THYROID CANCER TREATMENTS

The aggressiveness of each type of thyroid cancer is different. Cancer staging considers the size of the tumor, whether it has grown into surrounding lymph nodes and whether it has spread to distant parts of the body (metastasized). Age and general health status are also taken into account. In patients less than 45 years old there are only two stages. I papillary or follicular type thyroid cancer, stage I refers to patients without evidence of cancer that has spread to the body. Stage II refers to patients with spread of cancer outside the thyroid gland. In patients over 45, patients with tumors smaller than one cm are classified as stage I, those with tumors not broken through the capsule (covering) of the thyroid belong to stage II, those with tumors outside the capsule or lymph node involvement are called stage III and those with spread outside the thyroid area are stage IV. In medullary-type thyroid cancer, stage I and IV are the same. Stage II consists of patients with tumors greater than one cm and stage III comprises patients with lymph node involvement.

The papillary type (60-80% of all thyroid cancers) is a slow-growing cancer that develops in the hormone-producing cells (that contain iodine) and can be treated successfully. The follicular type (30-50% of thyroid cancers) also develops in the hormone-producing cells, has a good cure rate but may be difficult to control if the cancer invades blood vessels or grows into nearby structures in the neck. The medullary type (5-7% of all thyroid cancers) develops in the parafollicular cells (also known as the C cells) that produce calcitonin, a hormone that does not contain iodine. Medullary thyroid cancers are more difficult to control because they often spread to other parts of the body. The fourth type of thyroid cancer, anaplastic (2% of all thyroid cancers), is the fastest-growing and is usually fatal because the cancer cells rapidly spread to the different parts of the body.

More than 90% of patients who are treated for papillary or follicular cancer will live for 15 years or longer after the diagnosis of thyroid cancer. Eighty percent of patients with medullary thyroid cancer will live for at least 10 years after surgery. Only 3-17% of patients with anaplastic cancer survive for five years.

Like most cancers, cancer of the thyroid is best treated when it is found early by a primary physician. Treatment depends on the type of cancer and its stage. Four types of treatment are used: surgical removal, radiation therapy, hormone therapy and chemotherapy. Surgical removal is the usual treatment if the cancer has not spread to distant parts of the body.

The surgeon may remove the side or lobe of the thyroid where the cancer is found (lobectomy) or all of it (total thyroidectomy). If the adjoining lymph nodes are affected, they may also be removed during surgery. When the thyroid gland is removed and levels of thyroid hormones decrease, the pituitary gland starts to produce TSH that stimulates the thyroid cells to grow.

A radiation-oncologist uses radiation therapy with high-energy x-rays to kill cancer cells and shrink tumors. The radiation may come from a machine outside the body (external beam radiation), or the patient may be asked to swallow a drink containing radioactive iodine. Because the thyroid cells take up iodine, the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells. A hematologist-oncologist uses chemotherapy either as a pill or an injection through a vein in the arm.