Tnm System For Thyroid Cancer
Cancer staging describes how large a cancer is, and the degree to which the disease has spread. The staging guidelines developed by the American Joint Committee on Cancer are often used to stage thyroid cancers. The stages are based on three categories:
T : This describes the primary tumor size.
N : This indicates whether the thyroid cancer cells have spread to regional lymph nodes.
M : This refers to whether the cancer has metastasized .
Prophylactic Thyroidectomy In Patients With Men 2a And Men 2b
MTC is the most common cause of mortality in patients with MEN 2A and MEN 2B, and many patients who inherit these syndromes develop MTC in the first decade of life. Therefore, prophylactic thyroidectomy and central-compartment lymph-node dissection is being performed in children with these syndromes. Surgery is offered to patients when the diagnosis is made on the basis of RET mutational analysis. Children with RET mutations whose parents decline surgery should be monitored with annual measurement of calcitonin levels. Thyroidectomy is performed when results are abnormal.
Types Of Thyroid Cancer
There are 5 main types of thyroid cancer:
In addition, other types of cancer may start in or around the thyroid gland. For lymphoma in the thyroid, read Cancer.Nets Guide to Non-Hodgkin Lymphoma. For more information on sarcoma in the thyroid, read the Cancer.Net Guide to Sarcoma. For information on a tumor in the nearby parathyroid gland, read Cancer.Nets Guide to Parathyroid Cancer.
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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.
Who Might Have Thyroid Cancer
Women are three times more likely than men to get thyroid cancer. The disease is commonly diagnosed in women in their 40s and 50s, and men in their 60s and 70s. Even children can develop the disease. Risk factors include:
- Exposure to radioactive fallout from nuclear weapons or a power plant accident.
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Treatment Of Thyroid Cancer
There are different treatment options available for differentiated and undifferentiated thyroid cancer. How appropriate each form of therapy is will depend on the stage and type of thyroid cancer a person has.
The goal of treatment is to cure the condition by getting rid of the cancer completely or increasing a persons prognosis by removing as much cancer as possible.
Currently, standard treatment for thyroid cancer
- surgery, such as a lobectomy, thyroidectomy, or tracheostomy
- radiation therapy, which includes radioactive iodine therapy
- targeted therapy, which uses drugs such as tyrosine and protein kinase inhibitors
- watchful waiting
What Are The Different Types Of Thyroid Cancer
Thyroid cancer is categorized based on the type of thyroid cells where the cancer begins and how the cancer cells appear under a microscope.
There are two kinds of cells found in the thyroid.
Follicular cells are the most common. They produce thyroid hormone, which is important for growth, mental function and helping the body create energy. Most thyroid cancers develop from follicular cells.
Parafollicular cells, also known as C cells, produce a small amount of the hormone calcitonin, which helps control calcium metabolism. Most parafollicular cells are in the upper third of each lobe. Medullary thyroid cancer is the only thyroid cancer that develops from parafollicular cells.
Thyroid cancers can also be categorized based on the appearance of their cells. Cancer cells that look most like normal, healthy cells are called well differentiated. Patients with well differentiated thyroid cancers are most likely to be disease-free at the end of treatment. Poorly differentiated and undifferentiated cancer cells look less and less like healthy cells. These forms of thyroid cancer are usually harder to treat and the outlook for these patients is worse.
Doctors believe most thyroid cancers start as well differentiated. As the cancer grows, its cells can develop additional mutations, changing it into a less differentiated, harder-to-treat type of thyroid cancer.
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How Is Anaplastic Thyroid Cancer Diagnosed
ATC can start as a bump in the throat area. The tumor growing on the thyroid can make your voice hoarse by blocking your vocal chords, or it can make it difficult to breathe by blocking your windpipe. Sometimes people can have ATC for a while and not notice it because the tumor remains small.
Imaging: If you have symptoms of ATC, your doctor will use imaging scans such as ultrasound, CT, and MRI to look at the size of the tumor. They will also check for signs that the tumor has spread to other parts of the body.
Biopsy: To check if the tumor is ATC, your doctor will perform a biopsy, taking a small sample from the tumor with a needle. A pathologist will study cells from the sample under the microscope to see what kind of tumor it is.
Management Of Thyroid Cancer
Malignant diagnoses require surgical intervention. Papillary thyroid carcinoma and medullary thyroid carcinoma are often positively identified on the basis of FNAB results alone. Cervical metastases discovered preoperatively or intraoperatively should be removed by means of en bloc lymphatic dissection of the respective cervical compartment while sparing the nonlymphatic structures.
Patients with follicular neoplasm, as determined with FNAB results, should undergo surgery for thyroid lobectomy for tissue diagnosis. The extent of surgical therapy for well-differentiated neoplasms is controversial. Primary treatment for papillary and follicular carcinoma is surgical excision whenever possible. Total thyroidectomy has been the mainstay for treating well-differentiated thyroid carcinoma. Modifications to total thyroidectomy include subtotal thyroidectomy to reduce the risk of recurrent laryngeal nerve injury and hypoparathyroidism.
A 2015 consensus statement from the American Thyroid Association on the management of patients with differentiated thyroid cancer who have recurrent/persistent nodal disease stated the following :
HÃ¼rthle cell carcinomas
Medullary thyroid carcinomas and familialmedullary thyroid carcinomas
Anaplastic thyroid carcinoma, primary thyroid lymphoma, thyroid sarcoma
The treatment for thyroid sarcomas is total thyroidectomy. Radiation therapy may be used in an adjunctive setting.
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How Is Thyroid Cancer Managed Or Treated
Treatments for thyroid cancer depend on the tumor size and whether the cancer has spread. Treatments include:
- Surgery: Surgery is the most common treatment for thyroid cancer. Depending on the tumors size and location, your surgeon may remove part of the thyroid gland or all of the gland . Your surgeon also removes any nearby lymph nodes where cancer cells have spread.
- Radioiodine therapy: With radioiodine therapy, you swallow a pill or liquid containing a higher dose of radioactive iodine than whats used in a diagnostic radioiodine scan. The radioiodine shrinks and destroys the diseased thyroid gland along with cancer cells. Dont be alarmed this treatment is very safe. Your thyroid gland absorbs almost all of the radioiodine. The rest of your body has minimal radiation exposure.
- Radiation therapy: Radiation kills cancer cells and stops them from growing. External radiation therapy uses a machine to deliver strong beams of energy directly to the tumor site. Internal radiation therapy involves placing radioactive seeds in or around the tumor.
- Chemotherapy: Intravenous or oral chemotherapy drugs kill cancer cells and stops cancer growth. Very few patients diagnosed with thyroid cancer will ever need chemotherapy.
- Hormone therapy: This treatment blocks the release of hormones that can cause cancer to spread or come back.
Early Warning Signs Of Thyroid Cancer
The most common early sign of thyroid cancer is an unusual lump, nodule or swelling in the neck. If you notice a new or growing lump, you should see your doctor, who can run additional tests to identify the cause and determine if it is a tumor. Most nodules on the thyroid are usually benign, but it is important to have any unusual growths examined by a health care professional.
Other early warning signs of thyroid cancer include:
- Swollen glands in the neck
- A cough that persists and is not caused by a cold
Other possible symptoms of thyroid cancer include:
Neck pain: In many cases, neck pain starts in the front. In some cases, the neck pain may extend all the way to the ears.
Voice changes: Experiencing hoarseness or other voice changes that do not go away could be a sign of thyroid cancer.
Breathing problems: Sometimes thyroid cancer patients say it feels like they are breathing through a straw. This breathing difficulty is often a symptom of the disease.
Trouble swallowing: A growth or nodule on the thyroid gland may interfere with swallowing.
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After A Diagnosis Of Thyroid Cancer
After a diagnosis of thyroid cancer you may feel disbelief, uncertainty, fear and anxiety. There is no right or wrong way to feel and experiencing a range of emotions is normal. While the most common types of thyroid cancers have a very good long-term prognosis, you may still feel shocked and confused. It may help to talk to family and friends about how you are feeling.
Ask your specialist to explain treatment options and any potential side effects and financial concerns. Take as much time as you can so that you can make well-informed decisions.
What Is The Prognosis For People Who Have Thyroid Cancer
Eight out of 10 people who have thyroid cancer develop the papillary type. Papillary thyroid cancer has a five-year survival rate of almost 100% when the cancer is in the gland . Even when the cancer spreads , the survival rate is close to 80%. This rate means that, on average, youre about 80% as likely to live for at least five years after diagnosis as someone who doesnt have metastatic papillary thyroid cancer.
Five-year survival rates for other thyroid cancer types include:
- Follicular: Close to 100% for localized around 63% for metastasized.
- Medullary: Close to 100% for localized around 40% for metastasized.
- Anaplastic: Close to 31% for localized 4% for metastasized.
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What Questions Should I Ask My Doctor
If you have thyroid cancer, you may want to ask your healthcare provider:
- Why did I get thyroid cancer?
- What type of thyroid cancer do I have?
- Has the cancer spread outside of the thyroid gland?
- What is the best treatment for this type of thyroid cancer?
- What are the treatment risks and side effects?
- Will I need thyroid replacement hormone therapy?
- Is my family at risk for developing this type of thyroid cancer? If so, should we get genetic tests?
- Can I get thyroid cancer again?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Receiving a cancer diagnosis is unsettling, regardless of the type. Fortunately, most thyroid cancers respond extremely well to treatment. Your healthcare provider can discuss the best treatment option for the type of thyroid cancer you have. After treatment, you may need to take synthetic thyroid hormones for life. These hormones support vital body functions. They usually dont cause any significant side effects, but youll have regular checkups to monitor your health.
Last reviewed by a Cleveland Clinic medical professional on 08/13/2020.
Chemotherapy Or Targeted Therapy As Part Of Your Treatment Plan
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. See the Latest Researchsection for more information.
Learn more about the basics of 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.
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How Is Thyroid Cancer Diagnosed In Children
The first step in treating a child with thyroid cancer is forming an accurate and complete diagnosis. In addition to a medical history and physical exam, a physician may order a number of different tests to diagnose thyroid cancer and determine whether it has spread.
- Blood tests are used determine if the thyroid is working properly.
- Ultrasound is the best imaging technique to visualize a known or suspected thyroid nodule. Ultrasound uses sound waves to assess the location and characteristics of nodules in the thyroid gland. Because ultrasound uses only sound waves, it does not expose the patient to any harmful radiation.
- Fine-needle aspiration uses a very thin needle to take a sample of a thyroid nodule and/or lymph nodes to gather information about whether the thyroid nodule may be a thyroid cancer.
- Surgery is sometimes needed to determine whether a thyroid nodule is a thyroid cancer, if the result of fine-needle aspiration is not definitive.
- Computerized tomography scan is sometimes needed to take detailed images of the neck or chest, to help determine what surgery or other treatments are needed.
- Genetic testing is useful in many cases to determine whether a thyroid cancer may be part of an underlying genetic condition.
What To Do If You Notice Signs Of Thyroid Cancer
If you experience signs of thyroid cancer, its important to consult with your doctor to get an accurate diagnosis.
First, your doctor may conduct a physical examination, manually palpating your neck and throat to check for abnormal growths or areas of swelling, including the thyroid and lymph nodes. Your doctor may also gather your personal and family medical history, ask about your symptoms and risk factors, including any inherited genetic mutations.
A blood test called a tumor marker test may be recommended to check for high levels of certain hormones, such as:
- Thyroid-stimulating hormone
If cancer is suspected, one or more of the following diagnostic tests may be ordered:
Ultrasound. An ultrasound over the neck region may be done to locate any nodules that are present on your thyroid and determine whether theyre made up of solid or liquid material.
Chest X-ray: This basic imaging test may be done if your doctor suspects the cancer has metastasized to your lungs.
Magnetic resonance imaging scan: Using magnets, an MRI scan creates highly detailed images of the thyroid and surrounding areas.
Computed tomography scan or positron emission tomography scan: A CT scan uses contrast dye that helps your doctor pinpoint the size and location of your cancer, and whether it has metastasized to surrounding tissues. A PET scan is similar but uses an injection of radioactive sugar instead of contrast dye .
Expert cancer care
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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 .
What Is The Difference Between Differentiated And Non
These categories are based on the nature of the cancer cells themselves.
Differentiated cancers come from follicular cellsthe cells that make the thyroids metabolism-controlling hormones. They look similar to normal thyroid cells when looked at under a microscope, and are typically more responsive to treatment than non-differentiated cancers.
Non-differentiated cancers can come from the thyroids calcium-controlling cells, from the immune cells that fight infections within the thyroid, or from follicular cells that are so mutated that they no longer look much like thyroid cells under a microscope.
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Treatment Options By Stage
Almost all thyroid cancers are treated with surgery. 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.
Hormone therapy and radioactive iodine therapy are only given for papillary, follicular, and Hurthle cell thyroid cancers. MTC and anaplastic thyroid cancers are not managed with radioactive iodine thyroid or thyroid hormone therapy.
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. See below for more information, for Metastatic thyroid cancer.
What Are The Symptoms Of Thyroid Cancer In Children
Most children who are diagnosed with thyroid cancer feel well at the time of diagnosis, and many have no symptoms at all. While symptoms may vary from child to child, the most common include:
- a lump in the neck
- swollen lymph nodes in the neck
- a sensation of a lump in the throat when swallowing
- unexplained hoarseness
Keep in mind that similar symptoms can be associated with more common medical problems and conditions. Therefore, it is important to consult your child’s physician for a diagnosis if your child has one of these symptoms.
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