximately 80 percent develop recurrence with disease in the neck alone and the rest 20 percent develop recurrence with distant metastases. The most common site of distant metastasis is the lung. The prognosis for patients with clinically detectable recurrences is generally poor, regardless of the cell type.
Some laboratories follow the concurrent re-measurement approach which involves saving the unused blood sample left after a Tg test has been completed. This extra blood can be re-measured side by side with a future blood sample. This approach is considered to be the best way as it helps in tracking the recurrence of tumor at an early stage by indicating authentic changes in the Tg level. Additionally, laboratories that bank patient specimens will have them available for any new tumor marker tests that may be developed in the future.
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Can I Lower The Risk Of My Cancer Progressing Or Coming Back
If you have thyroid cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, its not yet clear if there are things you can do that will help.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight is important. We know that these types of changes can have positive effects on your health that can extend beyond your risk of cancer.
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