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Thyroid Cancer

thyroid cancer


Thyroid cancer is not a very common type of cancer. There are different types of thyroid cancer which have different treatments. The outlook for people with thyroid cancer varies depending on the type of thyroid cancer. However, in general, the outlook is good.

What is the thyroid gland?

The thyroid is a small gland in front of the neck. The thyroid gland contains cells called follicular cells. These make two main hormones, thyroxine (T4) and triiodothyronine (T3), which are needed to keep the body functioning at its normal rate. These hormones affect the heart rate, body temperature and energy level. The thyroid gland also contains C cells which make calcitonin, a hormone that helps to control the level of calcium in the blood.

There are four main types of thyroid cancer:

Papillary. This is the most common type of thyroid cancer.
Follicular. This is a less common type of thyroid cancer, usually found in older people. Both papillary and follicular thyroid cancers are sometimes called differentiated thyroid cancer. They are often treated in the same way.
Medullary. This is a rare type of thyroid cancer that can run in families. This grows from the C cells in the thyroid gland.
Anaplastic. This is also rare. It occurs more commonly in older people and grows quickly. Unlike other types of thyroid cancer, it can be difficult to treat.

The other types of cancer that can develop in the thyroid gland are lymphoma and Hürthle cell cancer. These will not be discussed in this article.
Papillary and follicular thyroid cancers account for 80-90% of all thyroid cancers. Both types begin in the follicular cells of the thyroid. Most papillary and follicular thyroid cancers tend to grow slowly. If they are detected early, most can be treated successfully.

What causes thyroid cancer?

A cancerous tumour starts from one abnormal cell. Many people develop thyroid cancer for no apparent reason. However, certain risk factors increase the chance that thyroid cancer may develop. These include:

Thyroid diseases. People who have some non-cancerous (benign) thyroid diseases are more likely to develop thyroid cancer. For example, a goitre (enlarged thyroid), thyroid nodules (adenomas), or inflammation of the thyroid (thyroiditis).

Note: Having hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid) does not increase your risk of developing thyroid cancer.

Previous radiation. Thyroid cancer is more common in people who had radiotherapy treatment to the neck area at a younger age.

Family history. Medullary thyroid cancer can be caused by inheriting abnormal genes. Low iodine levels.

What are the symptoms of thyroid cancer?

Thyroid cancer usually develops slowly and initially does not cause any symptoms. The most common first sign is a small lump in the neck, which is painless. Other symptoms which may develop as the cancer grows include:

Hoarseness or difficulty in speaking in a normal voice.
Swollen lymph glands in the neck.
Difficulty swallowing or breathing as the cancer presses on the foodpipe or windpipe.
Pain in the throat or neck.
Note: most lumps in the thyroid gland are not due to cancer. Only about 1 in 20 thyroid lumps are due to cancer.

How is thyroid cancer diagnosed and assessed?

Tests to confirm the diagnosis

An ultrasound scan may be done at first. This may strongly suggest a cancer and can also be used to assess the size and position of the cancer.

A biopsy (small sample) is usually taken to confirm the cancer and also to find out the type of thyroid cancer you have.

Thyroid radioisotope scan. This test involves having an injection of a small amount of a slightly radioactive liquid (technetium or iodine). Cancer cells do not usually absorb the radioactive liquid as well as normal thyroid cells do. So, any areas of cancer in the thyroid may be shown by the scan.

Assessing the extent and spread

If you are found to have a thyroid cancer, then other tests are likely to be advised to assess if it has spread from the thyroid. These may include one or more of: a CT or MRI scan, blood tests, a thyroid radioisotope scan and sometimes other tests.

Finding out the type of the cancer from the biopsy, and whether it has spread, helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for thyroid cancer?

Treatment options which may be considered include surgery, radioactive iodine and radiotherapy. More than one type of treatment may be given. Most types of thyroid cancer can usually be treated successfully and many people with thyroid cancer are cured.

Surgery

An operation to remove all (or sometimes part) of the thyroid gland is the most common treatment. Sometimes the surgeon also removes some, or all, of the lymph nodes close to the thyroid gland, to see whether the cancer has spread into them. If the cancer is at an early stage and not spread then surgery alone may be curative .After your operation, it is likely you will need to take thyroid hormones to replace those normally produced by the thyroid gland.

Radioactive iodine treatment

Many people are given radioactive iodine treatment after their thyroid surgery. It uses radioactive iodine (I-131) ,usually given as liquid or capsules to destroy thyroid cancer cells anywhere in the body. The thyroid cancer cells absorb the  radioactive iodine  which will help to destroy them. As other cells in the body do not absorb iodine, they are not affected by the radioactive iodine. Most radiation is gone from your body in a few days.

Medullary thyroid cancer or anaplastic rarely respond to it.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation to kill cancer cells, or stops cancer cells from multiplying. Radiotherapy may be advised if you have thyroid cancer that does not respond to radioactive iodine treatment.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Chemotherapy is rarely used to treat cancer of the thyroid but may be used if the cancer returns or has spread to other parts of the body.

Follow-up after treatment

After your treatment for thyroid cancer, you will be followed up by your specialist and have regular checkup and tests. You may have a blood test for thyroglobulin performed at regular intervals. Measuring thyroglobulin levels is a way of detecting any remaining papillary or follicular cancer cells. Radioactive iodine scans from time to time, to ensure there are no thyroid cancer cells in your body.

What is the prognosis (outlook)?

The outlook for many people with thyroid cancer is very good. People with papillary or follicular thyroid cancer have an excellent chance of cure with treatment. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.


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