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Thyroid Cancer: Know the Facts

Thyroid Cancer Awareness Month

Did you know that September is Thyroid Cancer Awareness Month? It was started in 2000 by the Thyroid Cancer Survivor’s Association and continues to this day to be observed during the entire month of September, in order to increase awareness about one of the most rapidly increasing types of cancer. The rates of thyroid cancer have tripled in the past 30 years and 62,450 people are expected to get diagnosed this year in the United States. There is some debate as to whether this number is truly increasing or if it may be attributed at least in part to better detection capabilities. Although thyroid cancer has a 5-year 97% survival rate (much better odds than many other cancers), roughly 2,000 people will lose their lives from it this year – which is 2,000 too many. In the event that thyroid cancer affects you or a loved one, being informed about the risks, detection measures, and treatment options can help one be prepared to take charge of his or her health and future.

Risk Factors & Warning Signs

While men can and do get thyroid cancer, the majority of cases (about 75%) are found in women. And unlike many other forms of cancer, it typically occurs in younger individuals. Two-thirds of all thyroid cancers are found in those between 20 and 55 years old. Family history also plays a role. One gene in particular, called the RET oncogene has been linked to a greatly increased risk of medullary thyroid cancer. Other risk factors include:

  • history of Hashimoto’s or goiter
  • previous exposure to radiation
  • iodine deficiency
  • certain inherited conditions (i.e. adenomatous polyposis, Gardner syndrome, Cowden disease, type I Carney complex)

Thyroid cancer is often asymptomatic, but when symptoms do occur, they can include pain or swelling in the neck, a feeling of fullness in the neck, enlarged lymph nodes, voice changes and/or even a palpable lump. In cases of anaplastic type, the person may have a fast-growing lump on their thyroid, chronic cough, coughing up blood and/or difficulty swallowing or breathing.

Not All Thyroid Cancer is Created Equal

It’s important to know the different types of thyroid cancer, since some of the symptoms, treatments, and likely outcomes vary greatly. The four main types are:

  • Papillary – most common (80% of cases); more common in parts of the world with low dietary iodine; usually affects one side only, but may spread into the lymph nodes; high cure rate
  • Follicular – 15% of cases; more aggressive than papillary, but still unlikely to spread – when it does occur, it is likely to spread to the arteries and veins of the thyroid, lungs, bones, and skin; also more common in parts of the world with low dietary iodine; good long-term survival rates
  • Medullary – 3% of cases; begins in the upper central lobe of the thyroid and usually spreads to the lymph nodes (sooner than papillary and follicular); unique in that it develops from the C cells (that produce calcitonin) and not the cells that make thyroid hormones; most likely to run in families
  • Anaplastic – the rarest (2%) but also the most serious; most likely to spread to other organs; mostly found in older individuals and men

Diagnosis & Treatment

You can perform a self-exam by standing in front of a mirror with your head bent slightly backwards, then swallowing a mouthful of water and watching to see if there is a lump or bulge that appears in your neck (just above your collar bone). The American Association of Clinical Endocrinologists recommends that everyone perform this self-check periodically. However, it must be noted that this does not replace a doctor’s exam. Physicians are specifically trained to check the thyroid and surrounding tissues and lymph nodes for abnormalities. Other diagnostic tools used for detecting and classifying thyroid tumors include:

  • Imaging tests – nuclear scan (radioactive iodine uptake test), MRI, thyroid ultrasound
  • Biopsy – Fine needle aspiration biopsy of the thyroid
  • Blood tests – abnormal TSH levels can indicate a potential problem; calcium testing may help identify medullary type; genetic testing for RET gene
  • Laryngoscopy – helps investigate a nodule located near the larynx

Once an individual has been diagnosed with thyroid cancer, the treatment plan will depend on a variety of factors such as type, stage, and size of tumor. The most common medical treatments are:

  • Thyroidectomy – surgery to remove part or all of the thyroid (often only a partial removal is required, such as in a small papillary tumor)
  • Radioactive Iodine (RAI) – usually performed after surgery to kill off any remaining thyroid tissue
  • External Beam Radiation – often done in cases where cancer is more advanced and did not respond to RAI.
  • Targeted drug therapies – medications sometimes used for cancers that have metastasized or did not respond to RAI

*Anaplastic thyroid cancer is usually treated differently than the other types due to its more aggressive nature. Generally, the individual will undergo surgery to remove the tumor followed by radiation. It typically is not responsive to chemotherapy. If the tumor has invaded other structures such as the trachea, it may be inoperable. Since thyroidectomies are considered a somewhat uncommon occurrence, patients should do their research in order to find an experienced surgeon.

Recent Developments: A More Conservative Approach

In recent years, there has been a shift to a more conservative stance regarding the treatment of thyroid cancer. This was due to concerns over the risks and long-term challenges involved in typical treatments such as thyroidectomy and exposure to radiation. Ultimately the changes have led to fewer unnecessary surgeries and less unwarranted emotional distress. The most recent example of this is the reclassification of a type of thyroid tumor once considered cancerous. It was referred to as an “encapsulated follicular variant of papillary thyroid carcinoma” but now has been downgraded to a “noninvasive follicular thyroid neoplasm with papillary nuclear features.” The decision was made by a panel of experts and recently reported in the journal JAMA Oncology. In these cases, the small lump in the thyroid appears cancerous but is extremely unlikely to break out of the fibrous tissue in which it is completely encapsulated. The change is expected to affect about 10,000 thyroid “cancer” patients per year and spare them from over-treatment.

Additionally, more advanced testing such as the Veracyte Afirma Thyroid Analysis has helped to gather more conclusive data about the status of tumors that were previously deemed inconclusive. About 70-80% of these cases are benign and yet in the past, most of the patients in this category would have been treated anyway as a precaution. This testing is drastically reducing those numbers. Many doctors have also adopted the “watch and wait” practice for small papillary “microcarcinomas” and they may only require a partial thyroidectomy if they do eventually require surgery.

Other Important Considerations

Even though thyroid cancer is generally considered a very treatable form of cancer, it is important for friends, family members, and doctors to remember that a cancer diagnosis of any kind is physically and psychologically distressing for the person. In addition, anytime the thyroid is removed, it requires lifelong thyroid replacement (and monitoring). That sometimes brings challenges of its own. Thyroid cancer survivors also have an increased risk of developing a second cancer (which is the highest during the first year after their diagnosis). Hopefully, these facts demonstrate how referring to thyroid cancer as a “good cancer” could come across as unsupportive even though it may be intended to encourage. Keep in mind that even though the thyroid is a small gland, it produces hormones that either regulate or play an important role in many crucial bodily functions such as body temperature, metabolism, digestion, and cognitive function. Know the facts about thyroid cancer and help us spread the word during this month of awareness.

References

1. Kolata, G. It’s Not Cancer: Doctors Reclassify a Thyroid Tumor. The New York Times. April 14, 2016. Available at: http://www.nytimes.com/2016/04/15/health/thyroid-tumor-cancer-reclassification.html

2. The Truth about Thyroid Cancer. Holtorf Medical Group. Available at: https://www.holtorfmed.com/the-truth-about-thyroid-cancer/

3. Thyroid Cancer Awareness Month: 5 Important Things to Know about Thyroid Cancer. Holtorf Medical Group. Available at: https://www.holtorfmed.com/thyroid-cancer-awareness-month/

4. Shomon, M. An Overview of Thyroid Cancer. VeryWell Website. Available at: https://www.verywell.com/thyroid-cancer-4013992

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