Thyroid Cancer
Condition Overview
Thyroid cancer originates in the thyroid gland, a butterfly-shaped gland located at the base of the neck. It is one of the most common types of cancer in women, and is the most prevalent endocrine malignancy. Thyroid cancer can be classified into several types, with the most common being papillary, follicular, medullary, and anaplastic thyroid cancer. Papillary thyroid cancer is the most frequent and generally has an excellent prognosis. On the other end of the spectrum, anaplastic thyroid cancer is rare and highly aggressive. The other variants fall somewhere in between with regards to how rare they are and how good their prognosis is.
Patients with thyroid cancer may not exhibit symptoms in the early stages. As the disease progresses, symptoms may include a noticeable lump in the neck, difficulty swallowing or breathing, hoarseness, and persistent neck pain. In some cases, enlarged lymph nodes in the neck may also be present.
Diagnosis typically involves a combination of physical examination, blood tests to measure thyroid function and specific tumor markers, imaging studies such as ultrasound, CT scans, and MRI, and a fine-needle aspiration biopsy to confirm the presence of cancerous cells.
Treatment Options
Total Thyroidectomy
- Description: Total thyroidectomy involves the surgical removal of the entire thyroid gland. This procedure is often recommended for treating thyroid cancer to eliminate the primary tumor and prevent the spread of cancerous cells. In the past, it was the first and only treatment recommended. Modern surgeons instead offer smaller surgeries in most cases. Central neck dissection can be performed at the same time as a total thyroidectomy (and can also be performed with a hemithyroidectomy). The more surgery that a patient has, the lower the recurrence risk and the higher the risk of complications. Finding a balance requires an experienced surgeon who prioritizes the patient's goals of care.
- Indications: Large primary tumors, multifocal disease, or when cancer has spread beyond the thyroid gland.
Radioactive Iodine (RAI) Therapy
- Description: RAI therapy involves the administration of radioactive iodine, which is selectively taken up by thyroid cells, including cancerous ones. The radiation can slow down the growth of these cells, making it an effective treatment for certain types of thyroid cancer, especially when the cancer has spread beyond the thyroid.
- Indications: Used after thyroidectomy to ablate any remaining thyroid tissue or metastatic disease, particularly effective in papillary and follicular thyroid cancers.
External Beam Radiation Therapy
- Description: This therapy uses high-energy X-rays or particles to destroy cancer cells. It is typically used for thyroid cancers that do not respond to RAI therapy or when the cancer has spread to areas that cannot be treated with surgery or RAI. Most thyroid cancers grow very slowly, and so radiation therapy is less effective. It is generally one of the last options that patients should consider when they have thyroid cancer.
- Indications: Advanced thyroid cancers, palliative treatment for symptomatic relief in metastatic cases.
Targeted Therapy
- Description: Targeted therapy involves drugs that specifically target molecular pathways involved in the growth and spread of thyroid cancer cells. These therapies can inhibit the growth of cancer cells while sparing normal cells. They are the newest weapon that can be used against aggressive thyroid cancers. Most work in a very focused fashion to improve the effectiveness of the immune system, and have limited side effects but are very effective against many thyroid cancers. Sadly, they are not an option for all patients, but can often be valuable when patients have certain mutations. Genetic testing of the cancer is required before these can be offered as a treatment.
- Indications: Advanced or metastatic thyroid cancer that does not respond to standard treatments, specific genetic mutations such as BRAF and RET.
Chemotherapy
- Description: Chemotherapy uses powerful drugs to kill rapidly dividing cancer cells. It is generally reserved for anaplastic thyroid cancer and other aggressive forms that do not respond to other treatments because it is usually has side effects that are more pronounced than other therapies.
- Indications: Anaplastic thyroid cancer, advanced thyroid cancers unresponsive to other treatments.
Thyroid Lobectomy
- Description: Thyroid lobectomy involves the removal of one lobe of the thyroid gland. It is a surgical option for smaller, localized tumors, and is the go-to surgery for most patients with thyroid cancer. It reduces the risk of permanent complications by almost 50% when compared to a total thyroidectomy. Most modern surgeons will turn to this as their preferred form of treatment for most slow-growing thyroid cancers.
- Indications: Small, localized tumors that have not spread outside of the thyroid. In most cases, these surgeries can be performed without a scar in the middle of the neck.
Radiofrequency ablation (RFA) or thermal ablation (TA)
- Description: RFA and other thermal ablation (TA) of thyroid cancer (including microwave ablation and laser ablation and even cryoablation) involves the use of heat to kill cancer cells. It is generally very well tolerated and has low risks, but we do not have long term results of treatment with RFA. For this reason, TA is usually only recommended for patients with very small cancers or those with advanced cancers in patients who are no longer candidates for surgery. Check out our animation and Instagram page for more information about RFA for thyroid cancer.
Management of Thyroid Cancer
Management of thyroid cancer requires a multidisciplinary approach involving endocrinologists, oncologists, surgeons, radiologists, and pathologists. The primary goals are to eliminate the cancer, prevent its spread, and maintain thyroid function when possible. Regular monitoring through physical exams, imaging studies, and blood tests is essential for detecting recurrences and managing long-term outcomes. Treatment plans are highly individualized, based on the type and stage of cancer, patient health, and response to initial treatments. The Russell Center prides ourselves on offering the most options with the most experience and the best outcomes of any center or group in the world.
Conclusion
Thyroid cancer, while generally treatable, requires precise and comprehensive care. Early detection and appropriate treatment can lead to favorable outcomes, particularly for the more common and less aggressive forms. Maintaining quality of life (QOL) after thyroid cancer is our top priority. In both early and late stage thyroid cancer, experience matters. When experience and innovation combine, patients have the best chance to maintain their quality of life through this challenging time. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your thyroid cancer.
