Clinical Presentation And Diagnosis
The patient, a 45-year-old female, was diagnosed with an infiltrating ductal carcinoma in the right breast by fine needle aspiration biopsy in June 2009. The patient subsequently received six cycles of neoadjuvant chemotherapy. A follow-up mammectomy was performed in November 2009. In June 2012, the patient presented with palpable masses on the right thyroid, isthmus and lateral neck. Subsequently, the patient underwent a bilateral subtotal thyroidectomy and lymphadenectomy. Histological assessment of the surgical thyroid specimens and the neck lymph nodes revealed multiple carcinoma foci. The microscopic and immunohistochemical findings confirmed that the thyroid masses were breast cancer metastases.
The primary lesion excised from the right breast was a 20×18×15-mm infiltrating ductal carcinoma. The metastases excised from the right and left thyroid three years later were 30×20×15 and 20×15×12 mm in size, respectively, and the lymph nodes contained sheets of metastatic carcinoma . The diagnosis of metastatic carcinoma was made based on immunostaining data for the estrogen receptor , progesterone receptor and CerbB-2 in neoplastic cells. Additionally, staining for thyroglobulin and thyroid transcription factor 1 , which are expressed in the thyroid gland but not in breast cancer tissue, was performed to differentiate the thyroid component from neoplastic breast cells.
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What Is Cancer Staging
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.
Doctors use diagnostic tests to find out the cancers stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient’s prognosis. There are different stage descriptions for different types of cancer.
This page provides detailed information about the system used to find the stage of thyroid cancer and the stage groups for thyroid cancer, such as stage II or stage IV.
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What Screening Tests Are Used For Thyroid Cancer
The early detection of thyroid cancers is generally through careful visual and physical examination of the neck. Palpation of the neck will detect many clinically significant thyroid nodules which may be cancer. This is part of a routine physical exam. In addition, the thyroid gland is included in many radiology studies performed to evaluate other organs, such as CT scans of the lungs and cervical spine.
All individuals suspected to have thyroid nodules, either from physical examination or from another radiology study, should have a thyroid ultrasound performed to take a picture of the thyroid. Thyroid ultrasound uses sound waves to produce an image of the thyroid gland and surrounding structures. The ultrasound appearance of the nodule can help healthcare providers determine if a fine-needle aspiration biopsy is required to further evaluate the nodule. There is no evidence that it is cost-effective to perform ultrasounds to screen for thyroid nodules in the general population. Notably, ultrasound detects the majority of small incidental thyroid cancers, which are unlikely to affect the survival of most patients.
Is Shoulder Pain A Symptom Of Breast Cancer
In rare cases, shoulder pain can be a symptom of breast cancer. When it occurs, it is often a sign that breast cancer has spread, or metastasized, to other areas of your body. Breast cancer cells can spread through the blood or lymphatic system.
The main causes of shoulder pain due to breast cancer are:
- Bone tumors:One of the most common places for breast cancer to spread is bone. In people with early stage breast cancer, bone ranks as the most common location for the first site of metastasis. Pain can occur when bones are weakened by a tumor that grows from the spread of breast cancer cells. Unlike sore muscle pain that commonly occurs with overuse or wear and tear, bone pain causes a throbbing or deep aching pain.
- Fractures:When breast cancer spreads to the bones, it can weaken them by accelerating the breakdown of normal bone tissue or the formation of too much new bone. When the breakdown of old bone tissue and/or the production of new bone tissue occurs at abnormal rates, it can make bones more susceptible to fractures with minimal stress.
- Deferred pain from breast cancer that has spread to other areas, like the liver:Breast cancer can also metastasize to the liver, which sits on the right side of your upper abdomen. When this occurs, the liver becomes enlarged and presses on nerves that also affect the right shoulder.
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Magnetic Resonance Imaging Scan
MRI scans use radio waves and strong magnets instead of x-rays, therefore there is no radiation exposure. A contrast material called gadolinium is often injected into a vein before the scan to better show details.
MRI of thyroid, neck and chest to evaluate for papillary thyroid cancer.
MRI of a patient with papillary thyroid cancer of the left thyroid lobe. . The arrow points to the thyroid cancer which is more invasive and aggressive than the usual papillary thyroid cancer. This cancer has spread to the overlying muscles.
Like CT scans, MRI scans can be used to look for a diagnosis of papillary thyroid cancer in the thyroid, for cancer that has spread to nearby or distant parts of the body. But ultrasound is usually the first choice for looking at the thyroid and neck structures.
MRI scans are very sensitive to movement and moving during the scanning process produces artifacts that make interpretation difficult. Because people are constantly swallowing and unconsciously moving their voice box and swallowing structures (and therefore their thyroid gland and surrounding lymph nodes, CT of the neck is the preferred cross-sectional study of the neck in patients with a diagnosis of papillary thyroid cancer.
What To Expect When Having A Pet Scan
In preparing for a PET scan, a radioactive substance is injected into the blood. The amount of radioactivity used is low. Because cancer cells in the body generally utilize sugar as their energy source to grow, they absorb more of the sugar than normal cells.
This test can be very useful for physicians to make a diagnosis of papillary thyroid cancer that has:
- Come back following prior surgery
- Spread to other sites in the body
- Diagnosed as papillary thyroid cancer but didnt take up radioactive iodine
The PET/CT scan for a diagnosis of papillary thyroid cancer combines images of both PET and CT scans at the same time. This is because PET images alone are not very detailed. The computer shows the relative amount of radioactivity in a particular area and where the sugar is localized, appearing red or hot. The combination of these two images lets the doctor compare an abnormal area on the PET scan with its detailed appearance and location on the CT scan.
PET/CT scanning is not always positive in patients with a diagnosis of papillary thyroid cancer.
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Positron Emission Tomography /ct Scan
This shows a PET/CT scan of a patient with recurrent papillary thyroid cancer.
PET/CT scan of a patient with recurrent papillary thyroid cancer. The patient had already undergone three surgeries to treat cancer. The bright orange circle on the left is a lymph node where the papillary thyroid cancer has spread. The black area to the left of the bright spot is the lungs. This view of thyroid cancer with metastatic lymph node involvement is located next to the trachea, which should only be removed by a highly skilled surgeon. It will take about 15 minutes with a nearly 98% chance that it will never recur.
What Is The Thyroid Gland
Your thyroid gland is one of many glands that make up your endocrine system. Endocrine glands release hormones that control different bodily functions.
The pituitary gland in your brain controls your thyroid gland and other endocrine glands. It releases thyroid-stimulating hormone . As the name suggests, TSH stimulates your thyroid gland to produce thyroid hormone.
Your thyroid needs iodine, a mineral, to make these hormones. Iodine-rich foods include cod, tuna, dairy products, whole-grain bread and iodized salt.
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How Common Is Breast Cancer
Breast cancer is one of the most common forms of cancer in the world, but have you ever wondered how prevalent it is?
According to BreastCancer.org, one in eight women will develop invasive breast cancer sometime in their life. This even more concerning since, the rate of death from breast cancer is the highest for any type of cancer
And besides skin cancer, breast cancer is the most frequently diagnosed cancer in American women. More than 85% of breast cancers occur in women who have no history of this severe disease in their family.
The American Cancer Society estimates that in 2019 about 268,600 new cases of breast cancer will be diagnosed in women. This year the number of deaths caused by breast cancer is expected to be about 41,760, figures show.
What Are Biopsies And Why Do I Need One
Biopsies are the most common way that doctors diagnose cancer. During a biopsy, a doctor takes a small piece of tissue, called a sample, from a suspected tumor or area of concern. Then, a pathologist looks at it under a microscope to make a diagnosis. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease, including cancer.
There are many different techniques for collecting a biopsy. For example, in a fine needle aspiration biopsy, the doctor inserts a needle attached to a syringe into the suspicious area to collect a small amount of tissue for diagnosis. In an excisional biopsy, the doctor removes the entire suspicious mass for examination.
Properly performed, biopsies often provide essential information to help diagnose, stage, and inform clinical decision-making for patients with suspected or known cancer. Jeffrey E. Gershenwald, MD, FACS, professor in the Department of Surgical Oncology in the Division of Surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas, and Cancer.Net Editorial Board member.
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What Is The Epidemiologic Evidence Of The Relationship Between Breast And Thyroid Cancer
Furthermore, and importantly for determining etiology, nonmalignant thyroid nodules are more common in women with breast cancer than those without breast tumors . There is an increased risk of developing thyroid cancer following breast cancer . Women with prior benign breast disease also are reported to be at a greater risk of thyroid cancer . The increased risk of thyroid cancer following breast cancer and breast cancer following thyroid cancer is reported in both women and men . Women with breast cancer are 2-fold more likely to develop future thyroid cancer and women with thyroid cancer have a 67% greater chance of developing breast cancer than the general population. These recent studies are summarized in Table 1. Importantly, the metachronous relationship was evaluated in nations with widespread cancer screening and nations where screening is becoming more common. In particular, Zhang and colleagues evaluated patients with cancer between 2001 and 2010 in China, which corresponded with investments into cancer registries .
Whos At Risk For Breast Cancer
According to Mayo Clinc, Breast cancer occurs when some breast cells start growing abnormally. These particular cells divide at a faster rate than healthy cells and accumulate thus causing the formation of lumps.
Breast cancer may start in the milk-producing ducts, but it may also begin in the lobules or glandular tissue.
The exact cause that induces abnormal growth of cancer cells is not quite known although scientists have discovered some factors including BRCA1 and BRCA2 genes.
Every woman and even a man can develop breast cancer. That being said, some people are at a higher risk than others. The most common risk factors associated with breast cancer are:
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Does Thyroid Cancer Spread To The Breast
- #1 11-10-2007 07:34 AM by Chellyfdoes thyroid cancer spread to the breast
- #2 11-10-2007 04:47 PM by ReeceRe: does thyroid cancer spread to the breastThryroid cancer primarily, if it spreads in the neck for pappillary, and sometimes to the lungs for follicular, and follicular sometimes to the bones.Breast cancer, occasionally, but rarely can go to the thryoid, but that is rare, and Ive personally never read or heard of thyroid cancer metasticising to the breast.
- #3 11-14-2007 02:08 PM by Dee2000Re: does thyroid cancer spread to the breastChelly,There is a study linking patients with previous thyroid cancer as being more prone to developing some form of breast cancers later. Breast cancer is also linked to colon: women with breast have been found to have 3% chance of also developing colon cancer hence screening for both are very important. Of course there are tons of on-going studies.My mother and her mom both had thyroid cancer early in life and my mom developed breast cancer at 46. The specialists at MD Anderson have informed her they are starting to relate radiation use for thyroid cancers to cause certain breast cancers.
Papillary Cancer And Its Variants
Most cancers are treated with removal of the thyroid gland , although small tumors that have not spread outside the thyroid gland may be treated by just removing the side of the thyroid containing the tumor . If lymph nodes are enlarged or show signs of cancer spread, they will be removed as well.
In addition, recent studies have suggested that people with micro-papillary cancers may safely choose to be watched closely with routine ultrasounds rather than have immediate surgery.
Even if the lymph nodes arent enlarged, some doctors recommend central compartment neck dissection along with removal of the thyroid. Although this operation has not been shown to improve cancer survival, it might lower the risk of cancer coming back in the neck area. Because removing the lymph nodes allows them to be checked for cancer, this surgery also makes it easier to accurately stage the cancer. If cancer has spread to other neck lymph nodes, a modified radical neck dissection is often done.
Treatment after surgery depends on the stage of the cancer:
People who have had a thyroidectomy will need to take daily thyroid hormone pills. If RAI treatment is planned, the start of thyroid hormone therapy may be delayed until the treatment is finished .
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Other Signs And Symptoms
Other, more rare or unusual signs of medullary thyroid cancer that you should be aware of include:
- Severe diarrhea. This is a very rare symptom sometimes found in people with advanced medullary thyroid cancer. The tumor produces high levels of calcitonin, a hormone that may cause severe diarrhea.
- Cushing syndrome. In rare cases, adrenal tumors can cause Cushing syndrome, a condition that arises when a tumor secretes hormones that the thyroid wouldnt normal create. Cushing syndrome associated with medullary thyroid cancer is uncommon. The syndrome is more commonly caused by the pituitary gland overproducing adrenocorticotropic hormone , or by taking oral corticosteroid medication.
- Facial flushing. A red face, neck, or chest paired with warm or burning sensations can be a sign of many conditions. Tumors or other abnormal growths can overproduce hormones, triggering flushing. The symptom can also be a response to certain drugs, foods, alcohol, or menopause.
- Bone pain. People with medullary thyroid cancer may have bone pain if the cancer has spread to form bone lesions.
- Lethargy. Many people with advanced cancer may feel physically, emotionally, or mentally tired. The causes of fatigue during cancer are complex and not well understood.
- Weight loss. Unusual weight loss is a symptom of advanced medullary thyroid cancer that has spread beyond the thyroid into other organs.
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How Does Thyroid Cancer Affect Pregnancy
Thyroid cancer is the second most common cancer diagnosed in pregnant women . Approximately 10% of thyroid cancers develop during pregnancy or within the first year after childbirth. Experts believe fluctuating hormone levels during pregnancy may trigger the cancer.
If you receive a thyroid cancer diagnosis during pregnancy, your healthcare provider can discuss treatment options. Depending on the cancer type and severity, your provider may recommend delaying treatment until after you deliver your baby. If treatment cant wait, most women can safely undergo surgery to remove the cancerous gland. You shouldnt have radioactive diagnostic tests or treatments when youre pregnant or breastfeeding.
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Treatment And Management Of Shoulder Pain
Shoulder pain that occurs with breast cancer is handled differently from shoulder pain that occurs from an injury or musculoskeletal disease. If you have shoulder pain from breast cancer, your healthcare team will likely use an imaging test like an X-ray or magnetic resonance imaging to identify the location and type of problem that exists.
Your treatment may involve one or more of the following therapies:
Thyroid Gland Metastasis Arising From Breast Cancer: A Case Report
This article is mentioned in:
Abstract
Introduction
The most common site of breast cancer metastasis isthe bone. Other common metastatic sites include the lungs, pleura,liver and brain . The majorityof metastatic lesions occur shortly after the detection of theprimary tumor . Metastasis tothe thyroid gland is rare . Thethyroid gland is also a rare site for metastatic disease to develop and metastatic lesions from non-thyroidcancers are infrequent. However, since treatment strategies used tocontrol primary and metastatic malignancies are different, accuratediagnosis appears important and may influence the prognosis andlikelihood of a cure for lesions of the thyroid. Therefore, whenencountering a patient with thyroid tumor, and with a long historyof breast cancer, clinicians should be aware of the possibility ofmetastatic disease, until such a diagnosis can be ruled out. Then,besides collecting full clinical information, further histologicalanalysis should be performed. Here, we report a case of thyroidmetastasis arising from breast cancer. The thyroid metastasisappeared 3 years after the initial diagnosis of breast carcinomaand was confirmed by histopathological analysis.
Case report
Clinical presentation and diagnosis
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