Management Of Thyroid Cancer
Malignant diagnoses require surgical intervention. Papillary thyroid carcinoma and medullary thyroid carcinoma are often positively identified on the basis of FNAB results alone. Cervical metastases discovered preoperatively or intraoperatively should be removed by means of en bloc lymphatic dissection of the respective cervical compartment while sparing the nonlymphatic structures.
Patients with follicular neoplasm, as determined with FNAB results, should undergo surgery for thyroid lobectomy for tissue diagnosis. The extent of surgical therapy for well-differentiated neoplasms is controversial. Primary treatment for papillary and follicular carcinoma is surgical excision whenever possible. Total thyroidectomy has been the mainstay for treating well-differentiated thyroid carcinoma. Modifications to total thyroidectomy include subtotal thyroidectomy to reduce the risk of recurrent laryngeal nerve injury and hypoparathyroidism.
A 2015 consensus statement from the American Thyroid Association on the management of patients with differentiated thyroid cancer who have recurrent/persistent nodal disease stated the following :
HÃ¼rthle cell carcinomas
Medullary thyroid carcinomas and familialmedullary thyroid carcinomas
Anaplastic thyroid carcinoma, primary thyroid lymphoma, thyroid sarcoma
The treatment for thyroid sarcomas is total thyroidectomy. Radiation therapy may be used in an adjunctive setting.
Thyroid Cancer: What Women Should Know
The symptoms start slowly. Fatigue is the most common. There might bechanges in hair, nails or skin, and other vague complaints that could becaused by aging, diet, stress or dozens of other factors.
Women in the prime of their lives, busy with work and families, may noteven notice. When a doctor finally diagnoses an underactivethyroiddue to cancer, it often comes as a shock.
Jonathon Russell, M.D., assistant professor ofOtolaryngology Head and Neck Surgeryat The Johns Hopkins Hospital, says, Typicalthyroid cancerpatients are women between the ages of 30 and 60younger than many peoplewould think. Theyre likely to put off getting seen by a doctor and mayblame their symptoms on other causes.
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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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
Thyroid Cancer Symptom #: Lump Or Mass In The Neck
When thyroid cancer symptoms do exist, the most common symptom is a lump or a mass in the neck. This lump can be noted from a mass within the thyroid gland itself or when a thyroid cancer has spread to a lymph node. Thyroid cancer lymph nodes are usually not painful whatsoever. When a thyroid cancer lymph node is painful, the most common diagnosis is a special type of thyroid cancer called medullary thyroid cancer.
A case in point. A healthy 35 year young woman is having lunch with a friend and this friend notices a lump in her neck. Her high resolution ultrasound shows a lump in her right thyroid gland
Figure 1: The red line points to the right thyroid mass shown in the high resolution ultrasound
Her needle biopsy shows the most common type of thyroid cancer effecting women called papillary thyroid cancer. Her ultrasound further confirmed that the papillary thyroid cancer had spread to some lymph nodes in her neck and the CAT scan examining her thyroid cancer is shown in Figure 2.
Figure 2: Red arrow in this CAT scan shows the right thyroid mass and the yellow arrow is pointing to the papillary thyroid cancer spread to a small neck lymph.
Expert thyroid cancer surgical care is required to achieve the best cure rate and lowest complication rate for thyroid cancer. Figure 3 Shows what this papillary thyroid cancer looks like after it has been removed.
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Biochemical Testing For Mtc
Because MTC cells produce calcitonin, elevated serum calcitonin levels are diagnostic of MTC. Although routine measurement of serum calcitonin has low yield in managing the solitary thyroid nodule because of the uncommon nature of MTCs, it is useful in the surveillance of patients with a history of MTC and in managing familial forms. Stimulating calcitonin release by using intravenous pentagastrin increases the sensitivity of the test. For pentagastrin-stimulated calcitonin evaluation, a baseline plasma calcitonin level is measured, followed by the intravenous administration of pentagastrin 0.5 mg/kg and serial measurements of calcitonin 1.5 and 5 minutes after injection. Elevated basal or stimulated calcitonin levels above the normal range for the laboratory strongly suggest MTC.
Plasma calcitonin levels are commonly increased before clinical evidence of MTC appears. Although this finding was once the mainstay in diagnosing familial forms of MTC, results of genetic testing have largely supplanted it. Plasma calcitonin testing is now used for the early detection of MTC in patients already known to be at risk for MTC because of their family history and genetic results. This level is most commonly used as a tumor marker to identify residual and metastatic disease after thyroidectomy to treat MTC.
What Are The Different Types Of Thyroid Cancer
Thyroid cancer is categorized based on the type of thyroid cells where the cancer begins and how the cancer cells appear under a microscope.
There are two kinds of cells found in the thyroid.
Follicular cells are the most common. They produce thyroid hormone, which is important for growth, mental function and helping the body create energy. Most thyroid cancers develop from follicular cells.
Parafollicular cells, also known as C cells, produce a small amount of the hormone calcitonin, which helps control calcium metabolism. Most parafollicular cells are in the upper third of each lobe. Medullary thyroid cancer is the only thyroid cancer that develops from parafollicular cells.
Thyroid cancers can also be categorized based on the appearance of their cells. Cancer cells that look most like normal, healthy cells are called well differentiated. Patients with well differentiated thyroid cancers are most likely to be disease-free at the end of treatment. Poorly differentiated and undifferentiated cancer cells look less and less like healthy cells. These forms of thyroid cancer are usually harder to treat and the outlook for these patients is worse.
Doctors believe most thyroid cancers start as well differentiated. As the cancer grows, its cells can develop additional mutations, changing it into a less differentiated, harder-to-treat type of thyroid cancer.
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Early Warning Signs Of Thyroid Cancer
The most common early sign of thyroid cancer is an unusual lump, nodule or swelling in the neck. If you notice a new or growing lump, you should see your doctor, who can run additional tests to identify the cause and determine if it is a tumor. Most nodules on the thyroid are usually benign, but it is important to have any unusual growths examined by a health care professional.
Other early warning signs of thyroid cancer include:
- Swollen glands in the neck
- A cough that persists and is not caused by a cold
Other possible symptoms of thyroid cancer include:
Neck pain: In many cases, neck pain starts in the front. In some cases, the neck pain may extend all the way to the ears.
Voice changes: Experiencing hoarseness or other voice changes that do not go away could be a sign of thyroid cancer.
Breathing problems: Sometimes thyroid cancer patients say it feels like they are breathing through a straw. This breathing difficulty is often a symptom of the disease.
Trouble swallowing: A growth or nodule on the thyroid gland may interfere with swallowing.
Treatments For Thyroid Cancer
Treatment for thyroid cancer depends on the type of thyroid cancer you have and how far it has spread.
The main treatments are:
- surgery to remove part or all of the thyroid
- radioactive iodine treatment you swallow a radioactive substance that travels through your blood and kills the cancer cells
- external radiotherapy a machine is used to direct beams of radiation at the cancer cells to kill them
- chemotherapy and targeted therapies medicines used to kill cancer cells
After treatment, you’ll have follow-up appointments to check whether the cancer has come back.
Read more about how thyroid cancer is treated.
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Radioactive Iodine Ablation And Treatment
131I has had an important role in the treatment and management of thyroid cancer since 1946. It is used in coordination with thyroidectomy to completely ablate the thyroid gland and to postoperatively eradicate possible residual cancer.131I works by entering the thyroid cells via the sodium iodide transporters and emitting short-wavelength beta rays, causing acute cell death. When administered the first time after surgery, it is referred to as ablation, whereas subsequent administrations for residual disease are referred to as treatment.,
Removing the remnant tissue serves to decrease the potential for relapse and also to increase the sensitivity of follow-up diagnostic tests that facilitate the detection of metastatic or residual disease. It is particularly useful for differentiated thyroid cancer, because they account for the majority of thyroid cancers and are associated with a 10-year survival rate of between 90% and 95%. This survival rate suggests a need for long-term surveillance and testing for recurrence., Although it has mainly been used as an adjuvant therapy, 131I therapy also remains the mainstay treatment for nonsurgical and incompletely resectable thyroid tumors, such as microscopic or metastatic disease.
Cancer May Spread From Where It Began To Other Parts Of The Body
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.
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Thyroid Cancer Risk Factors
Although the exact cause of thyroid cancer is unknown, certain risk factors have been identified. They include:
Not everyone with risk factors gets thyroid cancer. However, if you have risk factors it is a good idea to discuss them with your doctor.
Some cases of thyroid cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
When To Get Medical Advice
See a GP if you have symptoms of thyroid cancer. The symptoms may be caused by less serious conditions, such as an enlarged thyroid , so it’s important to get them checked.
A GP will examine your neck and can organise a blood test to check how well your thyroid is working.
If they think you could have cancer or they’re not sure what’s causing your symptoms, you’ll be referred to a hospital specialist for more tests.
Find out more about how thyroid cancer is diagnosed.
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Thyroid Cancer Symptom #: Fatigue
Fatigue is a common symptom of thyroid cancer but often overlooked due to the complexity of other potential causes of fatigue. In most circumstances, individuals with thyroid cancer usually present with normal production of thyroid hormone. Although almost all doctors examine thyroid function in the evaluation of a patient with a potential thyroid cancer, those thyroid functions are also almost always normal. The reason that thyroid cancers can produce a symptom of fatigue is not clearly understood. However, with the effective expert surgical management of a person with thyroid cancer who has a symptom of fatigue caused by their thyroid cancer, their symptom is relieved almost immediately following their operation. In fact, this relief, at times, can be quite amazing.
Thyroid Cancer Symptom #: A Cough That Wont Go Away
It is easy to dismiss a thyroid cancer symptom of a simple cough. Many other potential causes of a cough exist including allergies, post nasal drip, and reflux of stomach acids. These are much more commonly identified as the cause of the simple cough or need to clear the throat than thyroid cancer itself. The cause of the symptom of thyroid cancer of a cough which will not go away is likely due to some form of irritation to the sensory or movement nerves of the voice box. This can be caused by inflammation or irritation of the nerves to the voice box by the thyroid cancer or even due to direct or indirect pressure on these nerves or the breathing tube itself.
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Treatment Of Advanced Thyroid Cancer
Thyroid cancer that spreads outside the neck area is rare, but can be a serious problem. Surgery and radioactive iodine remain the best way to treat such cancers as long as these treatments continue to work. However, for more advanced cancers, or when radioactive iodine therapy is no longer effective, other forms of treatment are needed. External beam radiation directs precisely focused X-rays to areas that need to be treatedoften tumor that has recurred locally or spread to bones or other organs. This can kill or slow the growth of those tumors. Cancer that has spread more widely requires additional treatment.
New chemotherapy agents that have shown promise treating other advanced cancers are becoming more widely available for treatment of thyroid cancer. These drugs rarely cure advanced cancers that have spread widely throughout the body but they can slow down or partially reverse the growth of the cancer. These treatments are usually given by an oncologist and often require care at a regional or university medical center.
After A Diagnosis Of Thyroid Cancer
After a diagnosis of thyroid cancer you may feel disbelief, uncertainty, fear and anxiety. There is no right or wrong way to feel and experiencing a range of emotions is normal. While the most common types of thyroid cancers have a very good long-term prognosis, you may still feel shocked and confused. It may help to talk to family and friends about how you are feeling.
Ask your specialist to explain treatment options and any potential side effects and financial concerns. Take as much time as you can so that you can make well-informed decisions.
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Papillary Thyroid Cancer: What About Lymph Nodes
We have lymph nodes all over our body that are made up of groups of infection-fighting and cancer-fighting immune cells. We all have had “swollen glands” in our neck when we had a sore throat or tonsils. These same glands that get swollen when we have a neck infection can help fight cancer by preventing the cancer cells from spreading from the thyroid to the rest of the body. It is common for papillary thyroid cancer to spread into the lymph nodes of the neck before the cancer is discovered and diagnosed. Again, since there usually aren’t any symptoms, the cancer grows slowly for years and has time to spread into the lymph nodes, which are doing their job of capturing the cancerous cells before they can spread further. Thus, cancer that has spread into the neck lymph nodes is common with papillary thyroid cancer and may occur in as many as 40 percent of patients with small papillary cancers. In patients with larger papillary thyroid cancers, lymph node spread within the neck lymph nodes may occur in up to 75 percent of cases.
Signs Of Thyroid Cancer Include A Swelling Or Lump In The Neck
Thyroid cancer may not cause early signs or symptoms. It is sometimes found during a routine physical exam. Signs or symptoms may occur as the tumor gets bigger. Other conditions may cause the same signs or symptoms. Check with your doctor if you have any of the following:
- A lump in the neck.
- Trouble breathing.
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Age Gender And Being Exposed To Radiation Can Affect The Risk Of Thyroid Cancer
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Risk factors for thyroid cancer include the following:
- Being between 25 and 65 years old.
- Being female.
- Being exposed to radiation to the head and neck as an infant or child or being exposed to radioactive fallout. The cancer may occur as soon as 5 years after exposure.
- Having a history of goiter .
- Having a family history of thyroid disease or thyroid cancer.
- Having certain geneticconditions such as familial medullary thyroid cancer , multiple endocrine neoplasia type 2A syndrome , or multiple endocrine neoplasia type 2B syndrome .
- Being Asian.