Thyroid Cancer

Being diagnosed with cancer can be frightening. But knowledge may help you overcome your fears.

And one of the first things you should know is that, among cancers, thyroid cancer is one of the more treatable. Here are a couple of important facts:

Even after 30 years only about 8% die from well-differentiated thyroid cancer-related causes.

There is much to be learned about thyroid cancer, its management, and testing. As always, your doctor or nurse is your best source of information and guidance, but this section will give you a lot of the basics, including an overview of thyroid cancer, how it may be diagnosed, different treatment possibilities, and what you might expect as you carry on with your life.

The thyroid is a butterfly-shaped gland at the base of the throat. It has two wings, or lobes, one right and one left. These are connected in the middle. The thyroid gland makes, stores, and releases thyroid hormones (called T3 and T4) that affect almost every cell in your body and help regulate your metabolism.

Thyroid cancer is a cancerous tumour or growth in the thyroid gland. Normally, the replacement of old thyroid cells by newly produced cells is constant and regulated. In some cases, certain cells become abnormal and do not follow the regular cycle of growth. When these abnormal cells continue to grow and reproduce in an uncontrolled way, they form a tumour.

Papillary

Follicular

Medullary

Anaplastic

Papillary and follicular thyroid cancers are the most common, accounting for 90% of thyroid tumours. These are often referred to as "differentiated" or "well-differentiated" thyroid cancers.

Cancer of the thyroid is more common in women than in men - almost three times as many women as men get thyroid cancer. Thyroid cancer strikes people at a younger age than most other cancers - most patients are between 20 and 54 years old. The chances of recovery depend on what kind of thyroid cancer you have, where it's located (is it just in the thyroid, or has it spread?), and your age and overall health.

Generally, the prognosis for patients with well-differentiated thyroid cancer is good. Even after successful therapy, however, it is possible for thyroid cancer to return, sometimes decades after initial therapy. This means that it's important to keep getting routine checkups as recommended by your doctor. Generally, the earlier you catch a recurrence, the better the chances are for successful treatment.

There are several reasons why you or your doctor might suspect thyroid cancer. One of the most common is finding a thyroid nodule, either on your own or in a check-up. A nodule is a lump that you may feel around your thyroid. Nodules are not uncommon, and only about 5% are cancerous.

One of the most common ways to confirm thyroid cancer is with a fine needle aspiration biopsy. During this procedure, a small needle is inserted through the skin into the thyroid nodule, where it draws out a sample of the material inside the nodule. This sample is then examined under a microscope. These biopsies are generally quick and safe, and they don't usually cause much discomfort.

Often, scientists cannot pinpoint the exact cause of thyroid cancer in a particular patient. Although thyroid cancer can occur in anyone, there are a few factors that have been associated with a higher risk of thyroid cancer. These include:

Radiation exposure to the thyroid gland, possibly from radiation therapy to the head, neck, or chest during childhood. Radiation was used far more often before 1960, to shrink enlarged tonsils or adenoids and treat skin problems like acne. You should know that the kind of radiation you get in an x-ray has not been linked to a higher chance of getting thyroid cancer.

A family history of thyroid cancer

There are many different options for managing thyroid cancer. The most common treatments include surgical removal of the cancer followed by radiation therapy (called remnant ablation) to kill both normal thyroid and thyroid cancer cells. You should consult with your doctor on the best treatment for you.

Surgery may involve partial or total thyroidectomy (removal of the thyroid gland). After a total thyroidectomy, most patients undergo remnant ablation. This is an important step, since it should help clear all potentially cancerous thyroid cells that may not have been removed during surgery.

In remnant ablation, patients take a drink or a capsule that contains radioactive iodine (RAI), also called radioiodine. Any remaining thyroid cells should take up the RAI, which will kill the cells. This process uses a greater amount of radiation than a routine whole body scan, which is generally well tolerated. You should discuss the risks associated with RAI with your doctor.

After your initial treatment has been completed, your doctor will usually recommend that you be placed on thyroid hormone suppression therapy (THST). THST consists of taking hormones (T3 and/or T4) that essentially replace the hormones that would have been produced by your thyroid gland. This is important, because if you did not have these thyroid hormones, your body would try to stimulate more thyroid activity, which could increase your chances of a thyroid cancer recurrence.

Additionally, during THST, the hormones you are taking will take over the thyroid's role in regulating your body. This means that you will likely be able to go about your normal life after treatment with very few differences.

Very shortly after your initial therapy, your doctor will probably want to confirm that all of your cancer was removed. To do this, he or she will most likely conduct at least one whole body scan (WBS) to check for thyroid activity. You can read more about WBS in the Follow-up area.

After the success of your treatment has been confirmed, you should be able to get back to your regular activities very quickly. Your doctor will still want to see you fairly regularly in the first few years following successful therapy just to make sure that you're still cancer free. It's extremely important to keep going to your doctor for your scheduled checkups, since catching a recurrence earlier is more likely to result in successful treatment.

While at first it may feel like thyroid cancer has taken over your life, once you've been through your initial treatment and are taking thyroid hormone therapy, your life may settle into a more normal routine.

Your doctor may recommend some things you'll want to incorporate into your life that will help you take good care of yourself and stay healthy. They include:

Regular exercise

Good eating habits

Good stress management

Time for relaxation

Having any type of cancer will undoubtedly change your life. It's normal to feel frightened and as though your life will never be "normal" again. As you've read, the outlook for surviving well-differentiated thyroid cancer (WDTC) is generally good - only about 8% of patients with WDTC will die from cancer-related causes within 30 years. Once you've been through your initial treatment and are taking thyroid hormone therapy, you can likely look forward to a more normal life.

It is still important to bear in mind that recurrences are possible many years - even decades - after treatment. Long-term studies have shown that:

As many as 35% of patients with WDTC will experience a recurrence within 40 years from the time of initial therapy

1/3 of recurrences happen 10 years or more after treatment

These numbers shouldn't be frightening, since many recurrences of well-differentiated thyroid cancer are treatable. The prognosis is improved if you catch a recurrence relatively early. As you can see, it's important to keep having follow-up tests.

In the first few years after treatment for thyroid cancer, your doctor will probably want to do routine tests relatively often. Depending on your doctor and your individual condition, you may go for tests annually, or perhaps more frequently until you and your doctor are comfortable with less frequent monitoring.

Routine physical exams

Thyroglobulin (Tg) tests

Whole body scans

Even though most routine examinations may not uncover anything to be concerned about, it is possible that you may develop recurrent cancer in the thyroid area or metastatic recurrences. Seeing you physician regularly is the best first step in the management of Thyroid Cancer.


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