Thyroid Cancer

(Adapted from the NCI)

Thyroid cancer is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland.

Thyroid:
The thyroid is a gland at the base of the throat near the trachea (windpipe). The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make hormones. Thyroid hormones do the following:

• Control heart rate, body temperature, and how quickly food is changed into energy (metabolism).
• Control the amount of calcium in the blood.

Four main types of thyroid cancer :

• Papillary thyroid cancer: The most common type of thyroid cancer.
• Follicular thyroid cancer: Hürthle cell carcinoma is a form of follicular thyroid cancer and is treated the same way.
• Medullary thyroid cancer.
• Anaplastic thyroid cancer.

Age, gender, and exposure to radiation can affect the risk of developing thyroid cancer.

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 a child or being exposed to atomic bomb radiation. The cancer may occur as soon as 5 years after exposure.
• Having a history of goiter (enlarged thyroid).
• Having a family history of thyroid disease or thyroid cancer.
• Having certain genetic conditions such as familial medullary thyroid cancer (FMTC), multiple endocrine neoplasia type 2A syndrome , and multiple endocrine neoplasia type 2B syndrome.
• Being Asian.

Medullary thyroid cancer is sometimes caused by a change in a gene that is passed from parent to child (inheritable).

• Patients and family members can be tested for the changed gene.
• If you do carry the changed gene, you may want to consider  undergoing a thyroidectomy to reduce the chance of developing medullary thyroid cancer.

Thyroid cancers are usually first detected by:

• A lump in the neck.
• Trouble breathing.
• Trouble swallowing.
• Hoarseness.

The patient is then usually referred to an endocrinologists for a consultation.

Tests:

• If hoarseness is present, a referral to Head and Neck Surgery maybe made to evaluate the function of the vocal cords.
• Ultrasound  of the neck.
• Blood tests, such as:
• Thyroid Stimulating Hormone  (TSH).
• calcitonin.
• calcium.

Diagnosis of thyroid cancer may be made from a :

• Fine-needle aspiration of the thyroid - Ultrasound may be used to guide it.
• Surgical biopsy.

Other possible imaging scans:

• CT scan and/or MRI of the – do not use iodinated contrast, since it may interfere with the RAI (Radioactive Iodine) scan.
• Chest X-ray.
• PET scan they are more active and take up more glucose than normal cells do.
  

The prognosis and treatment options depend on the following:

• The age of the patient.
• The type of thyroid cancer.
• The stage of the cancer.
• The patient's general health.
• Whether the patient has multiple endocrine neoplasia type 2B (MEN 2B).
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options:

• Surgery is considered standard of care.
• Patients are sometimes placed on thyroid replacement after surgery.
• However, others are advised to stay off of thyroid replacement until after their RAI (Radioactive Iodine) scan and radioactive iodine treatment.
• RAI scan with TSH simulation of recombinant rhTSH simulation (Thyrogen).
• Other blood tests:
• Thyroglobulin with TSH
• Anti-thyroglobulin antibodies
• Radioactive iodine treatment
• Radiation therapy

 

Department Contact List

• Department of ENT at Santa Clara.
• Department of Nuclear Medicine at Santa Clara.
• Department of Endocronology at Santa Clara.
• Department of Radiation Oncology at Santa Clara.
• Department of Medical Oncology at Santa Clara.