If I Choose Surgery Will I Need Radiation Therapy Or Vice Versa
Surgery is the primary therapy for thyroid cancer and is often effective. If the tumor is large, has spread to lymph nodes or you are at high risk for the cancer returning after treatment, you will most likely have surgery followed by I-131 treatment. Surgery followed by EBT and chemotherapy or targeted therapy is used for medullary or anaplastic thyroid cancer. For advanced thyroid cancer patients, treatment may consist of all the therapies listed above.
Treatment Options For Thyroid Cancer
A team of doctors and other professionals discuss the best treatment and care for you. Your doctor will then talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.
Your treatment will depend on:;
- where your cancer is
- how big it is and whether it has spread
- your type of thyroid cancer
- how abnormal the cells look under a microscope
- your general health and level of fitness
The main treatments for thyroid cancer are described below. You may have more than one of these treatments.
How Is Thyroid Cancer Treated With Surgery
Thyroid cancer surgery is the preferred treatment option for all forms of thyroid cancer except thyroid lymphoma.
The best surgical treatment for most thyroid cancers is entire thyroid removal . ;Removing the entire thyroid gland prevents cancer from returning or spreading.
In some cases where the cancer is small and hasnt spread much, a thyroid lobectomy may be done instead. ;In this procedure, only the half of the thyroid that contains the cancer is removed. ;This is usually only an option for differentiated thyroid cancers, and even then, only for select cases.
Prior to the operation, a thyroid ultrasound exam that focuses on the lymph nodes of the neck is done to see if there are suspicious lymph nodes that may need to be removed along with the thyroid. The procedure to remove these lymph nodes is called a central neck dissection. ;Sometimes lymph nodes further along the neck need to be removed as well. ;This is called a modified radical neck dissection.
In follow-up appointments after surgery, a blood test for a protein called Thyroglobulin can be monitored to make sure treatment was effective. ;Thyroglobulin is made in the thyroid, so after surgery levels should be low. ;High thyroglobulin levels suggest that cancer cells may have returned.
Patients might need to replace thyroid hormones after surgery.
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How Does Your Thyroid Gland Work
Thyroid hormone production is regulated by a feedback loop between the hypothalamus, pituitary gland and the thyroid gland. Hypothalamic thyrotropin-releasing hormone stimulates pituitary thyrotropin synthesis and secretion.
In turn, TSH stimulates production and release of T4 and T3 from the thyroid gland. When enough T4 is produced, it signals to TRH and TSH that there is enough thyroid hormone in circulation and not to produce more.
About 85% of the hormone produced by our thyroid gland is T4, which is an inactive form of the hormone. After T4 is made, a small amount of it is converted into T3, which is the active form of thyroid hormone.
To complicate matters, T3 also gets converted into either Free T3 or Reverse T3 . Its the Free T3 that really matters in all of this, since its the only hormone that can attach to a receptor and cause your metabolism to rise, keep you warm, keep your bowels moving, mind working, and other hormones in check. The role of Reverse T3 is not well known, however, I do see it elevated in persons under extreme stress and those who have mercury toxicity.
And finally, Hashimotos thyroiditis, an autoimmune disease, is the most common form of hypothyroidism and its numbers are rising annually. An autoimmune disease is one in which your body turns on itself and begins to attack a certain organ or tissue believing its foreign.
If itÃ¢s caught early, thyroid cancer is one of the most treatable forms of cancer.
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.
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What Is The Thyroid Gland
Your thyroid gland is one of many glands that make up your endocrine system. Endocrine glands release hormones that control different bodily functions.
The pituitary gland in your brain controls your thyroid gland and other endocrine glands. It releases thyroid-stimulating hormone . As the name suggests, TSH stimulates your thyroid gland to produce thyroid hormone.
Your thyroid needs iodine, a mineral, to make these hormones. Iodine-rich foods include cod, tuna, dairy products, whole-grain bread and iodized salt.
Papillary Thyroid Cancer Surgery In Sites Other Than The Neck
Papillary thyroid cancer surgery is uncommonly proposed as a treatment approach when disease has spread to distant sites. Although surgery is not commonly proposed for distant spread of papillary thyroid cancer, consideration for surgery for distant disease is based upon the expert thyroid cancer team evaluation and considers the following issues:
- Where is the papillary thyroid cancer distant disease located?
- What are the risks and benefits of surgery?
- Are there other sites of distant spread?
- What papillary thyroid cancer treatments have already been used?
- What were the outcomes of other treatments for the papillary thyroid cancer?
- How fast is the papillary thyroid cancer growing?
- What are the patient’s treatment desires?
- What are the other treatment options?
- What is the papillary thyroid cancer pathologic type (what do the cells look like under the microscope?
- What are the papillary thyroid cancer genetic mutations?
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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.
If Treatment Does Not Work
Recovery from thyroid cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.
You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Radioactive Iodine Therapy For Thyroid Cancer
Your thyroid gland absorbs nearly all of the iodine in your body. Because of this, radioactive iodine can be used to treat thyroid cancer. The RAI collects mainly in thyroid cells, where the radiation can destroy the thyroid gland and any other thyroid cells that take up iodine, with little effect on the rest of your body. The radiation dose used here is much stronger than the one used in radioiodine scans, which are described in Tests for Thyroid Cancer.
This treatment can be used to ablate any thyroid tissue not removed by surgery or to treat some types of thyroid cancer that have spread to lymph nodes and other parts of the body.
Radioactive iodine therapy helps people live longer if they have papillary or follicular thyroid cancer that has spread to the neck or other body parts, and it is now standard practice in such cases. But the benefits of RAI therapy are less clear for people with small cancers of the thyroid gland that do not seem to have spread, which can often be removed completely with surgery. Discuss your risks and benefits of RAI therapy with your doctor. Radioactive iodine therapy cannot be used to treat anaplastic and medullary thyroid carcinomas because these types of cancer do not take up iodine.
Surgery For Papillary Thyroid Cancer
Papillary thyroid cancer is treated with surgery. It is important to understand that the best chance of cure is to have an expert thyroid cancer surgeon from the beginning. A surgeon who performs surgery for papillary thyroid cancer on a daily basis has a higher cure rate than a surgeon who performs thyroid surgery several times per week, or does other types of thyroid surgery . Surgery for thyroid cancer has become very specialized, so it is important for you to be comfortable with your choice of surgeon.
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How Is Thyroid Cancer Treated With Radioactive Iodine Ablation
A normal thyroid gland needs iodine to produce its metabolism-controlling hormones. ;With radioactive iodine treatment, radioactive iodine, swallowed in pill form, travels through the body until it is taken up by cells of the thyroid, just like the regular iodine found in everyday foods like salt and milk. ;Unlike regular iodine, though, the radioactive iodine is toxic to thyroid cells.
Radioactive iodine treatment helps prevent thyroid cancer from returning after surgery. ;It is typically used for papillary thyroid cancer and follicular thyroid cancers that have spread to lymph nodes or other body parts. ;
Radioactive iodine treatment does not work for medullary thyroid cancer and anaplastic thyroid cancer or for thyroid lymphoma because these forms of cancer do not involve the types of thyroid cells that use iodine.
Because all the radioactive material gets directed to the thyroid, Radioactive iodine treatment does not harm other cells in the body.
Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get;supportive care;to help with pain or other symptoms.
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Thyroid Hormone Suppressive Therapy For Papillary Thyroid Cancer
Thyroid hormone is a necessary hormone for life. The thyroid gland normally produces thyroid hormone to adequate levels. The amount of thyroid hormone produced by the body is strictly controlled by a portion of the brain called the pituitary gland. When the body has too little thyroid hormone, the pituitary gland senses the low levels and produces TSH . When thyroid hormone levels are elevated , the pituitary does the opposite and lowers its production of TSH. This is called an endocrine feedback loop.
Most papillary thyroid cancer cells and all normal thyroid cells have a site on the surface of the cell that can stimulate their growth. This site is called a “receptor” and when stimulated by TSH in normal thyroid cells, it causes increased production of thyroid hormone. In papillary thyroid cancer cells, this same TSH receptor can stimulate the growth of these cancer cells. Obviously, it is an undesirable concept to have TSH stimulate papillary thyroid cancer cells to grow. Therefore, the goal in the papillary thyroid cancer patient is to keep TSH levels low. So how is this done?
What Are The Symptoms Of Medullary Thyroid Cancer
Medullary thyroid cancer usually presents as a lump or nodule in the thyroid. It may be noted by the patient or discovered during routine neck examination by the doctor. Sometimes, the nodule is discovered incidentally by imaging studies done for other unrelated reasons . The nodule may cause no symptoms, but in some cases the tumor may have spread to lymph nodes in the neck, which may be enlarged on physical examination.
Patients with advanced MTC may complain of pain in the neck, jaw, or ear. If a nodule is large enough to compress the windpipe or the esophagus, it may cause difficulty with breathing or swallowing. Hoarseness can be present if the cancer invades the nerve that controls the vocal cords.
MTC is usually more aggressive than the other more common types of thyroid cancer , and it is usually easier to treat and control if it is found before it spreads to lymph nodes in the neck or other parts of the body.
Thyroid function tests such as TSH are usually normal, even when MTC is present.
If you have a family history of MTC and have tested positive for the RET mutation, then you should see an endocrinologist to help determine how best to follow you or treat you.
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What Is The Prognosis Of Thyroid Cancer
Overall, the prognosis of differentiated thyroid cancer is excellent, especially for patients younger than 45 years of age and those with small cancers. Patients with papillary thyroid cancer who have a primary tumor that is limited to the thyroid gland have an excellent outlook. Ten year survival for such patients is 100% and death from thyroid cancer anytime thereafter is extremely rare. For patients older than 45 years of age, or those with larger or more aggressive tumors, the prognosis remains very good, but the risk of cancer recurrence is higher. The prognosis may not be quite as good in patients whose cancer is more advanced and cannot be completely removed with surgery or destroyed with radioactive iodine treatment. Nonetheless, these patients often are able to live a long time and feel well, despite the fact that they continue to live with cancer. It is important to talk to your doctor about your individual profile of cancer and expected prognosis. It will be necessary to have lifelong monitoring, even after successful treatment.
What Does Rai Do
RAI treatment destroys any remaining thyroid cells after surgery, minimizing the risk of the cancer coming back.;It is also called ablation therapy.
The initial RAI treatment may be given anytime, but usually 6 weeks to 6 months after surgery. The reason for a delay may be because your doctor wants to see how youre doing after surgery before deciding if RAI is necessary.
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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.
Extended Or Complicated Thyroidectomy
Papillary thyroid cancer may sometimes be more aggressive than ultrasound or CT imaging suggested prior to undergoing surgery. In these cases, an expert surgeon that recognizes those “more aggressive” intraoperative findings such as growth or extension of the cancer outside of the thyroid gland or invasion of the cancer into adjacent structures such as the nerve to the voice box , breathing tube , voice box, or esophagus must adapt the surgery to adequately address the complete removal of the cancer. Unfortunately, occasional thyroid surgeons are commonly unprepared to perform the appropriate surgery and a subsequent surgery for persistent disease will be required.