Hurthle Cell Carcinoma is a rare type of thyroid cancer that is different from other forms of thyroid cancer because of how it spreads and how it is treated. It is slightly more aggressive than other differentiated thyroid cancers (such as papillary and follicular thyroid carcinomas). It originates in the Hurthle cells in the thyroid. Most patients who have a biopsy that shows Hurthle Cells do not have Hurthle Cell Carcinoma (HCC).
Usually, a diagnosis of Hurthle Cell Carcinoma requires a high level of suspicion before surgery and an excellent pathologist after surgery. Tumors that are suspicious for follicular neoplasms (Bethesda IV) can be included in this category, and sometimes an ultrasound can suggest to a surgeon that the tumor is more likely to be a "bad actor" than the traditional thyroid nodule or early thyroid cancer. In these cases, surgery can be slightly more aggressive than we would normally consider.
Hurthle Cell Carcinoma tends to spread hematogenously (via the blood), which makes it more difficult to treat. It can leave "nests" of tumor up to a few centimeters away from the original cancer, suggesting that a cuff of normal tissue, or a margin, may be necessary to completely remove the disease. Because the thyroid is so close to critical structures such as the trachea and the esophagus, that margin can be very challenging to achieve. Even in the best of cases, recurrence rates are high, and this tumor can keep coming back. Close surveillance is essential after surgery.
Clues about the potential for spread can also be collected from the pathology specimen after surgery: in addition to mutations, treatment teams look for the level of invasion into the blood vessels of the primary tumor. If there is significant invasion, removal of the entire thyroid is necessary so that radioactive iodine (RAI) can be considered. Unfortunately, most Hurthle Cell Cancers do not take up radioactive iodine. It is nevertheless considered to make surveillance simpler.
As noted by now, having a thorough first surgery is critically important. When the tumor recurs, an experienced team can also be valuable when making decisions about how aggressive to be. Make sure that you discuss your cancer with a very experienced surgical team.
