Parathyroid Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 11/2020

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with parathyroid cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for a parathyroid tumor. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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. It is very important that the health care team has experience treating parathyroid cancer. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

The most common types of treatments used for a parathyroid tumor are surgery and treatment of hypercalcemia. Chemotherapy and radiation therapy may also be recommended. Newer treatments, like immunotherapy and other new drugs, are being studied in clinical trials. Your treatment plan will include efforts to both eliminate the tumor and control the amount of calcium in your bloodstream. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of the tumor, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for parathyroid cancer because there are different treatment options. Learn more about making treatment decisions.

Treating hypercalcemia

As explained in the Introduction, a parathyroid tumor can cause high levels of calcium in the blood, also called hypercalcemia. Having too much calcium in the blood can cause serious problems. It may need immediate treatment.

There are a number of medications that can be used to reduce calcium levels in the blood or stop bones from breaking down due to hypercalcemia. Some of the drugs that are used to treat hypercalcemia are:

  • Bisphosphonates. Common types of this medication include pamidronate (Aredia), clodronate (Bonefos), ibandronate (Boniva), or zolendronic acid (Zometa).

  • Calcitonin (multiple brand names)

  • Cinacalcet (Sensipar)

  • Denosumab (Prolia, Xgeva)

  • Gallium nitrate (Ganite)

Most of these drugs are only used for short periods until treatment to remove the tumor can be started.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery is the main treatment for a parathyroid tumor, whether the tumor is benign or cancerous. A surgical endocrine oncologist is a doctor who specializes in treating an endocrine tumor using surgery. Because parathyroid cancer is so rare and it cannot be cured if it recurs, it is very important that surgery to remove it is performed by a surgical endocrine oncologist who has extensive expertise in thyroid and parathyroid surgery whenever parathyroid cancer is suspected.

It is difficult to know before surgery whether a parathyroid tumor is benign or malignant. Parathyroid cancer is the likely diagnosis whenever a patient has profound hypercalcemia, defined as a calcium level higher than 13 mg/dL, or a large parathyroid tumor, defined as larger than 3 centimeters. If this is the case, the parathyroid gland and surrounding structures should be removed. Those surrounding structures should include the same side of the thyroid gland, fatty tissue and lymph nodes surrounding the parathyroid tumor, and the overlying muscle of the center of the neck, called the sternothyroid muscle. The doctor may also recommend radiation therapy (see below) after surgery to the affected area of the neck.

The typical surgery for a benign parathyroid tumor is not the same as the surgery for a parathyroid cancer. Surgery for a benign parathyroid tumor is called a parathyroidectomy. If a surgeon finds out that the tumor is benign during surgery, it is common to check the patient’s level of PTH in the blood during the operation. If necessary, the surgeon will then put back 1 of the normal parathyroid glands that had been removed earlier in the operation. However, if the tumor is cancerous, the gland should not be put back to avoid any chance of putting cancer cells back into the body.

Before surgery, talk with your surgeon about what to expect, how long recovery will take, and the possible short- and long-term side effects. Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, which is your treatment plan, usually consists of a specific number of treatments given over a set period of time. This may also be called a schedule.

Occasionally, radiation therapy may be recommended after surgery for parathyroid cancer. Radiation therapy may help reduce the risk of parathyroid cancer recurring in the neck, but it is difficult to evaluate whether this treatment is beneficial because this type of cancer is so rare. Radiation therapy may also be recommended if surgery is not possible.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Talk with your doctor about how side effects can be relieved or managed during treatment. Most side effects go away soon after treatment has finished. Learn more about the basics of radiation therapy.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The medications used to treat tumors 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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

The main type of systemic therapy used for parathyroid cancer is chemotherapy. Other types of systemic therapies, such as immunotherapy, are being studied in clinical trials.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. Chemotherapy rarely works at treating metastatic or recurrent parathyroid cancer. More clinical trials are needed to find out the best use of chemotherapy to treat parathyroid cancer.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic parathyroid cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, chemotherapy, and radiation therapy. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if it does return. Learn more about coping with the fear of recurrence.

If the tumor returns after the original treatment, it is called a recurrent tumor. It may come back in the same place, meaning it is a local recurrence, or nearby, which is a regional recurrence. If it comes back in another place, it is a distant recurrence.

The first sign of recurrence after treatment may be high blood calcium levels. Therefore, you may have regular tests to watch for PTH and calcium level changes, as well as ultrasounds of the neck (see Diagnosis).

If there is a recurrence, a new cycle of testing will begin again to learn as much as possible about the tumor. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent disease often experience emotions such as disbelief or fear. People are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.