Thyroid CancerLast Updated: February 07, 2012 This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/11 Overview
Thyroid cancer begins in the thyroid gland, which is located in the front of the neck just below the larynx (voice box). Thyroid cancer starts when the cells in the thyroid begin to change, grow uncontrollably, and eventually form a tumor. There are two types of tumors: benign (noncancerous) and malignant (cancerous, meaning that it can spread to other parts of the body). Thyroid tumors can also be called nodules, and 90% of all thyroid nodules are benign. About the thyroid The thyroid gland is part of the endocrine system, which regulates hormones in the body. The thyroid gland absorbs iodine from the bloodstream to produce thyroid hormones, which regulate a person’s metabolism. A normal gland has two lobes, one on each side of the windpipe, joined by a narrow strip of tissue called the isthmus. A healthy thyroid gland is barely palpable (capable of being touched or felt). If a tumor develops in the thyroid, it is felt as a lump in the neck. A swollen or enlarged thyroid gland is called a goiter, which may be due to a person not getting enough iodine. However, most Americans receive enough iodine from salt, and a goiter under these circumstances is caused by other reasons. Types of thyroid cancer The thyroid gland contains two types of cells: follicular cells, which are responsible for the production of thyroid hormone, and C cells, which make calcitonin, a hormone that participates in calcium metabolism. There are four main types of thyroid cancer: Papillary thyroid cancer. Papillary thyroid cancer develops from the follicular cells and grows slowly. It is the most common type of thyroid cancer. It is usually found in one lobe; only 10% to 20% of papillary thyroid cancers appear in both lobes. Papillary thyroid cancer is a differentiated thyroid cancer, meaning that the tumor looks similar to normal thyroid tissue under a microscope. Follicular thyroid cancer. Follicular thyroid cancer also develops from the follicular cells and usually grows slowly. Follicular thyroid cancer is also a differentiated thyroid cancer, but it is less common than papillary thyroid cancer. These two types of cancer are very often curable, especially when found early and in people younger than 45. Together, papillary and follicular thyroid cancers make up about 90% of thyroid cancers. Medullary thyroid cancer (MTC). MTC develops in the C cells and is sometimes the result of a genetic syndrome called multiple endocrine neoplasia type 2 (MEN2). This tumor has very little, if any, similarity to normal thyroid tissue. MTC can often be controlled if it is diagnosed and treated before it spreads to other parts of the body. MTC accounts for about 5% of thyroid cancers. Anaplastic thyroid cancer. This type is rare, accounting for about 2% of thyroid cancers. It is a fast-growing, poorly differentiated thyroid cancer that starts from differentiated thyroid cancer or a benign tumor of the gland. Anaplastic thyroid cancer can be subtyped into giant cell classifications. Because this type of cancer grows so quickly, it is more difficult to treat successfully. This section addresses these four main types of thyroid cancer. There are also subtypes (or variants) within these main types, such as the follicular thyroid cancer variant called Hürthle cell cancer. For lymphoma in the thyroid, please read Cancer.Net’s Guide to Lymphoma, Non-Hodgkin. For more information on sarcoma in the thyroid, review the Cancer.Net Guide to Sarcoma. For information on a tumor in the parathyroid gland, read Cancer.Net’s Guide to Parathyroid Cancer. Find out more about basic cancer terms used in this section. Looking for More of an Overview? If you would like additional introductory information, explore this related item on Cancer.Net:
Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel on the right side of your screen. Statistics
This year, an estimated 56,460 adults (13,250 men and 43,210 women) in the United States will be diagnosed with thyroid cancer. It is estimated that 1,780 deaths (780 men and 1,000 women) from this disease will occur this year. Thyroid cancer is the fifth most common cancer in women. The incidence rates of thyroid cancer in both women and men have been increasing in recent years, and researchers are working to figure out why. The five-year survival rate (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) for all stages of thyroid cancer is about 97%. The five-year relative survival rate for papillary and follicular thyroid cancers that have not spread outside the thyroid and MTC is about 100%. For cancer that has spread to the regional lymph nodes, the five-year survival rate is, 97%. The five-year survival rate for cancer that has spread outside the thyroid to other parts of the body is 56% (see Staging). Anaplastic thyroid cancer is associated with a much lower survival rate. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with thyroid cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics. Statistics adapted from the American Cancer Society’s publication,Cancer Facts & Figures 2012. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The following factors can raise a person’s risk of developing thyroid cancer: Gender. Women are two to three times more likely to develop thyroid cancer than men. Age. Thyroid cancer can occur at any age, but about two-thirds of all cases are found in people between the ages of 20 and 55. Anaplastic thyroid cancer is usually diagnosed after age 60. Older infants (10 months and older) and adolescents can develop MTC, especially if they carry the RET proto-oncogene mutation (see below). Genetics. Some types of thyroid cancer are associated with genetics. Below are some key facts about this disease, genes, and family history; read more about the genetics of thyroid cancer.
Radiation exposure. Exposure to moderate levels of radiation may increase the risk of papillary and follicular thyroid cancers. Such sources of exposure include the following:
Race. White people and Asian people are more likely to develop thyroid cancer, but this disease can affect a person of any race or ethnicity. Symptoms and Signs
People with thyroid cancer often experience the following symptoms or signs. Sometimes, people with thyroid cancer do not show any of these symptoms. Or, these symptoms may be similar to those of other medical conditions. If you are concerned about a symptom or sign on this list, please talk with your doctor.
Talk with your doctor if you have any of these symptoms. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. These symptoms may be caused by thyroid cancer; other thyroid problems, such as a goiter; or a condition not related to the thyroid, such as an infection. Questions may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
The following tests may be used to diagnose thyroid cancer: Physical examination. The doctor will feel the neck, thyroid, throat, and lymph nodes (the tiny, bean-shaped organs that help fight infection) in the neck for unusual growths or swelling. If surgery is recommended, the larynx may be examined at the same time with a laryngoscope (thin, flexible tube with a light). Blood tests. There are several types of blood tests that may be done during diagnosis and to monitor the patient during and after treatment. This includes tests called tumor marker tests. Tumor markers are substances found at higher than normal levels in the blood, urine, or body tissues of some people with cancer.
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. An ultrasound wand or probe is guided over the skin of the neck area. High-frequency sound waves create a pattern of echoes that show the doctor the thyroid gland size and specific information about any nodules, including whether they are solid or cysts (fluid-filled sacs). Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. The way to determine whether a nodule is malignant or benign is through a biopsy. During this procedure, the doctor removes cells from the nodule that are then examined by a cytopathologist (a doctor who specializes in analyzing cells and tissue) to determine if cancer is present. A biopsy for thyroid nodules will be done one of two ways:
Radionuclide scanning. This test may also called a full-body scan or a radioactive iodine (I-131 or RAI) scan. It is used most often to learn more about a thyroid nodule. In this test, the patient swallows a very small, harmless amount of radioactive iodine, which is absorbed by thyroid cells; this make them appear on the scan image, allowing the doctor to see differences between thyroid cells and other body structures. X-ray. An x-ray is a way to create a picture of the structures inside of your body, using a small amount of radiation. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging With Illustrations
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
In addition to the TNM system, papillary and follicular thyroid cancers are also staged by the age of the patient. Tumor. Using the TNM system, the letter “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. When describing “T” in thyroid cancer, doctors may subdivide the general categories by adding the letter “s” to indicate a solitary (single) tumor or “m” to indicate multifocal (more than one) tumors. Specific tumor stage information is listed below. TX: The primary tumor cannot be evaluated. T0: There is no evidence of a tumor. T1: The tumor is 2 centimeters (cm) or smaller and limited to the thyroid. T1a: The tumor is 1 cm or smaller. T1b: The tumor is bigger than 1 cm but less than 2 cm. T2: The tumor is at least 2 cm, but it is not larger than 4 cm and is limited to the thyroid. T3: The tumor is larger than 4 cm, but the tumor does not extend beyond the thyroid gland. T4: The tumor is any size and has extended beyond the thyroid. T4a: The tumor has spread beyond the thyroid to nearby soft tissues, the larynx, trachea, esophagus or recurrent laryngeal nerve. T4b: The tumor has spread beyond the regions stated in T4a (above). Node. The “N” in the TNM staging system stands for lymph nodes. There are many regional lymph nodes located in the head and neck area, and careful assessment of lymph nodes is an important part of staging thyroid cancer. Lymph nodes in other parts of the body are called distant lymph nodes. NX: The regional lymph nodes cannot be evaluated. N0: There is no evidence of cancer in the regional lymph nodes. N1: Cancer has spread to the lymph nodes. N1a: Cancer has spread to the lymph nodes around the thyroid (called the central compartment; pretracheal, paratracheal, and prelaryngeal lymph nodes.) N1b: Cancer has spread beyond the central compartment, including unilateral cervical (lymph nodes on one side of the neck), bilateral cervical (lymph nodes on both sides of the neck), contralateral cervical (the opposite side of the tumor), or mediastinal (the chest) lymph nodes. Distant metastasis. The “M” in the TNM system indicates whether cancer has spread to other parts of the body. MX: Distant metastasis cannot be evaluated. M0: Cancer has not spread to other parts of the body. M1: Cancer has spread to other parts of the body. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. For thyroid cancer, this staging system differs by tumor type. For papillary or follicular thyroid cancers, it also depends on the age of the patient. Papillary or follicular thyroid tumors, in a person younger than 45 Stage I: This stage describes a tumor (any T) with or without spread to lymph nodes (any N) and no distant metastasis (M0). Stage II: This stage describes a tumor (any T) with any metastasis (M1) regardless of whether it has spread to the lymph nodes (any N). Papillary or follicular thyroid tumors, in a person 45 and older Stage I: This stage describes any small tumor (T1) with no spread to lymph nodes (N0) and no metastasis (M0). Stage II: This stage describes a larger, noninvasive tumor (T2) with no spread to lymph nodes (N0) and no metastasis (M0). Stage III: This stage describes a tumor larger than 4 cm but contained in the thyroid (T3) with no spread to lymph nodes (N0) and no metastasis (M0). Or, any localized tumor (T1-3) with spread to the central compartment of lymph nodes (N1a), but no distant spread (M0). Stage IVA: This stage describes a tumor that has spread to nearby structures (T4a), regardless of whether it has spread to the lymph nodes (any N), but it has not spread to distant places (M0). Or, this describes a localized tumor (T1-3), with lymph node spread beyond the central compartment (N1b), but no distant spread (M0). Stage IVB: This stage describes a tumor that has spread beyond nearby structures (T4b), regardless of spread to lymph nodes (any N), but no distant spread (M0). Stage IVC: This stage describes all tumors (any T, any N) when there is evidence of metastasis (M1). Medullary thyroid tumors Stage I: This stage describes a small tumor (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0). Stage II: This stage describes a larger localized tumor (T2, T3) with no spread to lymph nodes (N0) and no metastasis (M0). Stage III: This stage describes any localized tumor (T1-3) that has spread to the central compartment of lymph nodes (N1a) but has not metastasized (M0). Stage IVA: This stage describes a tumor that has spread to nearby structures (T4a), regardless of whether it has spread to the lymph nodes (any N), but it has not spread to distant places (M0). Or, this describes a localized tumor (T1-3), with lymph node spread beyond the central compartment (N1b), but no distant spread (M0). Stage IVB: This stage describes a tumor that has spread beyond nearby structures (T4b), regardless of spread to lymph nodes (any N), but no distant spread (M0). Stage IVC: This stage is used when there is evidence of metastasis (any T, any N, M1). Anaplastic thyroid tumors Stage IV: All anaplastic thyroid tumors are classified as stage IV, regardless of tumor size, location, or metastasis. Stage IVA: This stage describes an anaplastic tumor that has spread to nearby structures (T4a), regardless of whether it has spread to the lymph nodes (any N), but it has not spread to distant places (M0). Stage IVB: This stage describes an anaplastic tumor that has spread beyond nearby structures (T4b), regardless of spread to lymph nodes (any N), but no distant spread (M0). Stage IVC: This stage is used when there is evidence of metastasis (any T, any N, M1). Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (re-staged) using the system above. Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010),published by Springer-Verlag New York, www.cancerstaging.net. Treatment
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections. Treatment overview In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For thyroid cancer, this may include a surgeon, endocrinologist (a doctor specializing in problems with glands and the endocrine system), medical oncologist, and radiation oncologist. Thyroid cancer is commonly treated by one or a combination of treatments, including surgery, hormone treatment, radioactive iodine, external-beam radiation therapy, and/or chemotherapy. Descriptions of these options for thyroid cancer are listed below, followed by an outline of common cancer treatments given by stage of disease (see Staging). Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Cancer treatment is often selected based on guidelines recommended by panels of expert physicians. Although most thyroid cancers are curable, there can be different opinions in how to treat thyroid cancer, particularly regarding which combination of treatments to use and the timing when treatments are done. Patients are encouraged to seek a second opinion before starting treatment because they should be comfortable with the treatment plan they choose and should ask about clinical trials. Learn more about making treatment decisions. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. It is the main treatment for most people with thyroid cancers. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Depending on the size of the nodule, surgical options include: Total thyroidectomy. This surgery removes the entire thyroid gland. Near-total thyroidectomy. Also called subtotal thyroidectomy, this is surgery to remove the thyroid gland except for a small part. Lobectomy. This surgery removes the lobe with the cancerous nodule. Total or near-total thyroidectomies are the most common operations for thyroid cancer; lobectomies are performed on some patients with papillary or follicular thyroid cancer. If there is evidence or risk of spread of cancer to the lymph nodes in the neck, the surgeon may also perform a neck dissection. This is surgery to remove the lymph nodes in the neck that can also be called a lymphadenectomy. Complications of surgery may include damage to the nearby parathyroid glands (which help regulate blood calcium levels), excessive bleeding, or wound infections. If the nerves to the larynx are damaged during surgery, this may cause temporary or permanent hoarseness or a “breathy” voice. Learn more about cancer surgery. Without the thyroid gland, the body stops producing thyroid hormone, which is essential to a body’s functioning. Hormone replacement (see below), usually given by a daily pill, is the best solution. The patient may also have to take vitamin D and calcium supplements if the parathyroid gland function is impaired after surgery. Hormone treatment Patients who are treated for papillary, follicular, and medullary thyroid cancers by surgery require thyroid hormone therapy. In addition to replacing the hormone that is needed by the body, the thyroid hormone medication will slow down the growth of any remaining differentiated cancer cells, an important double purpose. Thyroid hormone replacement is levothyroxine (Levothroid, Levoxyl, Synthroid, Unithroid). Levothyroxine typically comes as a pill that should be taken daily, at the same time each day, so that the body receives a consistent supply. Also, be sure to talk with your doctor about all other medications (including dietary supplements, such as iron or calcium) you are taking to avoid interactions with your thyroid hormone replacement. Read more about tips to take your medication correctly. Thyroid pills may have a few side effects. Occasionally, some patients develop a rash or lose some hair during the first months of treatment. The doctor will monitor the patient’s thyroid hormone levels through regular blood tests. Hyperthyroidism (too much hormone) may cause weight loss, chest pain, rapid heart rate or arrhythmias (irregular heartbeat), cramps, and diarrhea; patients may also feel hot and sweaty. Bone loss (osteoporosis) is also possible. Hypothyroidism (too little hormone) may cause fatigue, weight gain, and dry skin and hair; patients may also feel cold. The amount or dose of thyroid hormone required is different for every patient and tumor type, and it can change as a person ages. Radioactive iodine (radioiodine) therapy The thyroid absorbs almost all iodine that enters a body. Therefore, a type of radiation therapy called radioactive iodine (also called I-131 or RAI) is given as a way to find and destroy thyroid cells not removed by surgery and those that have spread beyond the thyroid. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. This treatment is an option for most people with the papillary and follicular types. A small test dose may be given prior to full treatment, to be sure the tumor cells will absorb the I-131. Patients with medullary or anaplastic thyroid cancer are not treated with I-131. I-131 therapy is given in either liquid or pill form. Patients receiving I-131 to kill cancer cells may or may not be hospitalized for two to three days, depending on several factors including the dose given. Patients are encouraged to drink fluids to help the I-131 pass quickly through the body. Within a few days, most of the radiation is gone. Talk with your doctor about ways to limit radiation exposure to other people, including children, who may be around you during this treatment and the days following it. In preparation for radioactive iodine treatment after surgery, patients are usually asked to follow a low-iodine diet for two to three weeks beforehand. In addition to the low-iodine diet, patients will be asked to either stop taking thyroid hormone replacement pills temporarily or receive injections of recombinant TSH (Thyrogen) while taking the hormone replacement. If the hormone therapy is stopped during the preparation period, the patient will likely experience side effects due to hypothyroidism (see above). It is important to discuss the possible short-term and long-term effects of I-131 therapy with your doctor. On the first day of treatment, patients may experience nausea and vomiting. In certain circumstances, pain and swelling can occur in the areas where the radioactive iodine is collected. Because iodine is concentrated in salivary gland tissue, patients may experience swelling of the salivary glands; this may result in xerostomia (dry mouth). Large or cumulative doses of radioactive iodine may cause infertility (inability to produce a child), especially in men. It is recommended that women avoid pregnancy for at least one year after radioactive iodine treatment. There is a risk of secondary cancers with the use of I-131 (see After Treatment). Occasionally, patients may require repeated radioactive treatments over time. However, there is a maximum total dose of radioactive iodine allowed over time, and once reached, this may prevent further use of this treatment. External-beam radiation therapy External-beam radiation is another type of radiation therapy in which high-energy x-rays are given from a machine outside the body to kill cancer cells. An external-beam radiation therapy regimen (schedule) usually consists of a specific number of treatments given oven a set period of time. When used to treat thyroid cancer, radiation therapy is usually given as outpatient therapy, either in a hospital or clinic, five days a week for about five to six weeks. For thyroid cancer, external-beam radiation therapy is used only in certain circumstances, typically when advanced thyroid cancer has not responded to radioactive iodine therapy (see above). Radiation therapy is usually given after surgery, and treatment is concentrated on a specific area, only affecting cancer cells at that site. Side effects depend on the treatment dosage and area and may include redness of the skin, odynophagia (painful swallowing), cough, occasional hoarseness, nausea, and fatigue. Most side effects go away soon after treatment is finished. Learn more about external-beam radiation therapy. Chemotherapy and Targeted therapy Chemotherapy is the use of drugs to kill cancer cells and is sometimes used to treat thyroid cancer. Systemic chemotherapy is delivered through the bloodstream, usually aimed at stopping cancer cells’ ability to grow and divide throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce symptoms. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells, usually leading to fewer side effects than other cancer medications. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. Many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. For medullary thyroid cancer treatment, the U.S. Food and Drug Administration (FDA) in 2011 approved vandetanib tablets (Caprelsa, zd6474), which is a type of targeted therapy known as a tyrosine kinase inhibitor. Specifically, vandetanib is now a standard treatment for adults when MTC is not able to be removed surgically (unresectable), the disease is worsening, or if MTC has spread to other parts of the body (metastatic). The medication is given as a daily pill; the typical daily dose of vandetanib is 300 mg. Common side effects include diarrhea and colon inflammation, skin rash, nausea, high blood pressure, headache, fatigue, loss of appetite, and stomach pain. Additionally, more serious side effects such as respiratory and heart problems can occur. Before treatment begins, be sure to talk to your doctor about potential side effects, and let your doctor know right away about any side effects you experience during treatment. Blood tests, including serum potassium, calcium, magnesium, and TSH levels (see Diagnosis), may be done to monitor the body’s reaction to this medication on a regular basis. At this time, the use of other, systemic chemotherapy and targeted therapy for the treatment of thyroid cancer is determined on an individual basis and is most often given as part of a clinical trial (research study). See the Current Research section for more information. Learn more about chemotherapy, targeted treatments, and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Recurrent thyroid cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, targeted therapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence. Stage IV thyroid cancer If the cancer has spread beyond the thyroid to other organs, such as the bones or lungs, this is called metastatic or Stage IV thyroid cancer. Also, all anaplastic thyroid tumors are classified as stage IV at the time of diagnosis, regardless of tumor size, location, or spread. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials. Your health care team may recommend a treatment plan that includes a combination of surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Clinical trials on new treatment approaches may also be recommended. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. Although treatment is successful for the majority of people with thyroid cancer, sometimes it is not. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning. Treatment options by stage If the thyroid cancer is only within the tissues of the neck, both in the thyroid gland and in the lymph nodes, surgery will typically be the first treatment. Patients with later stage disease may be treated with surgery as well, but other treatments may be done first. Clinical trials may be recommended at any stage as a treatment option. Stage I: Surgery; hormone therapy; possible radioactive iodine therapy after surgery Stage II: Surgery; hormone therapy; possible radioactive iodine therapy after surgery Stage III: Surgery; hormone therapy; possible radioactive iodine therapy or external-beam radiation therapy after surgery Stage IV: Surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Radiation therapy may also be used to reduce pain and other problems. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with thyroid cancer. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating thyroid cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with thyroid cancer. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for thyroid cancer, learn more in the Current Research section. Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, lymphedema, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with thyroid cancer. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. For many patients, a diagnosis of thyroid cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for thyroid cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include physical examinations and/or medical tests on a regular basis to monitor your recovery in the coming months and years. People treated for thyroid cancer are encouraged to receive routine follow-up care over the course of their lifetimes. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed People treated for thyroid cancer are typically asked to return to the doctor’s office every six months to a year. At a follow-up care visit, the doctor will conduct a physical examination and blood tests to watch the level of TSH suppression and to test for Tg (see Diagnosis). If the thyroid gland has been removed, there should be little or no Tg in the blood; an elevated level may indicate the cancer has returned. Other blood tests may be done depending on the specific type of thyroid cancer treated. Blood tests also help the doctor determine the correct dosage of the patient’s thyroid replacement medication (if needed), which may be adjusted over time as the patient gets older. Other follow-up tests may include a chest x-ray, an ultrasound of the neck, a full-body scan, or other imaging tests. If the doctor recommends a procedure that uses radioactive iodine (I-131), patients may have to stop taking their thyroid medication up to six weeks and/or may be asked to follow a low-iodine diet for up to two weeks before having the test. Based on the type of treatment received, the doctor will determine what examinations and tests are needed to check for long-term side effects, including the possibility of secondary cancers. This is particularly important for people who have received I-131 treatment, who may be at higher risk of leukemia and urinary bladder cancer. And, young women who are treated for papillary or follicular thyroid cancer have a higher risk of developing breast cancer in the future and should talk with their doctor about appropriate breast cancer screening recommendations. People recovering from thyroid cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
Doctors are working to learn more about thyroid cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you. Updated surgical methods.
New treatments. Clinical trials for thyroid cancer include testing new medications, including drugs known as targeted therapy. As explained in Treatment, targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. In addition, researchers are looking at new combinations of chemotherapy and other treatments.
Data collection. There is an effort to create a volunteer registry of people with a history of thyroid cancer, to help doctors research this disease in the future. Participants are asked to provide information, tissue samples, and/or blood and urine samples. Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current thyroid cancer treatments in order to improve patients’ comfort and quality of life. To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now. Learn more about common statistical terms used in cancer research. Questions to Ask the Doctor
Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
