What Is Medullary Thyroid Cancer
Medullary thyroid cancer accounts for up to 3% of thyroid cancers. It is derived from the C-cells of the thyroid gland that produces calcitonin.
75% of the cases of medullary thyroid cancers are sporadic while 25% occur in patients who have a genetic mutation in the RET proto-oncogene and can be familial.
Mutations in the RET genes cause a syndrome called MEN . MEN-1 and MEN-II are the most common followed by mixed types.
MEN-1 syndrome is characterized by:
- Tumors of the anterior pituitary
- Pancreatic islet-cell tumors
MEN-2 is further divided into two subtypes:
- MEN-2A is characterized by:
MEN-2 B patients may have a marfanoid habitus.
MEN Syndromes: MEN-1, MEN-2A, and MEN-2B
It can be seen here that MEN-II syndromes predispose patients to medullary thyroid cancers. Thus, patients who have MEN-II syndromes are at risk of developing medullary thyroid cancer if they are given Ozmepic .
It is also likely that medullary thyroid cancer may be the first presentation of a person who has MEN-2 syndrome. It is this subgroup of patients who are at high risk of developing MTC when started on Ozempic .
Genetic testing for RET gene before Ozempic treatment initiation is not recommended because of the very low prevalence of the disease.
However, patients started on Ozempic must be advised to report to the doctor and stop Ozempic immediately if they develop any of the following symptoms:
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.
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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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.
Thyroid Cancer: Common In Women
Thyroid disorders are more common in women, probably due to the roles of hormones, which are different in femalesthan in males.
Thyroid nodules, Russell says, affect up to 80 percent of women, but only 5percent to 15 percent of those lumps and bumps are malignant. Bettertesting means thyroid tumors are on the rise, he notes, saying that itsprojected to become the third most common cancer.
Malignant and cancer are scary words, but Russell says that mostthyroid cancer is highly treatable, even when the cancer cells spread tonearby lymph nodes, which occurs frequently.
With thyroid cancer we talk about prognosis in terms of 20-year survivalinstead of five years, as we do with most other cancers. Its usually aslow-moving disease. Theres a 98 to 99 percent survival rate at 20 years,he says.
We treat it almost like a chronic condition where the patient getstreatment and visits her doctor regularly for follow-up.
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Does Medullary Thyroid Cancer Run In Families
Twenty-five percent of MTC cases run in families. MTC may be passed down when families carry a change in the RET gene that causes a condition called multiple endocrine neoplasia type 2, or MEN2. There are two types of MEN2: MEN2A and MEN2B.
MEN2A: If you have MEN2A, you have a high chance of getting MTC. You are also at risk for getting pheochromocytoma, a cancer of the adrenal glands. MEN2A is rare, affecting 1 in 40,000 people. MEN2A may also be called Sipple syndrome or PTC syndrome.
MEN2B: MEN2B can sometimes be passed from parent to child but most of the time, it isnt. If you have MEN2B, you have a 100% chance of getting MTC at a very young age. You also have a 50% chance of getting pheochromocytoma at some point in your life. MEN2B is also called WagenmannFroboese syndrome or MEN3.
Pathology And Molecular Biology
PTC is the most frequent form of thyroid carcinoma diagnosed after radiation exposure. After the Chernobyl accident, most young children had a solid or follicular PTC subtype with an aggressive behavior and a short latency period, whereas older children had more frequently classical PTC that was less aggressive and was discovered after a longer latency period. Solid subtype was also frequently observed in the rare PTC that occurred in young children in the absence of any radiation exposure, demonstrating that this subtype is associated with a younger age at occurrence of the tumor :S9-18.,3232. Schlumberger M, De Vathaire F, Travagli JP, Vassal G, Lemerle J, Parmentier C, et al. Differentiated thyroid carcinoma in childhood: long term follow-up of 72 patients. J Clin Endocrinol Metab. 1987 65:1088-94.).
Ionizing radiations induce DNA damage either directly or by generating reactive oxygen species :S9-18.). The thyroid tissue contains a high quantity of NADPH oxidases, which are specialized ROS-generating enzymes that are known as NOX/DUOX. Radiation exposure increases DUOX1 expression, leading to an important production of ROS in the thyroid gland after radiation exposure, and this may explain its high sensitivity to radiation :5051-6.). This DNA damage includes single- or double-strand breaks that will result in deletions and chromosomal rearrangements.
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External Beam Radiation Therapy
External beam radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread.
Most people diagnosed with thyroid cancer do not need EBRT, but it may be recommended in particular circumstances. In a small number of cases, it may be given:
- after surgery and RAI treatment if the cancer has not been completely removed or if there is a high risk of the cancer returning
- as palliative treatment to relieve symptoms such as pain caused by cancer that has spread to nearby tissue or structures
- to help control medullary or anaplastic thyroid cancer .
Radiation therapy is usually given 5 days a week over several weeks. You may be fitted for a plastic mask to wear during treatment, which will help you stay still so that the radiation is targeted at the same area of your neck during each session.
How Is Medullary Thyroid Cancer Diagnosed
MTC can start as a lump in the throat. The tumor growing in the thyroid can make your voice hoarse by blocking your vocal chords or it can make it hard to breathe by blocking your windpipe. Sometimes people can have MTC for a long time without symptoms because the tumor remains small. MTC can spread to other organs, such as lung, liver, bones, and brain.
Imaging: MTC is diagnosed by your doctor first feeling your throat to check for a lump, followed by imaging scans of the thyroid. Imaging scans might include ultrasound, CT, or MRI.
Biopsy: The doctor will also want to take out a small amount of tissue, called a biopsy, from the thyroid using a very thin needle. A pathologist will look at the tissue under the microscope to see if there are cancer cells and, if so, what type of thyroid cancer it is.
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The Role Of The Thyroid
The thyroid is part of the endocrine system, which is a group of glands that makes and controls the bodys hormones. Hormones are chemical messengers that help the body work properly.
The thyroid makes two hormones that control the speed of the bodys processes, such as heart rate, digestion, body temperature and weight. This speed is known as your metabolic rate. See below for more information about the role of T4 and T3. The thyroid also produces the hormone calcitonin, which plays a role in controlling the bodys calcium levels.
How Frequently Is Ozempic Associated With Thyroid Cancer
Ozempic has been associated with an increased risk of medullary thyroid cancer.
Although no cases of Medullary thyroid cancer have been reported in humans using Ozempic, in animal studies, the risk of developing MTC was high in mice treated with Ozempic.
The risk of developing Medullary Thyroid Cancer was dependent on the dose and duration of Ozempic use.
Post-marketing cases of MTC have been reported in patients using Liraglutide, another drug from the same class as Ozempic.
Because of the association of MTC in animal studies and post-marketing cases of MTC in patients using Liraglutide, Ozempic is contraindicated in the following high-risk patients:
- Patients with a personal or a family history of MTC
- Patients with MEN-2 syndrome
In addition, all patients must be asked to discontinue treatment and report if any of these symptoms develop while using Ozempic:
- Neck swellings or lumps in the neck
- Difficulty in swallowing
- Hoarseness of voice, especially if persistent and not relieved with symptomatic treatment
- Fatigue, skeletal pains, diarrhea, and cushingoid appearance.
Pretreatment monitoring of Calcitonin, Procalcitonin, or CEA levels is not routinely recommended because of very low specificity.
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How To Detect Thyroid Cancer At An Early Stage
Thyroid cancer can be detected earlier if the patient knows the symptoms and the healthcare provider keeps a low threshold of investigating any lump reported by the patient.
Symptoms of Medullary Thyroid Cancer can be very subtle. Patients should be asked to report symptoms of persistent hoarseness, change in voice, neck lump, difficulty swallowing, and systemic symptoms like weight loss, fatigue, and skeletal pains.
Thyroid ultrasound, Calcitonin levels, CEA levels, Procalcitonin levels, and FNAC may help in the early diagnosis of patients with MTC.
Patients with pheochromocytoma or parathyroid tumors and those with a family history of Medullary thyroid cancer or MEN-2 syndrome should also undergo genetic testing for RET gene mutations.
Patients with MEN-2 syndrome may develop MTC at the age of 10 to 20 years. Prophylactic thyroidectomy is recommended by most experts in high-risk patients.
Living With Advanced Cancer
Advanced cancer usually means cancer that is unlikely to be cured. During this time palliative care services can help. Most people with thyroid cancer respond well to treatment and do not need to access palliative care services. However, people at any stage of advanced thyroid cancer may benefit from palliative treatment.
Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.
Treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:
- Slow down how fast the cancer is growing.
- Shrink the cancer.
- Help you to live more comfortably by managing symptoms, like pain.
Treatment depends on:
- how far it has spread
- your general health
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Can Hyperthyroidism Be A Thyroid Cancer Symptom
Hyperthyroidism is not considered to be one of the primary symptoms of thyroid cancer, although some studies suggest that up to 20 percent of people with thyroid cancer might also have hyperthyroidism. Hyperthyroidism occurs when the thyroid gland overproduces a hormone called thyroxine. This can lead to fatigue, unexpected weight loss, heart palpitations, mood swings, sleep disturbances and other similar complications.
Reducing Your Risk And Other Possible Causes
You might have heard of other possible causes of cancer. Stories about potential causes are often in the media and it isnt always clear which ideas are supported by evidence.
We havent included them here, either because there is no evidence about them or it is less clear.
A pooled analysis of thyroid cancer incidence following radiotherapy for childhood cancer LHS Veiga and others
Cancer. Principles and practice of oncology VT De Vita, S Hellman and SA RosenbergLippincott, Williams and Wilkins, 2018
The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015KF Brown and othersBritish Journal of Cancer, 2018. 118, Pages 1130-1141
Family History of Cancer and Risk of Sporadic Differentiated Thyroid Carcinoma
L Xu and others
Papillary thyroid cancer: Clinical features and prognosis
R Tuttle and others
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How Long Does It Take To Recover From Thyroid Surgery
It will take your body a few weeks to recover after your thyroid is surgically removed . During this time you should avoid a few things, including:
- Submerging your incision under water.
- Lifting an object thats heavier than 15 pounds.
- Doing more than light exercise.
This generally lasts for about two weeks. After that, you can return to your normal activities.
What Other Issues Might I Encounter During Treatment
Cancer can be expensive. Dr. Lieb says that young adults with thyroid cancer have one of the highest rates of healthcare-related bankruptcy. This is partly due to the cost of imaging studies. Another factor is that many people only have insurance through their workplace and cancer treatment can impact your ability to work. Be sure you have support to help you examine medical bills and proactively engage with your insurance provider.
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Treatment Of Advanced Thyroid Cancer
Thyroid cancer that spreads outside the neck area is rare but can be a serious problem. Surgery and radioactive iodine remain the best way to treat such cancers as long as these treatments continue to work. However, for more advanced cancers, or when radioactive iodine therapy is no longer effective, other forms of treatment are needed.
Medications have now been approved for the treatment of advanced thyroid cancer. These drugs rarely cure advanced cancers that have spread widely throughout the body, but they can slow down or partially reverse the growth of the cancer. These treatments are usually given by an oncologist and often require care at a regional or university medical center. These agents can also be used to change a tumor that stopped responding to radioactive iodine to respond to this treatment again. This is called redifferentiation therapy.
External beam radiation directs precisely focused X-rays to areas that need to be treated. This may be tumor that has recurred locally in the neck or spread to bones or other organs. This can kill or slow the growth of those tumors.
What Is The Follow
Periodic follow-up examinations are essential for all patients with thyroid cancer, because the thyroid cancer can returnsometimes several years after successful initial treatment. These follow-up visits include a careful history and physical examination, with particular attention to the neck area. Neck ultrasound is an important tool to view the neck and look for nodules, lumps or cancerous lymph nodes that might indicate the cancer has returned. Blood tests are also important for thyroid cancer patients. Most patients who have had a thyroidectomy for cancer require thyroid hormone replacement with levothyroxine once the thyroid is removed . The dose of levothyroxine prescribed by your doctor will in part be determined by the initial extent of your thyroid cancer. More advanced cancers usually require higher doses of levothyroxine to suppress TSH . In cases of minimal or very low risk thyroid cancer, it is typically recommended to keep TSH in the normal range. The TSH level is a good indicator of whether the levothyroxine dose is correct and should be followed periodically by your doctor.
In addition to routine blood tests, your doctor may want to check a whole-body iodine scan to determine if any thyroid cancer cells remain. These scans are only done for high risk patients and have been largely replaced by routine neck ultrasound and thyroglobulin measurements that are more accurate to detect cancer recurrence, especially when done together.
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Types Of Thyroid Cancer
There are 4 main types of thyroid cancer:
- papillary carcinoma the most common type, accounting for about 8 in 10 cases it usually affects people under 40, particularly women
- follicular carcinoma accounts for up to 1 in 10 cases and tends to affect middle-aged adults, particularly women
- medullary thyroid carcinoma accounts for less than 1 in 10 cases unlike the other types, it can run in families
- anaplastic thyroid carcinoma the rarest and most serious type, accounting for around 1 in 50 cases it usually affects people over the age of 60
Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers. They tend to be easier to treat than the other types.