By Dr Barry Durrant-Peatfield
Thyroid cancer can occur in all age groups. People who have had radiation therapy to the neck are at higher risk. This therapy was commonly used in the 1950s to treat enlarged thymus glands, adenoids and tonsils, and skin disorders. People who received radiation therapy as children have a higher incidence of thyroid cancer.
Most distressing can be marked enlargement of the thyroid, which may be symmetrical or asymmetrical.
Thus, the goitre may be due to a number of factors. Iodine deficiency will cause chronic enlargement; but this is rarely seen today, except in remote inland areas. Many people develop a diffuse, usually soft enlargement, especially teenage girls, with no real symptoms requiring attention. Sometimes, these quietly disappear, but they may progress to become rather harder and with lumps and nodules over the years. It is then called multi-nodular goitre, and may be inconvenient or unsightly. At this point, medical advice should be sought. X-rays and ultrasound may show its full extent, and whether further tests or intervention is required. Once such is the use of radioactive iodine, which is taken up to a greater degree by the abnormally active thyroid nodules and will show up as hot spots on a thyroid scan, providing a picture of the thyroid tissue health. It is more common for the thyroid to present a nodule as a lump one side or the other.
Many of these patients will have had the full thyroid function tests, but most often will have the nodule drained by a fine needle (fine needle aspiration (FNA) for the technically minded). The fluid and cells are subjected to microscopy. At this point, cancer cells may be looked for, which is why a growing nodule is not something you should try to deal with yourself. Fortunately, cancer is really quite rare and has a very high survival rate (95% overall); the average practice may not see more than one case every few years or so.
For the sake of completeness, I am going briefly to list the types of thyroid cancer that occur. Early on in life, and in young women, the cancer is likely to be papillary cancer (from its frond like appearance under the microscope). Later on in life, after about the age of 30, the cancer is more likely to be follicular cancer.
Much rarer are medullary, lymphoma, or anaplastic cancer, the last two really only occurring in older age groups.
Symptoms of Thyroid Cancer
Most commonly, thyroid cancers in the early stage produce no symptoms. As the cancer grows, a small lump or nodule can be felt in the neck. The vast majority of thyroid nodules are caused by benign conditions, but about one per cent of these lumps represent early stages of thyroid cancer. If the cancer spreads, it can cause symptoms that include:
- A lumpsometimes growing rapidlyin the front of your neck, just below your Adams apple
- Hoarseness or difficulty swallowing
- Swollen lymph nodes, especially in your neck
- Pain in your throat or neck, sometimes spreading up to your ears
- Coughor cough with bleeding
Having one or more of these symptoms doesnt necessarily mean you have thyroid cancer. Other conditionsincluding a benign thyroid nodule, an infection or inflammation of the thyroid gland and a benign enlargement of the thyroid (goitre)can cause similar problems, all of which are highly treatable.
Treatment of Thyroid Cancer
Treatment is essentially surgical; the whole gland is removed, together with any associated glands with papillary cancer; some tissue may safely be left in surgical treatment of the follicular form. Any stray cancer cells are mopped up by a course of radioactive iodine a few weeks after the surgery and before thyroid replacement has been started. It is considered good practice to prevent thyroid stimulating, as by the TSH, to prevent recurrence; so thyroid replacement ensures the TSH is kept very low.
A physical examination can reveal a thyroid mass or nodule (usually in the lower part of the front of the neck), or enlarged lymph nodes in the neck.
Tests that indicate thyroid cancer:
Thyroid Biopsy showing anaplastic, follicular, medullary or papillary cancer cells
Ultrasound of the thyroid showing a nodule
Thyroid Scan showing cold nodule (a nodule that does not light up on scan)
Laryngoscopy showing paralysed vocal cords
Elevated serum calcitonin (for medullary cancer) or serum thyroglobulin (for papillary or follicular cancer)
This disease may also alter the results of the following tests: TSH, T4 and T3.
People with thyroid cancer often want to take an active part in making decisions about their medical care.
They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder.
Some also want to have a family member or friend with them when they talk to the doctorto take part in the discussion, to take notes, or just to listen.
The doctor may refer patients to a specialist (oncologist) who specialise in treating cancer, or patients may ask for a referral. Specialists who treat thyroid cancer include surgeons, endocrinologists, medical oncologists, and radiation oncologists. Treatment generally begins within a few weeks after the diagnosis.
There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about thyroid cancer.
The following are some questions you may want to ask your doctor before treatment begins:
What type of thyroid cancer do I have?
Has the cancer spread? What is the stage of the disease?
Do I need any more tests to check for spread of the disease?
What are my treatment choices? Which do you recommend for me? Why?
What are the benefits of each kind of treatment?
What are the risks and possible side effects of each treatment?
How will the treatment affect my normal activities?
Would a clinical trial (research study) be appropriate for me? Can you help me find one?