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Thyroid Cancer
• Definition of Thyroid Cancer
• Description of Thyroid Cancer
• Causes and Risk Factors of Thyroid Cancer
• Symptoms of Thyroid Cancer
• Diagnosis of Thyroid Cancer
• Treatment of Thyroid Cancer
• Questions To Ask Your Doctor About Thyroid Cancer
Definition of Thyroid Cancer
Cancer of the thyroid is the most common endocrine malignancy,
although it is an uncommon cancer, comprising only about
1 percent of invasive cancers.
Description of Thyroid Cancer
Although invasive thyroid cancer is uncommon, doctors often
have to diagnose and treat thyroid nodules, since about
4 percent of adults develop them.
Thyroid cancer commonly appears as a "cold" nodule,
meaning that it does not take up radioactive iodine. About
20 percent of cold nodules are cancer.
About 90 percent of thyroid cancers develop from the follicular
cells. Some develop from the parafollicular cells or C cells
(medullary).
Patients with well-differentiated tumors generally have
a good prognosis. Those with undifferentiated or anaplastic
tumors do not.
Papillary carcinomas are generally slow-growing, with an
80 percent overall survival at 10 years. Even when tumors
spread to regional lymph nodes or the lungs, survival may
be more than 10 years.
Tiny, clinically insignificant papillary carcinomas are
found in 5 to 10 percent of thyroid glands examined at routine
autopsies.
Follicular carcinomas occur in patients about 10 years older
than those who get papillary carcinomas. Although these
tumors are also usually slow growing, they behave somewhat
more aggressively than papillary carcinomas and are more
likely to spread to the lungs or bones.
Three percent of thyroid cancers are undifferentiated (anaplastic)
carcinomas. They occur in older patients, grow rapidly,
behave aggressively and respond poorly to treatment.
Medullary carcinomas make up almost 5 percent of thyroid
cancers. These tumors secrete calcitonin, a tumor marker
that is helpful in diagnosis and follow-up and also in screening
relatives of those affected, since this tumor may occur
on a familial, or inherited, basis.
Papillary carcinomas spread to nearby lymph nodes and the
tissues in the neck, with metastatic lesions to the lungs
and bones. These tumors spread through the bloodstream with
metastasis occurring more often to bone.
Anaplastic carcinoma usually extensively invades surrounding
tissue. Medullary carcinoma spreads to lymph nodes and may
invade blood vessels with metastases to the liver.
A number of factors affect the prognosis for papillary and
follicular thyroid cancers. A better prognosis can be expected
with a pure papillary carcinoma in younger patients (women
under 50 and men under 40), a tumor smaller than 3/4 inch
(2 cm.) small diffuse metastases, female sex, and low-grade
lesions.
A worse prognosis is related to age over 40, the degree
of invasion (vascular and thyroid capsule) in follicular
carcinoma, distant metastases, a large tumor (especially
over 1 1/2 inch (5cm), large nodular metastases, male sex
and high-grade lesions (aneuploid).
Causes and Risk Factors of Thyroid Cancer
Most cases occur between 25 and 65 years of age, and the
age at diagnosis is one of the most important factors in
predicting prognosis. Men under 40 and women under 50 have
significantly lower rates of recurrence and better survival
rates than older persons.
Some thyroid cancers tend to run in families, but most often
the cause is unknown and there is no genetic link.
Symptoms of Thyroid Cancer
In early thyroid cancer, there are typically no
symptoms. It is often discovered on a routine exam as a
nodule in the thyroid gland (in the front of the neck just
below the Adam's apple).
In advanced stages, symptoms and signs relate to the type
of cancer and whether it has metastasized.
Diagnosis of Thyroid Cancer
Diagnosis is based upon clinical history, findings on examination,
scanning tests and blood tests. Additionally, biopsy material
may be taken to establish the definitive diagnosis.
Treatment of Thyroid Cancer
The primary treatment of thyroid cancer is surgery, but
there are some differences in opinion about the extent of
thyroid resection required for the best prognosis.
A near-total thyroidectomy - removing almost all of the
thyroid - offers the best chance of cure, especially if
the cancer is in several places within the gland. The removal
of all functioning thyroid tissue also makes it possible
to scan for metastatic disease with radioactive iodine and
to use serum thyroglobulin values to detect persistent disease.
One of the risks of total thyroidectomy is the inadvertent
removal of the parathyroid glands, which are situated, two
on each side, at the edge of the thyroid. When a total thyroidectomy
is done, an attempt is usually made to leave all four parathyroid
glands in place.
Questions To Ask Your Doctor About Thyroid Cancer
How extensive is the tumor?
What type is it?
What is the staging?
How extensive will the surgery be?
What are the chance of complications of surgery, especially
of damage to the parathyroid glands and the risk of nerve
malfunction?
Will you use radioactive iodine?
What follow-up is needed?
What is the chance of cure, and when can you be sure?
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