Thyroid cancer

Diagnosis

The following tests and techniques are used to identify thyroid cancer:

• Physical exam. Your doctor will examine your neck for any thyroid changes, such as a lump, during the examination. Your risk factors, such as prior radiation exposure and a family history of thyroid cancer, may also be brought up by the doctor.
• Thyroid function tests. Your doctor may receive information about the condition of your thyroid from tests that check the blood levels of thyroid-stimulating hormone (TSH) and hormones generated by your thyroid gland.
• Ultrasound imaging. High-frequency sound waves are used in ultrasound to provide images of the organs inside. The ultrasound transducer is positioned on your lower neck to produce an image of your thyroid.

An ultrasound image of a thyroid nodule might be used by your doctor to assess its likelihood of being cancerous. Calcium deposits (microcalcifications) within a thyroid nodule and an irregular border around the nodule are indicators that the nodule is more likely to be malignant. To confirm the diagnosis and identify the specific type of thyroid cancer present, additional tests are required.

Lymph node mapping is a technique your doctor may use to make images of your neck’s lymph nodes in order to check for cancerous lesions.

• Biopsy. A long, thin needle is passed through your skin and into the thyroid nodule during a fine-needle aspiration biopsy. The most common method for precisely guiding the needle is ultrasound imaging. The doctor will use the needle to remove certain thyroid cells. The sample is then examined in a lab.

A pathologist, a medical professional who specializes in the examination of blood and bodily tissue, examines the tissue sample under a microscope in the lab to determine whether cancer is present. Certain thyroid cancers, particularly Hurthle cell and follicular thyroid cancers, are more prone to have unpredictable outcomes (indeterminate thyroid nodules). Your doctor might advise a different biopsy procedure or a surgery to remove the thyroid nodule for testing. Molecular marker testing, a specialized procedure that examines cells to check for alterations in genes, is also beneficial.

• An imaging test that uses a radioactive tracer. A radioactive type of iodine and a specialized camera are used in a radioactive iodine scan to locate thyroid cancer cells in the body. It is most frequently done following surgery to look for any remaining cancer cells. The test is most beneficial for papillary and follicular thyroid malignancies.

Iodine from the blood is absorbed and used by healthy thyroid cells. This is also a behavior of several thyroid cancer cell types. Any thyroid cancer cells in the body will absorb the radioactive iodine when it is injected into a vein or ingested. On the radioactive iodine scan photos, any cells that absorb the iodine are visible.

• Other imaging tests. To assist your doctor in determining whether your cancer has progressed outside of the thyroid, you can undergo the ultrasonography, CT, and MRI.
• Genetic testing. Some medullary thyroid tumors are brought on by genes that are passed down from parents to their offspring. If you are told that you have medullary thyroid cancer, your doctor might suggest that you consult a genetic counselor to discuss genetic testing. Understanding your chance of developing various types of cancer and what your inherited gene may entail for your children will help you comprehend your risk of cancer.

Treatment

The treatment depends on the type and stage of the thyroid cancer and your general health. Since most thyroid cancers are curable with treatment, the majority of patients who are diagnosed with thyroid cancer have a very good prognosis.

Prompt treatment may not be required

Very small papillary thyroid cancers (papillary microcarcinomas), which have a minimal risk of developing into larger tumors, may not require immediate treatment. Consider active surveillance, which involves regular cancer screening, as an alternative to surgery or other treatments. Once or twice a year, your doctor could advise blood tests and an ultrasound of your neck.

Some people may not experience a growth with the cancer cells and so, they don’t need further treatment. Others may eventually experience growth, at which point treatment can start.

Surgery

The majority of patients with thyroid cancer who need treatment will have their thyroid partially or completely removed through surgery. Depending on your type of thyroid cancer, the extent of the tumor, and whether the cancer has spread to your lymph nodes, your doctor may advise a certain procedure. When developing a treatment plan, your doctor also takes into account your preferences.

The following procedures are used to treat thyroid cancer:

• Thyroidectomy. Total thyroidectomy refers to the removal of entire thyroid tissue, while near-total thyroidectomy refers to removal of most thyroid tissue. To lessen the chance of harming the parathyroid glands, which help control the calcium levels in your blood, the surgeon frequently leaves tiny rims of thyroid tissue surrounding them.
• Thyroid lobectomy. A thyroid lobectomy may involve the surgeon removing half of the thyroid. If you have a slow-growing thyroid cancer in one area of the thyroid, no worrisome nodules in any other thyroid regions, and no lymph node cancer signs, a lobectomy may be advised.
• Lymph node dissection. Lymph nodes in the neck close by are frequently affected by thyroid cancer. Before surgery, an ultrasound of the neck may detect indications that cancer cells have moved to the lymph nodes. If so, the surgeon might take out some neck lymph nodes for analysis.

Typically, an incision is made in the lower region of the neck to access the thyroid. Your circumstances, including the type of surgery and the size of your thyroid gland, will determine the size of the incision. The incision is typically made in a fold of skin to make it harder to see as it heals and creates a scar.

There is a chance of bleeding and infection after thyroid surgery. Additionally, surgery can harm your parathyroid glands, which can lower your body’s calcium levels.

The nerves that control your vocal cords may not function as they should following surgery, which could result in hoarseness and voice alterations.

You can anticipate some discomfort following surgery while your body heals. Depending on your circumstances and the sort of surgery you underwent, recovery times will vary. In 10 to 14 days, the majority of patients begin to feel better. There may still be some limitations on your behavior. For example, your doctor might advise avoiding intense activity for a few more weeks.

You might undergo blood testing to determine whether all thyroid cancer has been eradicated following surgery to remove all or most of the thyroid. Tests may assess:

• Thyroglobulin: a protein produced by differentiated thyroid cancer cells and healthy thyroid cells
• Calcitonin: a hormone produced by medullary thyroid cancer cells
• Carcinoembryonic antigen: a chemical made by medullary thyroid cancer cells

Additionally, these blood tests are utilized to search for indications of cancer recurrence.

Thyroid hormone therapy

The hormones produced by the thyroid can be replaced or supplemented with the help of thyroid hormone therapy. Medication for thyroid hormone therapy is often administered orally as pills. It may be utilized for:

• Replace thyroid hormones after surgery. You will need to take thyroid hormones for the rest of your life if your thyroid is fully removed in order to make up for the hormones your thyroid produced before to the procedure.

After having surgery to remove a portion of the thyroid, you might also require thyroid hormone replacement, though not everyone does. Your doctor may advise thyroid hormones if your post-surgery thyroid hormone levels are too low (hypothyroidism).

• Suppress the growth of thyroid cancer cells. The generation of thyroid-stimulating hormone (TSH) by the pituitary gland in your brain can be inhibited by higher dosages of thyroid hormone therapy. TSH can promote the growth of thyroid cancer cells. For aggressive thyroid malignancies, high doses of thyroid hormone therapy may be suggested.

Radioactive iodine

A radioactive type of iodine is used in radioactive iodine therapy to destroy thyroid cells and any cancerous thyroid cells that could still be present after surgery. It is most frequently applied to differentiated thyroid tumors that are at risk of metastasizing to other body regions.

Since not all types of thyroid cancer respond to this treatment, you can have a test to see whether your cancer is likely to be benefited by radioactive iodine. Papillary, follicular, and Hurthle cell types of differentiated thyroid carcinoma are more likely to respond. Radioactive iodine is typically not used to treat anaplastic and medullary thyroid cancers.

You can take radioactive iodine therapy as a liquid or tablet to ingest. There is little chance that the radioactive iodine may harm other cells in your body because thyroid cells and thyroid cancer cells are the main recipients of it.

The radioactive iodine dose you get will determine which side effects you experience. Higher doses could result in mouth pain, dry mouth, eye inflammation, and changes in sense of taste or smell.

Within the first few days following treatment, the majority of the radioactive iodine leaves your body through your urine. You’ll receive instructions on the safety measures you need to take to shield others from the radiation during that period. For instance, you might be instructed to refrain from making close contact with others for a while, especially kids and pregnant women.

Alcohol ablation

Alcohol is injected by a needle into small thyroid cancerous spots in a procedure known as alcohol ablation, also known as ethanol ablation. In order to guide the needle precisely, ultrasound imaging is used. The thyroid cells will shrink from the alcohol. Small regions of thyroid cancer, such as carcinoma discovered in a lymph node after surgery, may be treatable with alcohol ablation. This could be an alternative treatment to surgery.

Treatments for advanced thyroid cancers

Additional therapies may be necessary to control aggressive thyroid tumors that spread more quickly. Possible choices include:

• Targeted drug therapy. Targeted medication therapies concentrate on particular compounds found in cancer cells. Targeted medication treatments can kill cancer cells by blocking these substances. These treatments can be administered intravenously or as pills.

Drugs for thyroid cancer targeted therapy come in a wide variety. Some try to destroy the blood vessels that cancer cells produce so they can acquire the nutrition they need to thrive. Other medications target particular gene alterations. To determine which treatments might be helpful, your doctor may suggest specific tests of your cancer cells. The drug you take will determine which side effects you experience.

• Radiation therapy. To kill cancer cells, external beam radiation uses a system that directs high-energy beams, such X-rays and protons, to specific areas on your body. If your cancer doesn’t respond to other therapies or if it recurs, radiation therapy may be advised. Cancer that has spread to the bones may cause discomfort, which radiation therapy can help manage. The radiation’s target determines the side effects of radiation therapy. A sunburn-like skin reaction, a cough, and uncomfortable swallowing are possible adverse effects if it is directed at the neck.
• Chemotherapy. Chemotherapy is a medication that destroys cancer cells using chemicals. Chemotherapy medications come in a wide variety that can be combined or used alone. Some are administered as pills, but most are injected into a vein. Anaplastic thyroid carcinoma is one type of thyroid cancer that responds well to chemotherapy. Chemotherapy may be applied in rare circumstances to treat other thyroid cancer types. Radiation therapy and chemotherapy are sometimes used together.
• Radiofrequency ablation and cryoablation. Heat and cold therapy can be used to eliminate thyroid cancer cells that have spread to the lungs, liver, and bones. Through radiofrequency ablation, cancer cells are heated to death using electrical energy. In cryoablation, cancer cells are frozen and killed using a gas. Small areas of cancer cells are controlled by these treatments.