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Thyroid Cancer

The thyroid is the butterfly-shaped organ that regulates many bodily functions, including growth and energy expenditure.

 

What are the symptoms of thyroid cancer?

Patient with thyroid cancer may experience any of the symptoms:

  • Swelling of the throat as the thyroid gland enlarges
  • Hoarse voice
  • Change in voice
  • Persistent cough
  • Gastrointestinal disturbances, such as constipation or diarrhea.

 

 

What causes thyroid cancer and who is at risk?

A person can develop thyroid cancer at any age, although the exact cause of thyroid cancer is unknown. It has been linked to various risk factors like:

  • Radiation exposure: Exposure to a high dose of radiation during treatment or radiation fallout from power plant accidents or nuclear weapons increases the risk of thyroid cancer.
  • Being obese: According to some researches, people who are overweight or obese have a greater risk of developing thyroid cancer than people who have a healthy weight.
  • Iodine deficiency: People who consume a diet low in iodine are at higher risk of developing thyroid cancer.
  • Chronic goitre: Persistent enlargement of the thyroid gland may increase the risk.
  • Family history: People who have anyone in a closed family diagnosed with thyroid cancer are at higher risk.
  • Gender: It is more common in women than men.
  • Age: It can occur at any age; in women, the peak rises in their 40s or 50s and men in their 60s or 70s.

 

How is thyroid cancer diagnosed?

Cancers are difficult to diagnose in the early stages. When you visit the doctor with symptoms, he will examine you to identify the problem.

 

  • Physical examination: The doctor will take your health history, including eating habits, past illness, etc. He will check your neck and look for any lump or growth and swelling of any nearby lymph nodes.
  • Blood tests: Your doctor may ask you to go for blood tests to look for any abnormal thyroid-stimulating hormone (TSH) levels in the blood. TSH other than the normal range means the thyroid gland is not working properly.

 

Based on the physical examination and blood test observations, he will suggest some tests that will help confirm the diagnosis.

 

  • Ultrasound: An ultrasound device uses sound waves which make a pattern of echoes as they bounce off organs inside your neck and create a picture of your thyroid and nearby tissues. The doctor uses the image to look for the shape and size of each nodule. Nodules filled with fluid are usually not cancerous. Solid nodules may be cancerous.
  • Thyroid scan: In this procedure, the patient is given a small amount of radioactive substance to swallow, traveling through the bloodstream. These radioactive substances are absorbed by the thyroid cells, which can be seen on a scan. Nodules which take up less than nine substances than the thyroid tissue around them are called “cold” nodules, and they may be cancerous.
  • Biopsy: A biopsy is the only sure way that helps in diagnosing thyroid cancer. It is the diagnostic procedure that helps to confirm the diagnosis of thyroid cancer. There are various techniques to do a biopsy, and a pathologist checks a sample of thyroid tissue for cancer cells using a microscope.

 

 

 

What are the next steps after confirmation of cancer?

After confirmation of cancer, your doctor may ask you to go for additional tests to determine the tumor spread to the lymph nodes or other areas of your body. These tests also help in determining the grade of cancer. These tests may include:

 

  • CT scan: This test uses a special dye medium that helps with a clear image of the body parts from different angles. It can help in seeing detailed images of soft tissue and blood vessels. CT scan is used to measure the tumor size and helps look for the spread of the tumor to different body organs.
  • Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed body images. It helps in measuring the size of the tumor and also to look for the spread of cancer.
  • Chest X-ray: X-ray uses a small amount of radiation to create a picture of the structures inside of the body. It helps the doctors to find out if cancer has spread to the lungs.
  • Positron emission tomography (PET) or PET-CT scan: A PET scan uses a small amount of radioactive sugar substance, which is injected into the patient's body. This sugar substance is then used by cells, and a scanner then detects this substance to make images of the organs inside of the body.

 

 

What are the stages of thyroid cancer?

 

 

Stages

Papillary or follicular thyroid cancer-Cancer in persons younger than 55- (these cancers are stage I if they have no distant spread and stage II if they have distant spread.)

 

Papillary or follicular thyroid cancer in a persons 55 and older

 

Medullary thyroid cancer

 

Anaplastic thyroid cancer- (All anaplastic thyroid tumors are classified as stage IV, regardless of tumor size, location, or metastasis)

Stage I

The tumor may or may not have spread to lymph nodes. There is no evidence of spread to distant organs. 

A small tumor is present with no spread to lymph nodes or any other organ.

A small tumor is present with no spread to lymph nodes or any other organ.

 

Stage II

The tumor has spread to other organs regardless of whether it has spread to the lymph nodes.

  A larger, non-invasive tumor is present with no spread to lymph nodes or any other organ. 

              

A large localized tumor is present with no spread to lymph nodes or any other organ. 

 

Stage III

 

  • The tumor size is greater than 4 cm but still contained in the thyroid with no spread to lymph nodes or any organ.

 

  • Or, any localized tumor with spread to the central compartment of lymph nodes but no spread to any organ.

 

Any localized tumor has spread to the central compartment of lymph nodes but has not metastasized.

 

 

Stage IV

 

  • Stage IVA: Tumor has spread to nearby structures, regardless of whether it has spread to the lymph nodes, but it has not spread to distant places.

 

  • Or, a localized tumor with lymph nodes spread beyond the central compartment but no distant spread.

 

  • Stage IV B: Tumor has spread beyond nearby structures, regardless of spread to lymph nodes, but no distant spread.

 

  • Stage IVC: All tumors that have spread to distant organs.

 

  • Stage IVA: Tumor has spread to nearby structures, regardless of whether it has spread to the lymph nodes, but it has not spread to distant places.

 

  • Or, a localized tumor with lymph nodes spread beyond the central compartment but no distant spread.

 

  • Stage IVB: A tumor has spread beyond nearby structures, regardless of spread to lymph nodes, but no distant spread.

 

  • Stage IVC: All tumors that have spread to distant organs.

 

  • Stage IVA: Tumor that has spread to nearby structures, regardless of whether it has spread to the lymph nodes, but it has not spread to distant places.

 

  • Stage IVB: Tumor that has spread beyond nearby structures, regardless of spread to lymph nodes, but no distant spread.

 

  • Stage IVC: All tumors that have spread to distant organs.

 

 

How is thyroid cancer treated?

Treatment of cancer depends on many factors like the stage of the disease, patient's age, and his overall health. A combination of treatments like surgery, radiation therapy, chemotherapy, etc.,  are planned for patients which are best suited for them.

  • Surgery: Surgery is the primary treatment for thyroid cancer. There are various surgical procedures done depending upon the stage of cancer. Different surgical treatments available like lobectomy, near-total thyroidectomy, and thyroidectomy.
  • Hormone therapy: After surgery, patients usually require thyroid hormone therapy. Thyroid hormone replacement is generally given by an endocrinologist, who is a doctor specializing in treating problems with hormones and the endocrine system. Levothyroxine is the drug used in hormonal therapy.
  • Radioiodine therapy: This uses radioactive iodine to find and destroy thyroid cells that are not removed by surgery and have spread beyond the thyroid. It is used to treat people with differentiated thyroid cancers which have spread to lymph nodes or distant sites.
  • Chemotherapy: Chemotherapy uses drugs that stop the cancer cells from multiplying, either by killing the cancer cells or by inhibiting them from multiplying. These drugs are administered through the vein or can be given in the form of pills.
  • Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. As this treatment focuses on cancer cells, it is less harmful in comparison to radiation and chemotherapy. Sorafenib and Lenvatinib are some drugs approved by the food and drug administration (FDA) for the treatment of patients with thyroid cancer.

 

 

What to expect after surgery?

 

After removing the thyroid gland, the body stops producing thyroid hormone, essential to the body’s function. Hormone replacement therapy is usually started after surgery. You may also have to take calcium and vitamin D supplements if the parathyroid gland's function is reduced after surgery.

After surgery, patients have to stay in the hospital on an average of 1-2 days. This is the time where your body is in the recovery phase. Immediately after the thyroid operation, most people will have a sore throat from the breathing tube used for anesthesia. You may experience some complications like sore throat from the breathing tube used for anesthesia. Your doctor will give you the best guidance and medicine to manage any problem you face post-operation.

Once discharged from the hospital, the pain will be managed by the oral medications prescribed by your doctor. Full recovery from surgery may take two weeks. You may be instructed to avoid lifting heavy objects for at least two weeks after surgery.

 

 

What is the survival rate of thyroid cancer?

 

5-years survival rate of patient with Thyroid cancer

Types

Localized

Regional

Distant

Papillary or follicular thyroid cancer

 

100%

99%

76%

Medullary thyroid cancer

 

100%

91%

38%

Anaplastic thyroid cancer

31%

10%

3%

 

 

How to keep a check on reoccurrence?

Thyroid cancer may recur years after the initial treatment is completed. Recurrence may occur in the neck area, such as the lymph nodes, or may to distant organs. It is advisable to be vigilant with the follow-up protocol, and in case of any problem you experience, inform your doctor immediately. The doctor will do a physical exam and recommend you to go for tests to learn as much as possible about the recurrence. After this testing is done, your doctor may plan the best treatment option available that might include previous treatment as well.

 

Prevention tips

Most patients diagnosed with thyroid cancer do not have any known risk factors. Hence it is often difficult to prevent. Thyroid cancer has often been linked to low levels of iodine in the diet and exposure to radiation, especially during childhood. Early diagnosis is essential for good response to treatment and recovery. However, by making some lifestyle changes, you may lower the risk.

  • Avoid smoking: Smoking is often linked as the risk factor in the development of cancer, and quitting smoking will help in lowering the risk.
  • Manage weight: Being obese or overweight increases the risk of cancer. Involve in some form of physical activity like exercising, yoga, etc., to keep your body fit.
  • Diet: People eating a diet high in fruits, vegetables, and whole grains and low in sugar drinks, processed food probably has a lower risk of cancer risk. It is recommended to take salt that has iodine in it.

 

 

 

 

 

 

 

 

 

 

 

Types of thyroid cancer

There are five principal types of thyroid cancer:

  • Papillary thyroid cancer
  • Follicular thyroid cancer
  • Hurthle cell cancer
  • Medullary thyroid cancer (MTC)
  • Anaplastic thyroid cancer

Symptoms

Thyroid cancer will not display any symptoms early in the disease. Following are the symptoms of thyroid cancer:

  • A lump (nodule) that can be felt through the skin on your neck
  • Changes to your voice, including increasing hoarseness
  • Difficulty swallowing
  • Pain in your neck and throat
  • Swollen lymph nodes in your neck

Diagnosis

Tests and procedures used to diagnose thyroid cancer are:

  • Physical exam: The doctor will physically examine the neck to look for any thyroid modules. The doctor may ask you about your medical and family history and risk factors such as past exposure to radiation.
  • Blood tests: The doctor may propose you to go for blood tests to help determine if the thyroid gland is functioning normally.
  • Ultrasound imaging: The doctor will suggest ultrasound, which uses high-frequency sound waves to create pictures of body structures. The doctor will analyze the pictures to observe whether a thyroid nodule is cancerous or not.
  • Extracting a sample of thyroid tissue: The doctor may extract a tissue using a needle from your thyroid nodule. The suspicious sample is then sent to the lab for analyzing to look for any cancerous cells.
  • Other imaging tests: The doctor may ask you to have one or more imaging tests such as CT Scan, PET, MRI to help your doctor determine whether your cancer has spread beyond the thyroid.
  • Genetic testing: If the doctor thinks that your family's medical history might be the cause of your cancer, then it will be recommended to you go for genetic testing to look for genes that increase your risk of cancer.

Treatment

Your thyroid cancer treatment right depends on the stage and type of your thyroid cancer, your overall health, and your preferences.

  • Surgery for Thyroid Cancer: The surgeon will remove the thyroid gland, which might involve removing all of the thyroid tissue (total thyroidectomy) or most of the thyroid tissue (near-total thyroidectomy). The operation your doctor performs will be recommended depending on the size of cancer, type of thyroid cancer, or whether cancer has spread beyond the thyroid.
  • Radioactive iodine: Using large doses of a form of iodine that's radioactive to destroy any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren't removed during surgery.
  • Radiation treatments: A powerful beam of energy that aims high-energy beams is used to target and eliminate cancerous cells before and after surgery. It is exerted to kill any cancer cells that may be left after surgery. The process is usually recommended if cancer continues to grow after radioactive iodine treatment.
  • Chemotherapy: Chemotherapy is implemented to kill cancer cells and limit the growth of cancer cells. However, Chemotherapy isn't frequently used in the treatment of thyroid cancer. But sometimes it is recommended for people with anaplastic thyroid cancer.
  • Targeted Therapy: These drugs chiefly affect cancer cells and not active cells. These drugs block the abnormalities causing cancer cells to die.
  • Thyroid hormone therapy: After thyroidectomy, a doctor may suggest you take thyroid hormone medication levothyroxine for a lifetime. This medicine suppresses the production of thyroid-stimulating hormone (TSH) from your pituitary gland, which may stimulate any remaining cancer cells to grow.
  • Injecting alcohol into cancers: Small thyroid cancers are injected with alcohol using imaging such as ultrasound to ensure precise placement of the injection. This process constricts the thyroid cancer. This option is exercised if the cancer is very small, and surgery is not the option.

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