Medullary Thyroid Cancer Is Sometimes Caused By A Change In A Gene That Is Passed From Parent To Child
The genes in cells carry hereditary information from parent to child. A certain change in the RET gene that is passed from parent to child may cause medullary thyroid cancer.
There is a genetic test that is used to check for the changed gene. The patient is tested first to see if he or she has the changed gene. If the patient has it, other family members may also be tested to find out if they are at increased risk for medullary thyroid cancer. Family members, including young children, who have the changed gene may have a thyroidectomy . This can decrease the chance of developing medullary thyroid cancer.
How Is Thyroid Cancer Prevented
In most cases, the cause of thyroid cancer isnt known, which means that theres no known way to prevent it for many people.
Medullary thyroid cancer can be hereditary, so its best to talk to a doctor if your family has a history of this type of thyroid cancer. The doctor can refer you to a genetic counselor who can determine how likely you are to develop thyroid cancer.
Types Of Thyroid Cancer
There are 4 main types of thyroid cancer. They are:
- papillary carcinoma this is the most common type, accounting for about 6 out of 10 cases it usually affects people under the age of 40, particularly women
- follicular carcinoma accounts for around 3 out of 20 cases of thyroid cancer and tends to affect older adults
- medullary thyroid carcinoma accounts for between 5 and 8 out of every 100 diagnosed cases unlike the other types of thyroid cancer, medullary thyroid carcinoma can run in families
- anaplastic thyroid carcinoma this is the rarest and most aggressive type of thyroid cancer, accounting for less than 1 in 20 thyroid cancers it usually affects older people over the age of 60
Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers, and they’re often treated in the same way.
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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.
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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Optimized Surgery For Ptc
Surgery for PTC can be divided into two components: thyroidectomy, and lymphadenectomy. Based on the preponderance of data from large, relevant retrospective studies, the American Thyroid Association has enumerated a treatment strategy with :
- Several reasonable overall goals:
- Allow staging that facilitates further management and follow-up
- Minimize disease recurrence, both local and distant.
- Specific to surgical goals, excerpts from Recommendation 15 state:
- To remove the primary tumor, disease that has extended beyond the thyroid capsule and involved cervical lymph nodes. Completeness of surgical resection is an important determinant of outcome, while residual metastatic lymph nodes represent the most common site of disease persistence/recurrence.
- To minimize the risk of disease recurrence and metastatic spread. Adequate surgery is the most important treatment variable influencing prognosis
- The specific tactics to achieve the goals are also enumerated:
- For PTC > 1 cm, total or near-total thyroidectomy is indicated. Lobectomy is sufficient for < 1 cm PTC if low risk, unifocal, intrathyroid, with no metastatic lymph nodes or prior radiation
- Therapeutic clearance of C-VI or lateral neck LNM is indicated
- Prophylactic clearance of C-VI may be performed
- No C-VI dissection may be appropriate for small, T1-2 PTC.
An important corollary to the above guidelines is that these recommendations should be interpreted in light of available surgical expertise.
What Is The Thyroid Gland
Treatment of Recurrent Thyroid Cancer
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
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Can Papillary Thyroid Cancer Be Prevented
Most people with thyroid cancer have no known risk factors, so its not possible to prevent most cases of papillary thyroid cancer.
Radiation exposure, especially in childhood, is a known PTC risk factor. Because of this, healthcare providers no longer use radiation to treat less serious diseases. Imaging tests, such as X-rays and CT scans, also expose children to radiation, but at much lower doses. Its not clear how much they might increase the risk of PTC.
If you have a family history of thyroid cancer, you may want to get genetic counseling to see if you have any inherited conditions that put you at a higher risk of developing PTC. If this is the case, your healthcare provider may recommend getting preventive surgery to remove your thyroid gland before cancer develops.
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:
- Triiodothyronine
- 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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Treatments For Thyroid Cancer
Treatment for thyroid cancer depends on the type of thyroid cancer you have and how far it has spread.
The main treatments are:
- surgery to remove part or all of the thyroid
- radioactive iodine treatment you swallow a radioactive substance that travels through your blood and kills the cancer cells
- external radiotherapy a machine is used to direct beams of radiation at the cancer cells to kill them
- chemotherapy and targeted therapies medicines used to kill cancer cells
After treatment, youâll have follow-up appointments to check whether the cancer has come back.
There are several different types of thyroid cancer, the most common is papillary thyroid cancer, which usually grows in one lobe of the thyroid gland . Follicular thyroid cancer accounts for about 20% of thyroid cancers.
Less common thyroid cancers include medullary thyroid cancer, anaplastic thyroid cancer and thyroid sarcoma or lymphoma.
It is projected that 3830 new cases of thyroid cancer will be diagnosed in Australia in 2021, and it is more common in women.
The five year survival rate for thyroid cancer is 97%.
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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.
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Evaluation And Management Of The Solitary Thyroid Nodule
The key to the workup of the solitary thyroid nodule is to differentiate malignant from benign disease and, thus, to determine which patients require intervention and which patients may be monitored serially. History taking, physical examination, laboratory evaluation, and fine-needle aspiration biopsy are the mainstays in the evaluation of thyroid nodules. Imaging studies can be adjuncts in select cases.
A 2015 consensus statement from the American Thyroid Association on preoperative imaging for thyroid cancer surgery stated the following :
Needing Second Thyroid Cancer Surgery: Persistent Or Recurrent Thyroid Cancer
Persistent or recurrent papillary thyroid cancer in residual thyroid tissue is much more concerning for the potential for the cancer to spread directly into the breathing tube or voice box. Only the most skilled and experience thyroid cancer surgery experts should manage such circumstances. The purpose of this specific thyroid cancer surgery is to maintain vocal and swallowing function, parathyroid function, and airway control. These are the most complicated and complex of all thyroid cancer surgeries.
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Patient Clinical Data And Bioinformatics
Bioinformatic analysis of potential clinical biomarkers for thyroid cancer recurrence was performed using 3 study arms: mRNA expression, somatic mutation, and miR expression ). Candidate biomarkers were validated by functional assessment to interrogate mechanisms of recurrence and significant output integrated to construct a prognosis risk model.
Total RNAseq data from the 501 thyroid cancer samples described in The Cancer Genome Atlas were analyzed, including 455 nonrecurrent and 46 recurrent tumor specimens ). In addition, 59 tumor/normal matched samples were also analyzed. Bioinformatic and statistical analyses were predominantly performed in the open-source software R . RNA expression analysis was performed with the TCGA RNA sequencing data through the FireHose portal . The TCGA RNA sequencing data have been upper quartile normalized. For each of the 20 532 genes, the absolute median differential expression between recurrent and nonrecurrent patients was calculated. The Mann-Whitney U value was calculated in R, and the genes were then ranked by median differential expression. MiR data from 502 THCA samples in TCGA were downloaded and normalized to reads per million counts. The median differential expression of each miR was conducted in the same way as the RNAseq data.
What Causes Papillary Thyroid Cancer
Scientists still dont know the exact cause of papillary thyroid cancer, but they have identified risk factors that increase your risk of developing PTC, including radiation exposure and certain genetic conditions.
Radiation exposure and papillary thyroid cancer
The rates of papillary thyroid cancer are higher in people who have a history of exposure to significant ionizing radiation. This exposure could be due to:
- High-dose external radiation treatments to your neck, especially during childhood, used to treat cancer or some noncancerous conditions.
- Radiation exposure from nuclear plant disasters. The Chernobyl nuclear accident in 1986 led to a 3- to 75-fold increase in PTC cases in fallout regions.
Genetics and papillary thyroid cancer
A few genetic conditions are associated with PTC, including:
Only 5% of all papillary thyroid cases are associated with these genetic conditions.
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What Should I Do If I Have Symptoms Of Metastatic Thyroid Cancer
As with other types of cancer, thyroid cancer that is detected in its early stages is more easily treatable and more likely to lead to a positive outcome and quality of life. If you are experiencing any symptoms associated with thyroid cancer, it is important to consult a physician as soon as possible to receive an accurate diagnosis and treatment plan.
Moffitt Cancer Center offers comprehensive diagnostic, treatment and supportive care services for individuals with thyroid cancer. Whether you have been diagnosed with thyroid cancer or are experiencing metastatic thyroid cancer symptoms, you can find all of the services you need under a single roof at Moffitt.
Call or fill out a new patient registration form online to learn more about thyroid cancer treatment services at Moffitt. We welcome patients with or without a referral.
If The Cancer Comes Back
If your cancer does come back at some point, your treatment options will depend on the where the cancer is, what treatments youve had before, and your current health and preferences. Treatment options might include surgery, radiation therapy, chemotherapy, targeted therapy or some combination of these. For more on how recurrent cancer is treated, see Treatment of Thyroid Cancer, by Type and Stage.
For more general information on recurrence, see Understanding Recurrence.
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Papillary Thyroid Cancer Recurrence Risk Factors
Hannah R Nieto, Caitlin E M Thornton, Katie Brookes, Albert Nobre de Menezes, Alice Fletcher, Mohammed Alshahrani, Merve Kocbiyik, Neil Sharma, Kristien Boelaert, Jean-Baptiste Cazier, Hisham Mehanna, Vicki E Smith, Martin L Read, Christopher J McCabeThe Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 5, May 2022, Pages 13921406
Thyroid Hormone Replacement Therapy
Many people who have a partial thyroidectomy wont need thyroid hormone replacement therapy because the remaining lobe will continue to make enough hormones.
After the whole thyroid is removed, your body will no longer produce the hormones that maintain your metabolism, and you will be prescribed a hormone tablet.
Taking thyroid hormone tablets can keep your bodys metabolism functioning at a normal healthy rate and reduce the risk of the cancer coming back.
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Recurrence Of Thyroid Cancer And Treatment Options
There are four main types of thyroid cancer:
- Papillary thyroid cancer: This is the most common form of thyroid cancer arising from the follicular cells. Almost 86 out of every 100 cases diagnosed as thyroid cancers are of this type. Papillary thyroid cancer is a slow growing tumor and generally responds well to treatment.
- Follicular thyroid cancer: It is the second most common type of thyroid cancer and represents 9 out of every 100 cases of thyroid cancer. This tumor also shows good response to treatment.
- Medullary thyroid cancer: 2 out of every 100 cases of thyroid cancer are of medullary type. They arise from the C cells and produce large quantities of calcitonin. They are slow going tumors and can be treated if caught early.
- Anaplastic thyroid cancer: This type of thyroid cancer is extremely rare affecting 1 in every 100 cases of thyroid cancer. The tumor arises from the follicular cells, is fast growing in nature and metastasizes early. Therefore, these type of tumors are the most difficult to treat.
The treatment of thyroid cancer usually involves:
- Radioactive iodine therapy
- Targeted therapy
Follow up in case of medullary thyroid cancer: The levels of calcitonin and carcino-embryonic antigen are tested. It they show a rise, ultrasound of neck, CT scan and a MRI scan are done to find any evidence of recurrence.
Further treatment in case of recurrence depends upon the following factors:
Can I Lower The Risk Of My Cancer Progressing Or Coming Back
If you have thyroid cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, its not yet clear if there are things you can do that will help.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight is important. We know that these types of changes can have positive effects on your health that can extend beyond your risk of cancer.
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