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What Are The Symptoms Of Medullary Thyroid Cancer

What Are The Signs And Symptoms Of Familial Medullary Thyroid Cancer

Diagnosis and Initial Treatment of Medullary Thyroid Cancer

Medullary thyroid cancer may present as either a single swelling or nodule felt in the neck, or as symptoms of the cancer spreading to other areas of the body , or as symptoms and signs secondary to the release of calcitonin protein.

The commonest symptoms are associated with discomfort due to the presence of the nodule in the neck. Depending on its size and location within the thyroid, the lump can be visible and palpable more rarely and especially if invading the surrounding tissues and organs, it can be also associated with difficulties in swallowing, breathing or hoarse voice.

Other associated symptoms can include the skin appearing flushed and diarrhoea, which are caused by excessive production of the hormone calcitonin as well as other hormones.

Computed Tomography Scan For Medullary Thyroid Cancer

The CT scan of the neck for medullary thyroid cancer is an x-ray test that produces detailed cross-sectional images of your body from the bottom of your brain to the middle of your chest. It can help determine the location and size of the medullary thyroid cancer, whether the cancer has invaded into any nearby structures, and whether they have spread to lymph nodes in nearby areas. A CT scan can also be used to look for spread into distant organs such as the lungs.

A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures while you lie on the table. A computer then combines these pictures into images of slices of the part of your body being studied. A CT scan designed for a diagnosis of papillary thyroid cancer is sliced at 1mm steps. It is an incredibly detailed study that creates very exquisite images.

This is a CT scan of the neck in a patient with a small medullary thyroid cancer of the right thyroid lobe. The dashed arrow points to a small lymph node in the right mid neck.

Types Of Thyroid Cancer

There are 4 main types of thyroid cancer. They are:

  • papillary carcinoma this is the most common type, accounting for about 6 out of 10 cases it usually affects people under the age of 40, particularly women
  • follicular carcinoma accounts for around 3 out of 20 cases of thyroid cancer and tends to affect older adults
  • medullary thyroid carcinoma accounts for between 5 and 8 out of every 100 diagnosed cases unlike the other types of thyroid cancer, medullary thyroid carcinoma can run in families
  • anaplastic thyroid carcinoma this is the rarest and most aggressive type of thyroid cancer, accounting for less than 1 in 20 thyroid cancers it usually affects older people over the age of 60

Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers, and they’re often treated in the same way.

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Outlook For Thyroid Cancer

Around 9 in every 10 people are alive 5 years after a diagnosis of thyroid cancer. Many of these are cured and will have a normal lifespan.

But the outlook varies depending on the type of thyroid cancer and how early it was diagnosed. At present the outlook is:

  • more than 9 in 10 people with papillary carcinoma live at least 5 years after diagnosis
  • more than 9 in 10 people with follicular carcinoma live at least 5 years after diagnosis
  • more than 7 in 10 men, and around 9 in 10 women with medullary thyroid carcinoma live at least 5 years after diagnosis
  • around 1 in 10 people with anaplastic thyroid carcinoma live at least 5 years after diagnosis

Up to 1 in 4 people treated for thyroid cancer are later diagnosed with cancer in another part of the body, such as the lungs or bones, but cancer can often be treated again if this happens.

Page last reviewed: 28 August 2019 Next review due: 28 August 2022

How Is Familial Medullary Thyroid Cancer Treated

Medullary thyroid carcinoma: The third most common thyroid ...

The main treatment option is surgery, specifically a procedure called total thyroidectomy and central node dissection. This involves the complete removal of the thyroid gland and associated lymph nodes in the central compartment of the neck. The surgery can be performed either in patients with a confirmed diagnosis of medullary thyroid cancer or in patients with a strong family history of the condition who test positive for the RET gene mutation. In patients with confirmed familial medullary thyroid cancer, this surgery is carried out in advance, usually between 5 and 10 years of age, to prevent medullary thyroid cancer from developing in the future. If a patient who tests positive for the RET gene refuses preventative surgery, they will need regular blood tests to monitor calcitonin levels and scans of the neck to check for nodule growths.

Radiotherapy may be used to relieve symptoms in cases where surgery is not possible or where the cancer has spread. Chemotherapy is not usually used to treat medullary thyroid cancer, but can occasionally be used if the disease has spread to other organs of the body. In a small number of cases there are no curative treatment options and patients are treated in a palliative manner, that is, to relieve symptoms.

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Nci Ccr Medullary Thyroid Carcinoma Clinic

Each year, the NCI staff host the NCI CCR Medullary Thyroid Carcinoma Clinic. The clinic reviews the cases of patients with multiple endocrine neoplasia type 2 and/or medullary thyroid carcinoma and offers recommendations for the treatment and management of their disease. The next MTC Clinic is scheduled for February 19-21, 2020. Visit the clinic website to learn more.

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What Is Familial Medullary Thyroid Cancer

Medullary thyroid cancer is a rare form of thyroid cancer. The term medullary describes the type of cells in the thyroid gland affected by the cancer. The majority of patients with medullary thyroid cancer have no family history of the condition the remaining 20% of patients inherit the condition from a parent . Familial medullary thyroid cancer is inherited in a dominant way, which means a patient with the gene mutation for medullary thyroid cancer will have a 50% chance of passing it on to their offspring.

The inherited form of medullary thyroid cancer is associated with three conditions: familial medullary thyroid cancer, multiple endocrine neoplasia type 2A and multiple endocrine neoplasia type 2B . Both multiple endocrine neoplasia syndromes are characterised by the presence of other diseases in addition to medullary thyroid cancer.

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Imaging Tests For A Diagnosis Of Medullary Thyroid Cancer

Imaging tests may be done for a number of reasons, including to help find suspicious areas that might be cancer, to learn how far cancer may have spread, and to help determine the extent of surgery and the role of other treatments or therapies.

People who have or may have a diagnosis of medullary thyroid cancer will get one or more of the following tests:

How To Spot The Symptoms Of Thyroid Cancer

Is Stage 1 Thyroid Cancer Curable? | Thyroid Cancer Symptoms | Medullary Thyroid Carcinoma

You might be diligent with your smear tests and head to your GP as soon as you see a mole that’s changed shape. But theres one cancer on the rise in women that we might not be paying quite as much attention to: thyroid.

‘Thyroid cancer is an abnormal growth of thyroid cells that has the potential to spread to other parts of the body,’ says Dr. Kyle Zanocco, an endocrine surgeon and assistant professor of surgery at UCLA Health. Thyroid cancer occurs when thyroid cellswhich make up the butterfly-shaped gland that sits below your voice boxacquire genetic mutations that lead to an uncontrolled growth, says Dr. Zanocco.

The condition is especially common in women, who are three times more likely to develop thyroid cancer than men. While the disease can be found in any gender at any age, its most frequently found in women in their 40s and 50s, says Dr. Zanocco.

Experts dont know why thyroid cancer strikes more women, but there are theories. ‘Before puberty, thyroid cancer is seen evenly distributed in boys and girls, and we only see the proportion of women increasing after puberty,’ says Dr. R. Michael Tuttle, an endocrinologist at Memorial Sloan Kettering Cancer Center who specialises in thyroid cancer. ‘So it likely has something to do with the female hormones, but no one is really sure.’

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How Do I Know If I Have Thyroid Cancer

Thyroid cancer is unique since it can remain dormant for many years before symptoms appear. If you have any of the following symptoms, you should see a doctor immediately.

  • a lump or swelling in the front of the neck
  • swollen lymph nodes in the neck this can often take the form of a large mass in the neck or as multiple swollen nodes in the thyroid
  • hoarseness or other voice changes, including difficulty speaking in a normal voice
  • trouble swallowing or breathing
  • persistent pain in the throat or neck that does not go away
  • diarrhea

Although you should see your doctor if you are having any of these symptoms, it does not mean you have cancer. Tests for thyroid cancer include physical examinations a blood test, ultrasounds, thyroid screening or a laryngoscopy .

Treatment For Thyroid Cancer

The thyroid cancer could be treated both with surgery and by radioactive iodine. In certain cases, radiation therapy is also used as a mode of treatment. Before treating a patient with this cancer, it is more important to check the age of a patient, type, and stage of thyroid cancer. Other treatments include:

  • Targeted drug therapy.
  • Removal of the thyroid and the infected gland through surgery.
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    Signs And Symptoms Of Medullary Thyroid Cancer

    The main symptom of thyroid cancer is a nodule, or lump, in the thyroid gland. Sometimes, lymph nodes in the neck will appear swollen. Other possible symptoms include problems breathing, difficulty or pain swallowing, and hoarseness. However, often thyroid cancer does not cause any symptoms and may be found as part of a routine exam.

    In children, medullary thyroid cancer is most often seen as part of a genetic syndrome. In certain cases, the thyroid gland may be removed before there are any signs of cancer as a way to prevent MTC.

    What Is The Prognosis For Someone With Medullary Thyroid Cancer

    Medullary carcinoma of thyroid. Causes, symptoms ...

    The estimate of how a disease will affect you long term is called prognosis. Every person is different and prognosis will depend on many factors, such as:

    • If the cancer has spread to other parts of your body
    • If the cancer responds to chemotherapy
    • How much of the tumor was taken out during surgery

    If you want information on your prognosis, it is important to talk to your doctor. NCI also has resources to help you understand cancer prognosis.

    Doctors estimate MTC survival rates by how groups of people with MTC patients have done in the past. Given that there are so few MTC patients, survival rates may not be very accurate. They also dont consider newer treatments being developed. We know that people can live with MTC for many years, even though there is no cure.

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    Signs And Symptoms Of Mtc

    The symptoms associated with medullary thyroid cancer are similar to other forms of thyroid cancer such as differentiated thyroid cancer.

    Symptoms may include:

    • The sensation of a lump with swallowing
    • Hoarseness or enlarged lymph nodes that do not go away

    For patients with medullary thyroid cancer and MEN2 type B, additional physical features may be present. In infancy, the most common signs are the inability to make tears and constipation. In school-age children, symptoms include:

    • An elongated face
    • Nodules on the lips, tongue or on the inside cheeks of the mouth
    • Droopy or swollen-appearing eyelids or lips
    • Scoliosis
    • Constipation

    School-age children with abdominal distension and constipation should also be evaluated for Hirschsprungs disease, a rare intestinal disorder, which is often associated with MEN2 type A.

    What Are Symptoms Of Medullary Thyroid Cancer

    Symptoms of medullary thyroid cancer include:

    • A lump or nodule in the thyroid
    • Nodule may cause no symptoms
    • In some cases, the tumor may have spread to lymph nodes in the neck, which may be enlarged
  • Pain in the neck, jaw, or ear
  • Difficulty breathing or swallowing if the nodule is large
  • Hoarseness if the cancer invades the nerve that controls the vocal cords
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    The Following Are A List Of Tests That Are Frequently Used In Patients With A Diagnosis Of Medullary Thyroid Cancer

    Studies-Scans-Xrays For Diagnosis of Medullary Thyroid CancerOther Scans and X-rays

    • MRI scan as indicated primarily for concern of spine or soft tissue spread
    • PET/CT scan as indicated for assessment of metastatic disease

    Medical history and physical examination is required for all patients with a potential diagnosis of medullary thyroid cancer

    If there is a suspicion that you may have a diagnosis of medullary thyroid cancer, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had a diagnosis of medullary thyroid cancer, sudden cardiac death, high blood calcium levels, kidney stones, adrenal tumors, parathyroid tumors… these are all important factors.

    Your doctor will examine you to get more information about possible signs of medullary thyroid cancer and other health problems. During the exam, the doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck. They will look at you eyes and in your mouth as well. Examination of your voice box is part of the physical examination obtained by the surgeon for any thyroid lump. This is called a laryngoscopy and more is written about it at the end of this section.

    What Is My Risk Of Getting It

    Medullary Thyroid Cancer Update.

    There is no one thing that causes a person to get thyroid cancer. The following may contribute to thyroid cancer

    • exposure to large amounts of radiation
    • family history of either thyroid cancer or goitres
    • too little or too much iodine in a persons diet.

    Having any of the above risk factors does not guarantee that someone will develop this type of cancer. In fact, thyroid cancer most often develops without many of these risk factors. You should see your doctor if you develop symptoms that do not go away.

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    How Is Familial Medullary Thyroid Cancer Diagnosed

    The diagnosis is based on history of a thyroid nodule or lump and also specifically on whether the patient has a family history of any similar lumps or diagnoses of thyroid cancers in family members. This would provide strong evidence of a genetic link, which is important in diagnosing familial medullary thyroid cancer and deciding on future treatment.

    It may also be necessary to obtain a tissue sample to analyse what is happening to the C-cells within the nodule. To do this, a test called fine needle aspiration cytology of the thyroid nodule is required. This involves using a small thin needle to obtain a specimen of the tissue in the lump or nodule this can be uncomfortable, but there is usually little to no pain. The specimen is then analysed under a microscope to look for certain features associated with medullary thyroid cancer, such as the hormone calcitonin, that can be present as a single protein or aggregated in a complex structure called amyloid. In case the tumour has spread to one or more lymph nodes, they can be sampled as well to make a clear diagnosis.

    A blood test is carried out to measure levels of calcitonin, which are raised in medullary thyroid cancer.

    The definitive diagnosis of familial medullary thyroid cancer is made through genetic analysis of the RET gene mutation. The presence of this gene mutation suggests a strong chance of the patient developing medullary thyroid cancer.

    All of these tests can be performed as outpatient investigations.

    What Is The Prognosis Of Medullary Thyroid Cancer

    The prognosis of MTC is usually not as favorable as differentiated thyroid cancers . However, if discovered early, surgery can be curative. Even in cases where it is not caught early, MTC often progresses relatively slowly. Long-term survival depends on the stage of disease at the time of diagnosis. The blood levels of calcitonin or CEA over the first year after surgery can also be a predictor of a patients survival.

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    Surgical Removal Of The Thyroid

    Total thyroidectomy is a first-line treatment for medullary thyroid cancer. Sometimes individuals who have not been diagnosed with MTC but who have been tested and found to have the RET mutation opt to have a total thyroidectomy in order to prevent MTC.

    In cases of confirmed MTC lymph nodes or other tissue in the surrounding area are often removed at the same time as the thyroid. This may depend on the size of the tumor and other individual circumstance.

    If the tumor is small and confined to the thyroid surgery may be the only treatment necessary for MTC. Following a total thyroidectomy it is necessary to take levothyroxine for the remainder of your life since you no longer have a thyroid gland to produce thyroid hormones for you.

    Your experience following a total thyroidectomy will be individual and also depend on whether or not your healthcare provider found it necessary to remove lymph nodes in your neck or other tissues at the same time. Most people can expect to have a small incision on the front lower portion of the neck, approximately 6-8 cm in length. Immediately after total thyroidectomy you can expect to have some throat pain and hoarseness. Most people stay overnight in the hospital.

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