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.
Sarahs Stage 1 Papillary Thyroid Cancer Story
Sarah shares her stage 1 papillary thyroid cancer story, undergoing a total thyroidectomy and radioactive iodine treatment.
In her story, Sarah highlights how she navigated life after a cancer diagnosis, including self-advocacy as a patient, approaching the issue of fertility preservation, the importance of having caregivers during treatment, and dealing with loved ones and their emotions. Thanks, Sarah!
In the moment, you just kind of do what you have to do and you get through it. I had to be fine in the moment, I had to put all the emotions on the back burner and just get through it.
This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.
Describe your first symptoms
I didnt really have any that I noticed, honestly. I went to my primary care physician because I had a really sore throat. I wanted to make sure it wasnt strep throat so I went in for a strep test.
The doctor was prodding around my neck and was asked if anyone had ever told me about my thyroid being enlarged. And I was like No, I honestly didnt even know where my thyroid was. He said it was enlarged and probably nothing, but recommended that I get an ultrasound.
What was your diagnosis experience like
Crying a lot. I had a couple of appointments before I was diagnosed. I had the appointment where I went and got the strep test and they sent me for an ultrasound.
Thyroid Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Thyroid Gland
The thyroid is a gland at the base of the throat near the trachea . It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin piece of tissue, connects the two lobes. A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin.
The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:
- Control heart rate, body temperature, and how quickly food is changed into energy .
- Control the amount of calcium in the blood.
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What Are The Symptoms Of Papillary Thyroid Cancer
The main sign of papillary thyroid cancer is a painless lump or nodule on your thyroid gland. PTC usually doesnt cause any other symptoms.
In rare cases, you may experience pain in your neck, jaw or ear from PTC. If the nodule is large enough to compress your windpipe or esophagus, it may cause difficulty with breathing or swallowing.
What Is The Prognosis Of Papillary Thyroid Cancer
Overall, the prognosis of papillary thyroid cancer is excellent, especially if youre younger than 40 at diagnosis and have a small tumor. PTC can often be treated successfully and is rarely fatal, even if it has spread to lymph nodes in your neck.
Factors that may lead to a worse prognosis include:
- Being older than 55 years at diagnosis.
- Having a large tumor.
- If the cancer has spread to distant parts of your body.
- If you have a rare subtype of PTC, which are typically more aggressive, including the tall cell variant, diffuse sclerosis variant or solid variant.
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Papillary Thyroid Cancer: What About Lymph Nodes
We have lymph nodes all over our body that are made up of groups of infection-fighting and cancer-fighting immune cells. We all have had “swollen glands” in our neck when we had a sore throat or tonsils. These same glands that get swollen when we have a neck infection can help fight cancer by preventing the cancer cells from spreading from the thyroid to the rest of the body. It is common for papillary thyroid cancer to spread into the lymph nodes of the neck before the cancer is discovered and diagnosed. Again, since there usually aren’t any symptoms, the cancer grows slowly for years and has time to spread into the lymph nodes, which are doing their job of capturing the cancerous cells before they can spread further. Thus, cancer that has spread into the neck lymph nodes is common with papillary thyroid cancer and may occur in as many as 40 percent of patients with small papillary cancers. In patients with larger papillary thyroid cancers, lymph node spread within the neck lymph nodes may occur in up to 75 percent of cases.
Treatment Option Overview For Thyroid Cancer
Standard treatment options for thyroid cancer are described in Table 1.
|Type of Thyroid Cancer||Disease Status||Standard Treatment Options|
|T = primary tumor N = regional lymph node M = distant metastases EBRT = external-beam radiation therapy RAI = radioactive iodine.|
|Papillary and follicular|
|Recurrent papillary and follicular thyroid cancer|
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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 .
Thyroid Nodules Are Common But Usually Are Not Cancer
Your doctor may find a lump in your thyroid during a routine medical exam. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. Nodules may be solid or fluid-filled.
When a thyroid nodule is found, an ultrasound of the thyroid and a fine-needle aspiration biopsy are often done to check for signs of cancer. Blood tests to check thyroid hormone levels and for antithyroid antibodies in the blood may also be done to check for other types of thyroid disease.
Thyroid nodules usually don’t cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only a small number of thyroid nodules are diagnosed as cancer.
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Recurrence Of Thyroid Cancer
Although thyroid cancer recurrence is not common, there are many treatment options available if it happens. If a cancer recurrence is detected in the neck lymph nodes, the best course of action is usually an operation to remove the affected node or additional treatment with RAI ablation. In order to determine the best treatment for recurrent thyroid cancer, it is critical to work with an experienced team of thyroid specialists.
Characteristics Of Papillary Thyroid Cancer
Peak onset ages are 30 to 50 years old.
Papillary thyroid cancer is more common in females than in males by a 3:1 ratio.
The prognosis is directly related to tumor size. Less than 1.5 cm is a good prognosis.
The prognosis is also directly related to age. Patients under 55 years of age do much better than patients who are over 55 years of age.
The prognosis is directly related to gender. Women have a much better prognosis than do similarly aged men.
This cancer accounts for 85% of thyroid cancers due to .
In more than 50% of cases, it spreads to lymph nodes of the neck.
Distant spread is uncommon.
The overall cure rate is very high .Management of Papillary Thyroid Cancer
Considerable controversy exists when discussing the management of well-differentiated thyroid carcinomas both papillary thyroid cancer and even follicular thyroid cancer.
Some experts contend that if these tumors are small and not invading other tissues then simply removing the lobe of the thyroid that harbors the tumor will provide as good a chance of cure as removing the entire thyroid.
These proponents of conservative surgical therapy relate the low rate of clinical tumor recurrence despite the fact that small amounts of tumor cells can be found in up to 88% of the opposite lobe thyroid tissues. They also cite some studies showing an increased risk of and recurrent laryngeal nerve injury in patients undergoing total thyroidectomy .
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Thyroid Cancer Types Stages And Treatment Overview
In addition to the material on this page, the Newly Diagnosed section has about 30 subsections related to treatment of different types of thyroid cancer.
Thyroid Cancer Basics: Free 50-page Handbook in
The 2018 Updates to the Staging System for Differentiated Thyroid CancerPapillary, Follicular, Hurthle Cell, and Variants
The following information was obtained from the National Cancer Institute.
What is cancer of the thyroid?
Cancer of the thyroid is a disease in which cancer cells are found in the tissues of the thyroid gland. The thyroid gland is at the base of the throat. It has two lobes, one on the right side and one on the left. The thyroid gland makes important hormones that help the body function normally.
Cancer of the thyroid is more common in women than in men. Most patients are between 25 and 65 years old. People who have been exposed to large amounts of radiation, or who have had radiation treatment for medical problems in the head and neck have a higher chance of getting thyroid cancer. The cancer may not occur until 20 years or longer after radiation treatment.
A doctor should be seen if there is a lump or swelling in the front of the neck or in other parts of the neck.
Stages of cancer of the thyroid
The following stages are used for papillary cancers of the thyroid:
Papillary and Follicular Thyroid Cancer in Patients Younger than 45 Years of Age:
Stage I Papillary and Follicular
Medullary Thyroid Cancer
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 .
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Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.
Papillary Thyroid Cancer Quick Facts:
- Peak onset ages 30 through 50
- Females more common than males by 3 to 1 ratio
- Prognosis directly related to tumor size
- Accounts for 85% of thyroid cancers
- Can be caused by radiation or x-ray exposure
- Spread to lymph nodes of the neck present in up to 50% of cases
- Distant spread is very rare
- Overall cure rate very high
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If Treatment Does Not Work
Recovery from thyroid 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 some 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 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.
How Is The Stage Determined
The staging system most often used for thyroid cancer is the AJCC TNM system, which is based on 3 key pieces of information:
- The extent of the tumor : How large is the cancer? Has it grown into nearby structures?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes?
- The spread to distant sites : Has the cancer spread to the distant organs such as the lungs or liver?
The systems described below are the most recent AJCC systems effective January 2018 and applies to differentiated, anaplastic and medullary thyroid cancers.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging.
The staging system in the table below uses the pathologic stage . It is determined by examining tissue removed during an operation. Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and might not predict the patients outlook as accurately as a pathologic stage.
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Signs Of Thyroid Cancer Include A Swelling Or Lump In The Neck
Thyroid cancer may not cause early signs or symptoms. It is sometimes found during a routine physical exam. Signs or symptoms may occur as the tumor gets bigger. Other conditions may cause the same signs or symptoms. Check with your doctor if you have any of the following:
- A lump in the neck.
- Trouble breathing.
When Should I See My Healthcare Provider About Papillary Thyroid Cancer
If youve been diagnosed with papillary thyroid cancer, youll need to see your healthcare team regularly to monitor your treatment progress. Youll also need long-term monitoring every six to 12 months to look for cancer recurrence for at least five years.
If you had your thyroid removed and/or had radioactive iodine therapy as part of treatment, youll need to take thyroid hormone medication for the rest of your life. Your healthcare provider will want to monitor your thyroid hormone levels throughout your life to make sure your medication dosage is working for you.
A note from Cleveland Clinic
Receiving a cancer diagnosis is unsettling, regardless of the type. The good news is that papillary thyroid cancer often has an excellent prognosis. Your healthcare team will work with you to determine the best treatment plan for you.
Last reviewed by a Cleveland Clinic medical professional on 06/28/2022.
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