Papillary Thyroid Cancer Surgery
Papillary thyroid cancer surgery is introduced here. The correct operation depends upon the papillary thyroid cancer, patient evaluation, and surgeon’s expertise. Virtually all patients should have one operation! That surgery can frequently be a minimally invasive surgery. What is most important, is that all of the papillary thyroid cancer is removed from the neck in this initial surgery!
For papillary thyroid cancer of papillary thyroid cancers that exist within this group), surgery, by far, is the most common first treatment. In fact, papillary thyroid cancer surgery is not only the first treatment but is commonly the only treatment that may be indicated. It is critical that a highly experienced surgeon and the right surgery is obtained the first time. Papillary thyroid cancer surgery should only be done by expert surgeons. By choosing the right surgeon and surgery, you are cured. The wrong choice may lead to repeated surgeries, complications, and even worse! :320-30)
Thyroid surgery was one of the first ever described surgeries in medicine, but early on it wasn’t very pretty or safe. Over the past 100 years, thyroid surgery has evolved into its current state of the art by some of the most recognized names in surgical history. Today, in skilled hands, papillary thyroid cancer surgery may be considered an art form in its own right.
What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
The Low Risks And High Rewards Of Thyroid Cancer Treatment
A recent article in The New York Times argues doctors treat thyroid cancer too aggressively. The article focuses on a study that appeared in The New England Journal of Medicine covering the increase in reported cases of thyroid cancer. The authors suggest many of these cases actually are overdiagnoses or the diagnosis of small tumors that wouldnt cause symptoms or death if left alone.
The conversation that results from this study is an important one: What is the risk of treatment versus no treatment? For small thyroid tumors in otherwise healthy patients, there usually is very little risk involved with treatment. Thats why I recommend treatment to the majority of my thyroid cancer patients.
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How Is Papillary Thyroid Cancer Treated
Treatments for papillary thyroid cancer depend on the tumor size and whether the cancer has spread .
Surgery is the most common treatment for PTC. Depending on the tumors size and location, your surgeon may remove part of your thyroid gland or all of your gland . If you have cancer present in the lymph nodes of your neck, your surgeon may remove the affected lymph nodes at the time of the initial thyroid surgery or as a second procedure.
If you have a total thyroidectomy, youll need to take thyroid hormone replacement medication for the rest of your life.
Additional treatments for PTC include:
- Radioiodine therapy: Thyroid cells and papillary thyroid cancer cells absorb iodine, a mineral found in some food. Because of this, healthcare providers sometimes use a radioactive form of iodine to destroy all remaining normal thyroid tissue and potentially destroy residual cancerous thyroid tissue after a thyroidectomy.
- 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 stop cancer growth. Very few people diagnosed with thyroid cancer will ever need chemotherapy.
How Thyroid Cancer Is Treated
In many cases, a team of doctors works together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For thyroid cancer, this team may include a surgeon, medical oncologist, radiation oncologist, radiologist, nuclear medicine physician, and endocrinologist. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, speech therapists, and others.
Thyroid cancer is commonly treated by one or a combination of treatments. The common types of treatments used for thyroid cancer are listed below, followed by an outline of common cancer treatments given by stage of disease .
Treatment options and recommendations depend on several factors, including the type and stage of thyroid cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Talk with your health care team 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 thyroid cancer because there are different treatment options.
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How Is Papillary Thyroid Cancer Diagnosed
Papillary thyroid cancer usually presents as a lump or nodule on your thyroid gland. You may notice it, or your healthcare provider may discover it during a routine neck examination. Sometimes, the nodule is discovered incidentally by imaging tests you get for other medical reasons.
Your healthcare provider will likely order the following tests to help diagnose PTC:
- Imaging tests: Your provider may order imaging tests to identify the nodule on your thyroid. These tests might include thyroid ultrasound, CT scan and/or magnetic resonance imaging .
- Fine needle aspiration : Your provider will likely want to take a small tissue sample, called a biopsy, from the nodule on your thyroid using a very thin needle. A pathologist will look at the tissue under a microscope to see if there are cancer cells and, if so, what type of thyroid cancer it is.
Your healthcare provider may also recommend genetic counseling to see if you have a genetic condition that may have caused PTC and may cause other types of tumors.
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 cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .
If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. 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, radioactive iodine therapy, targeted therapy, external-beam radiation therapy, hormone therapy, and chemotherapy. However, 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 recurrent thyroid cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
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Extended Or Complicated Thyroidectomy
Papillary thyroid cancer may sometimes be more aggressive than ultrasound or CT imaging suggested prior to undergoing surgery. In these cases, an expert surgeon that recognizes those “more aggressive” intraoperative findings such as growth or extension of the cancer outside of the thyroid gland or invasion of the cancer into adjacent structures such as the nerve to the voice box , breathing tube , voice box, or esophagus must adapt the surgery to adequately address the complete removal of the cancer. Unfortunately, occasional thyroid surgeons are commonly unprepared to perform the appropriate surgery and a subsequent surgery for persistent disease will be required.
How Serious Is My Cancer
If you have thyroid cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage describes the spread of the cancer through the thyroid gland. It also tells if the cancer has spread to other organs of your body that are close by or far away.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside of the thyroid gland. Be sure to ask the doctor about the cancer stage and what it means for you.
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Cohort And Subgroup Characteristics
Descriptive characteristics of the overall CCSS cohort and the subgroups are summarized in Table 1. Except for type of first cancer and age at first cancer, differences in descriptive characteristics for the overall cohort and the subgroups were not of clinical importance. The patients who received radiation dose greater than 20 Gy were most likely treated for HL and had the highest mean age at first cancer as compared to the cohort overall and the other two subgroups .
The proportion of patients treated with chemotherapy was lower in the > 20 Gy subgroup than the 20 Gy subgroup or among patients not treated with radiation . In the overall cohort, 81% were treated with chemotherapy. Among those receiving chemotherapy, alkylating agents and anthracyclines were the most commonly used classes of drugs.
The mean size of the thyroid tumors at the time of diagnosis was 1.7 cm . No statistically significant difference in tumor size was observed between survivors of HL as compared to other types of first cancer . Among the patients who developed thyroid cancer, neuroblastoma survivors were youngest at first cancer treatment , whereas survivors of bone cancer, HL and NHL were oldest at time of treatment.
Side Effects Of Radioactive Iodine Therapy
Side effects from radioactive iodine can include:
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Mild nausea during the first day
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Swelling and pain in the neck where thyroid cells remain
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Temporary loss of smell and/or taste
Additionally, high doses of RAI can cause problems with fertility . They can also kill normal thyroid cells along with the cancerous ones, which can lead to the need for thyroid hormone replacement medication.
If you have to have RAI multiple times, the radiation can increase the risk of some cancers, including leukemia, says Dr. Lieb.
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Papillary Thyroid Cancer Surgery For Spread Of Cancer To Lymph Nodes Along The Side Of The Neck
- Just the presence of enlarged lymph nodes does not mean papillary thyroid cancer has spread and does not require additional surgery
- A procedure called an anterolateral neck dissection , in untreated patients, should only be performed in instances where an ultrasound with fine needle aspiration has confirmed papillary thyroid cancer spread to lymph nodes in the side of the neck
- The papillary thyroid cancer anterolateral neck dissection is not the same neck dissection as for other cancers that occur in the neck. Papillary thyroid cancer spreads to particular areas of the neck called levels. Removing just some of the lymph nodes has been called “cherry picking” and is the wrong surgery! A papillary thyroid expert surgeon trained and experienced to perform modified neck dissections specifically for thyroid cancer is needed to prevent recurrent or persistent disease.
- The anterolateral neck dissection, in skilled hands, spares all critical nerves, muscles, and blood vessels which are not directly involved with cancer . It ads approximately 40 minutes of surgery to remove the lymph nodes and fatty tissue.
What Is Differentiated Thyroid Cancer
Most thyroid cancers are differentiated, according to the American Cancer Society, which means that when the cells are looked at under a microscope they appear similar to normal thyroid cells. Papillary, follicular, and Hurthle cell thyroid cancer are all types of differentiated thyroid cancer. When the cancerous cells are not similar in appearance to normal thyroid tissue, the cancer is called poorly differentiated or undifferentiated. Medullary and anaplastic thyroid cancers fall into this category.
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How Does The Doctor Know I Have Thyroid Cancer
Most thyroid cancers are found when patients see a doctor because of new neck lumps . Sometimes doctors find neck lumps during a physical exam. Yet other times thyroid cancer may be found during an ultrasound test for other health problems.
If signs are pointing to thyroid cancer, more tests will be done.
Thyroid Hormone Replacement Therapy
Thyroid hormone replacement therapy is often prescribed after thyroid surgery to replace the hormones that are no longer being produced by your thyroid tissue. Depending on how much of your thyroid was taken out, you may have to take the medication most commonly levothyroxine for the rest of your life.
Thyroid hormone replacement can also help prevent the growth or recurrence of thyroid cancer. It does this by lowering your circulating level of the hormone TSH, which is secreted by your brains pituitary gland and tells your thyroid to make more thyroid hormone. High TSH levels can stimulate the growth of thyroid cancer cells. Higher doses of replacement thyroid hormone tell your body to make less TSH, slowing the growth of any thyroid cancer cells and lowering the odds of your cancer coming back.
It can take a few adjustments to find the correct dosage of thyroid hormone replacement. During this time, you may need to see the doctor every 6 to 8 weeks for a blood draw to determine if your levels are optimal.
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How Do I Choose A Thyroid Surgeon
A high-volume surgeon is best. Whether you opt for a general, endocrine, or head and neck surgeon, you want to choose a provider who does a lot of these surgeries every year, says Dr. Lieb. Dr. Chen says a good volume to shoot for is 100 per year or more.
You can find directories of qualified surgeons at the American Association of Endocrine Surgeons or the American Academy of Otolaryngology Head and Neck Surgery.
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.”
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Thyroid Cancer Survival Rate
Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer papillary and follicular cancers have a more than 98% cure rate if theyre caught and treated at an early stage. The earlier you are diagnosed, the less likely it is that your cancer will have spread beyond the thyroid and the easier it is to treat.
Medullary thyroid cancer has a worse prognosis and is likely to include lymph node involvement. Once cancer has entered the lymph nodes it spreads readily through the lymphatic system, meaning your cancer will require more extensive and possibly more aggressive treatment.
The least common type of thyroid cancer, anaplastic thyroid cancer, has a very poor prognosis. The best results occur when localized anaplastic thyroid cancer is diagnosed early and completely removed via a thyroidectomy, as its very aggressive. Unfortunately, this cancer tends to be found after it has already spread.
Because most people dont die from thyroid cancer, its sometimes called a good cancer to get even by some physicians. Almost everyone I take care of has heard that, Dr. Lieb says. But I take issue with it. Physicians can feel very bad telling people they have cancer, and rather than saying your prognosis is good, some downplay the diagnosis. But there isnt a good cancer.
Thyroid Hormone Suppressive Therapy For Papillary Thyroid Cancer
Thyroid hormone is a necessary hormone for life. The thyroid gland normally produces thyroid hormone to adequate levels. The amount of thyroid hormone produced by the body is strictly controlled by a portion of the brain called the pituitary gland. When the body has too little thyroid hormone, the pituitary gland senses the low levels and produces TSH . When thyroid hormone levels are elevated , the pituitary does the opposite and lowers its production of TSH. This is called an endocrine feedback loop.
Most papillary thyroid cancer cells and all normal thyroid cells have a site on the surface of the cell that can stimulate their growth. This site is called a “receptor” and when stimulated by TSH in normal thyroid cells, it causes increased production of thyroid hormone. In papillary thyroid cancer cells, this same TSH receptor can stimulate the growth of these cancer cells. Obviously, it is an undesirable concept to have TSH stimulate papillary thyroid cancer cells to grow. Therefore, the goal in the papillary thyroid cancer patient is to keep TSH levels low. So how is this done?
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