Thyroid Cancers A Synopsis

The thyroid gland is a butterfly-shaped organ located at the front of your neck. It plays an important role in regulating your metabolism, which controls how your body uses energy.

Thyroid cancer is relatively uncommon, affecting about 5 to 6 people per 100,000. Generally, thyroid cancer is not considered an aggressive type of cancer. It often starts as a painless lump or swelling in the neck. As the cancer progresses, it may cause swelling in the lymph nodes, difficulty swallowing, changes in the voice (such as hoarseness), or in rare cases, the windpipe may shift, and the swelling may extend into the upper chest. In advanced cases, the cancer may spread to the lungs or bones.

If you notice a swelling in your neck, your doctor will perform several tests to determine the cause. These may include thyroid function tests, tumor markers, an ultrasound of the thyroid, and a fine needle biopsy to collect a sample. In some cases, a PET scan or CT scan of the neck may also be necessary.

Most cases of thyroid cancer are well-differentiated, which means they grow slowly and are easier to treat. The most common types are papillary and follicular thyroid cancers, which have excellent survival rates. Another type, medullary thyroid cancer, can sometimes run in families. Anaplastic thyroid cancer is rare but more aggressive and has a poorer outlook.

Treatment Options

For papillary, follicular, and medullary thyroid cancers, surgery is the main treatment. Depending on the size and spread of the cancer, as well as the patient's age, the surgery may involve removing part of the thyroid (a hemi-thyroidectomy) or the entire thyroid (a total thyroidectomy). If cancer has spread to nearby lymph nodes, a more extensive surgery may be needed, including the removal of lymph nodes in the neck.

After a total thyroidectomy, a radioiodine scan is performed 3 to 4 weeks later. This scan is sensitive and can detect even small amounts of remaining cancer cells, which can be treated with a large dose of radioactive iodine to help cure the disease.

After surgery and treatment, patients with well-differentiated thyroid cancer will need lifelong thyroid hormone supplements and regular follow-up visits, including blood tests and imaging, to monitor for any recurrence.

For medullary thyroid cancer, surgery to remove the thyroid and affected lymph nodes is also the primary treatment. In some cases, additional tests such as a PET DOPA scan may be done to check for spread. Treatment may also include specialized imaging or therapy, such as Gallium scan or Lutetium DOTA therapy, and occasionally, targeted chemotherapy.

Anaplastic thyroid cancer is rare but aggressive, often presenting as a hard lump in the thyroid. Since these cancers tend to grow quickly and recur after surgery, surgery is generally not recommended. Treatment focuses on controlling symptoms with chemotherapy, radiation, and pain management.

Risks of Thyroid Surgery

Like any surgery, thyroid surgery carries some risks like change or hoarseness of the voice, usually temporary. Low calcium levels (Hypocalcemia) could be another complication which can cause symptoms like muscle cramps.

Incidental Finding of Thyroid Cancer

Thanks to routine health checkups, small thyroid cancers are often found by chance during neck ultrasounds, particularly in large cities. These cancers are usually less than 1 cm in size and often have an excellent prognosis. If this happens, the surgery can be planned as an elective surgery and there is no need to rush or panic since most of these cancers are well-differentiated with high survival rates.

Thyroid cancers have excellent prognosis and patients have very good quality of life post surgery.