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.
Signs And Symptoms Of Advanced Medullary Thyroid Cancer
5 percent of thyroid cancer diagnoses. Detecting the cancer early can be difficult.
Medullary thyroid cancer commonly advances from the thyroid into the lymph nodes. Undiagnosed medullary thyroid cancer can spread into other neck tissues and eventually reach the liver, lungs, bone, and brain. Once it reaches distant parts of the body its unlikely to be cured.
What Is The Thyroid
The thyroid is a gland located at the front of the neck. You can feel it just below the thyroid cartilage, or “Adam’s apple.” It is a butterfly-shaped gland that stretches across the middle of the neck just below the thyroid cartilage, with its “wings” spreading towards the head, on either side of the thyroid cartilage. These “wings” are called the lobes of the thyroid, with the middle section being called the isthmus.
The thyroid gland produces, stores, and secretes the thyroid hormones thyroxine and triiodothyronine into the bloodstream. The thyroid does this as a response to a hormone produced by the pituitary gland, called thyroid stimulating hormone, or TSH. When the thyroid gland is “turned on” by TSH, it increases its uptake of iodine, which is needed to make thyroid hormone.
The principal cells of the thyroid are called follicular cells. These cells are mainly responsible for making and secreting thyroid hormone. Thyroid hormone plays an important role in controlling our metabolic rate. Many body functions such as temperature and heart rate are regulated by thyroid hormone. Too much thyroid hormone in your system is called hyperthyroidism, while too little is called hypothyroidism. An imbalance of thyroid hormone may cause serious health problems if not properly treated.
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What Stages Have To Do With Cancer Spread
Cancers are staged according to tumor size and how far it has spread at the time of diagnosis. Stages help doctors decide which treatments are most likely to work and give a general outlook.
There are different types of staging systems and some are specific to certain types of cancer. The following are the basic stages of cancer:
- In situ. Precancerous cells have been found, but they havent spread to surrounding tissue.
- Localized. Cancerous cells havent spread beyond where they started.
- Regional. Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant. Cancer has reached distant organs or tissues.
- Unknown. Theres not enough information to determine the stage.
- Stage 0 or CIS. Abnormal cells have been found but have not spread into surrounding tissue. This is also called precancer.
- Stages 1, 2, and 3. The diagnosis of cancer is confirmed. The numbers represent how large the primary tumor has grown and how far the cancer has spread.
- Stage 4. Cancer has metastasized to distant parts of the body.
Your pathology report may use the TNM staging system, which provides more detailed information as follows:
T: Size of primary tumor
- TX: primary tumor cant be measured
- T0: primary tumor cant be located
- T1, T2, T3, T4: describes the size of the primary tumor and how far it may have grown into surrounding tissue
N: Number of regional lymph nodes affected by cancer
M: Whether cancer has metastasized or not
What Causes Thyroid Cancer And Am I At Risk
Most cases of thyroid cancer have no risk factors. Thyroid cancer is more common in women. Studies have shown an increased risk of certain types of thyroid cancer in geographic areas where there is a high incidence of goiters due to a lack of dietary iodine. This is further supported by the decrease of thyroid cancers in these areas when individuals are given supplemental iodine.
The most established risk factor for the development of thyroid cancer is exposure to ionizing radiation to the neck area at a young age . This is supported by the high incidence of thyroid cancer seen in many populations exposed to radiation. This includes children 18 years or younger who were treated with radiation therapy for cancers such as Hodgkin’s disease or nasopharyngeal cancer, or as part of their therapy to prevent leukemia from spreading to the brain. In addition, children who received total body irradiation in preparation for bone marrow transplantation are also at higher risk. Radiation therapy was also used in the 1940-1960s for benign conditions like acne, and this population has an increased risk for thyroid cancer.
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Causes Of Thyroid Cancer
Thyroid cancer happens when there’s a change to the DNA inside thyroid cells which causes them to grow uncontrollably and produce a lump.
It’s not usually clear what causes this change, but there are a number of things that can increase your risk.
- other thyroid conditions, such as an inflamed thyroid or goitre but not an overactive thyroid or underactive thyroid
- a family history of thyroid cancer your risk is higher if a close relative has had thyroid cancer
- radiation exposure in childhood such as radiotherapy
- a bowel condition called familial adenomatous polyposis
- acromegaly a rare condition where the body produces too much growth hormone
How Does The Doctor Know I Have Thyroid Cancer
Most thyroid cancers are found when patients see a doctor because of new neck lumps . Sometimes doctors find neck lumps during a physical exam. Yet other times thyroid cancer may be found during an ultrasound test for other health problems.
If signs are pointing to thyroid cancer, more tests will be done.
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Is There A Way To Get A Better Idea Of Which Tumors Will Actually Grow
This is a very important question we are actively researching. The laboratories of James Fagin and Michael Berger are actively doing research to try to determine whether there is a genetic signature that would allow us to predict whats going to happen. If we can identify which mutations are important, we could just use a small needle to biopsy the cancer, analyze the genes, and be able to more accurately predict the likelihood that an individual cancer will progress.
I think patients would find that kind of information very helpful in deciding whether to be watched or proceed to immediate surgery. So even though active surveillance is working well in the vast majority of our patients with very small papillary thyroid cancers, were trying to use our molecular research laboratories to give us an even clearer idea of which tumors will cause problems so we can give our patients the best option.
Symptoms Of Lung Cancer
At first, you may not know the cancer has spread to your lungs. Thatâs because some people have no symptoms. If you do have symptoms, they may include:
- Pain in your chest or ribcage
- Frequent chest infections
Of course, these are all common signs of many other medical conditions, from mild to serious. Thatâs why itâs important to see your doctor if you have any of these symptoms.
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How Is Thyroid Cancer Managed Or Treated
Treatments for thyroid cancer depend on the tumor size and whether the cancer has spread. Treatments include:
- Surgery: Surgery is the most common treatment for thyroid cancer. Depending on the tumors size and location, your surgeon may remove part of the thyroid gland or all of the gland . Your surgeon also removes any nearby lymph nodes where cancer cells have spread.
- Radioiodine therapy: With radioiodine therapy, you swallow a pill or liquid containing a higher dose of radioactive iodine than whats used in a diagnostic radioiodine scan. The radioiodine shrinks and destroys the diseased thyroid gland along with cancer cells. Dont be alarmed this treatment is very safe. Your thyroid gland absorbs almost all of the radioiodine. The rest of your body has minimal radiation exposure.
- Radiation therapy: Radiation kills cancer cells and stops them from growing. External radiation therapy uses a machine to deliver strong beams of energy directly to the tumor site. Internal radiation therapy involves placing radioactive seeds in or around the tumor.
- Chemotherapy: Intravenous or oral chemotherapy drugs kill cancer cells and stops cancer growth. Very few patients diagnosed with thyroid cancer will ever need chemotherapy.
- Hormone therapy: This treatment blocks the release of hormones that can cause cancer to spread or come back.
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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How Is The Stage Determined
The staging system most often used for thyroid cancer is the AJCC TNM system, which is based on 3 key pieces of information:
- The extent of the tumor : How large is the cancer? Has it grown into nearby structures?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes?
- The spread to distant sites : Has the cancer spread to the distant organs such as the lungs or liver?
The systems described below are the most recent AJCC systems effective January 2018 and applies to differentiated, anaplastic and medullary thyroid cancers.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging.
The staging system in the table below uses the pathologic stage . It is determined by examining tissue removed during an operation. Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and might not predict the patients outlook as accurately as a pathologic stage.
Metastatic Lung Cancer Outlook
Lung cancer is the leading cause of cancer deaths in the world. Thereâs no way to prevent lung cancer, but there are ways to treat it. And thereâs reason to be hopeful: Doctors are working on new treatments every day. Immunotherapy, which boosts your bodyâs own cancer-fighting powers, has shown promise in recent years.
Your outlook for living with metastatic lung cancer depends in part on where the cancer started. Itâs rare, but people with sarcoma, renal cell carcinoma, bladder cancer, colon cancer, or melanoma can sometimes be cured with surgery. And chemotherapy may cure some people with cancer that started in the testicles or lymph nodes.
Most people with this type of cancer can expect to live about 5 years. But that doesn’t take into account newer treatments, like immunotherapy, which boosts your bodyâs own cancer-fighting powers. And it also doesnât reflect that everyone is different. How well you respond to treatment depends on what treatment you and your doctor chose, your overall health when you were diagnosed, how soon you were diagnosed, and how far the cancer has spread.
Joining a cancer support group or talking privately with a therapist are booth good ways to deal with your feelings. Ask your doctor to suggest options that may be right for you.
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Who Might Have Thyroid Cancer
Women are three times more likely than men to get thyroid cancer. The disease is commonly diagnosed in women in their 40s and 50s, and men in their 60s and 70s. Even children can develop the disease. Risk factors include:
- Exposure to radioactive fallout from nuclear weapons or a power plant accident.
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.
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My Short Time As A Lab Rat
Sadly, the next scan found the cancer was progressing. This became my time as an official lab rat.
I signed away my precious bodily fluids, my tissue, and all the data that can be generated about me when I agreed to participate in a clinical trial. Technically this is called
which is a fancy way of saying its a Phase II, Open-label, study in subjects with BRAF V600E-mutated rare cancers with several histologies to investigate the clinical efficacy and safety of the combination therapy of Dabrafenib and Trametinib. Which is another fancy way of saying Ill be taking pills designed to slow or shrink thyroid cancer tumors that have metastasized to my lungs.
My job was simple, just wash down a couple of pills a day and return over and over and over again to Houston for scans. Just meeting the study criteria was daunting. I had to visit the doc, sign a consent form, do blood work, EKG, chest X-ray, echocardiogram, and then visit skin, heart, eye, and lung doc. The skin doc was the most fun. Two female doctors gave me a thorough going over and when done they asked if they should leave the room while I dressed.
Why bother I said. Youve seen everything there is to see.
And thats just to see if I met the study criteria, which I did, and I then had to fly to Houston every two weeks for checkups, at least for a couple of months, all on my dime.
Why participate in a clinical trial?
What Will Happen After Treatment
Most people do very well after treatment, but you may need follow-up care for the rest of your life. This is because most thyroid cancers grow slowly and can come back even 10 to 20 years after treatment. Your cancer care team will tell you what tests you need and how often they should be done.
Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back. At first, your visits may be every 3 to 6 months. Then, the longer youre cancer-free, the less often the visits are needed.
Sometimes treatments may not cure your cancer. You many need to keep getting treatment and care. From time to time tests will be done to see how your treatment is working.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life.
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