An estimated 42 million people in India suffer thyroid diseases, including Goiter. Thyroid is a small gland in the neck that contains cells called Follicular Cells. These cells are responsible for making Thyroxine (T4) and Triiodothyronine (T3), which keeps the body functioning normally. C cells are also present in the Thyroid gland, which makes a hormone that helps control the levels of calcium in the body.
However, unlike in other developing countries, Thyroid Cancer in India is rare. With wide availability of scans and other diagnostic modalities increasing number of patients are diagnosed with thyroid nodule. Challenges in diagnosing Thyroid Cancer is compared with ‘Finding a needle in a haystack’. Large number of people have thyroid nodule, of which only a small proportion is cancer.
Many people develop Thyroid Cancer for no particular reason. However, certain risk factors increase the chances of Thyroid Cancer. These include people who have pre-existing thyroid diseases such as Goiter or inflammation. However, it is important to note that having Hypothyroidism and Hyperthyroidism does not increase the risk of Thyroid Cancer. Family history is another risk factor that cannot be ruled out.
Cancers of the thyroid gland are divided into three main types, namely Differentiated Thyroid Cancers, Anaplastic Thyroid Cancers, and Medullary Thyroid Cancers. Each one behaves differently from the other, and portend contrasting fates for the respective sufferers.
Differentiated Thyroid Cancer or DTC is fortunately the most common thyroid malignancy. And even though there is no such thing as a good cancer, DTCs can be considered as a ‘Good Cancer’ as rarely patients die of this cancer; especially in those patients who are diagnosed at early stage and in young age group. By contrast, Anaplastic Thyroid Cancer (ATC), are rare but one of the most aggressive human cancers. The disease progresses rapidly, and patients do poorly in spite of the best treatment available. The third type of thyroid malignancy is Medullary Thyroid Cancer(MTC), which is often familial.
The commonest and often the earliest symptom of thyroid cancer is a painless swelling in the neck. Rarely patients can present with other symptoms such as change in voice, difficulty in eating, etc. For the diagnosis of Thyroid Cancer the first test to perform is to estimate thyroid hormone levels, which is often normal in Thyroid Cancer. The next important test to be performed is an ultrasound examination. This examination will allow the doctor to suspect the possible cancer.
Any suspected cancer nodule should undergoes a needle biopsy examination, preferably under ultrasound guidance so as not to miss suspicious areas of the nodule. If Thyroid Cancer is detected, few other tests may be recommended to assess the spread from the thyroid region. The final decision for treatment is taken putting the results of all three tests together to reach a working diagnosis. Knowing the type of cancer from the biopsy examination helps the doctor to recommend the most suitable treatment option.
Surgery is the main stay of treatment for Thyroid Cancer. It may be supplemented with radio-iodine therapy and thyroid hormone therapy. Considering the indolent nature of thyroid cancer, there is a recent trend towards management of thyroid cancer by limited surgery (lobectomy) and using radio-iodine therapy sparingly. Several minimally invasive approaches also are now in use to limit both side effects and avoid visible scar from the surgery.
Two main side effects of surgery: –
- Change in voice
- Low blood calcium.
It has been demonstrated that these side effects are less by twenty folds in specialised centres that are treating high-volume of Thyroid Cancers patients.
In cancer patients, follow up is as important as the treatment itself. Periodic clinical and ultrasound examination along with blood testing is important since it allows early detection of disease relapse. Overall, if the cancer is diagnosed early and treated appropriately one can expect excellent chances of recovery and improved quality of life.
By
Dr. Vivek Shetty,
Consultant Head and Neck Onco-Surgeon,
Mazumdar Shaw Cancer Centre, Narayana Health City