Thyroid Cancer

Thyroid cancer is a growth of cells that starts in the thyroid. The thyroid is a butterfly-shaped gland located at the base of the neck, just below the Adam’s apple. The thyroid produces hormones that regulate heart rate, blood pressure, body temperature and weight.

Thyroid cancer might not cause any symptoms at first. But as it grows, it can cause signs and symptoms, such as swelling in your neck, voice changes and difficulty swallowing

• A lump (nodule) that can be felt through the skin on your neck
• A feeling that close-fitting shirt collars are becoming too tight
• Changes to your voice, including increasing hoarseness
• Difficulty swallowing
• Swollen lymph nodes in your neck
• Pain in your neck and throat

Types of thyroid cancer include:

• Differentiated thyroid cancers.This broad category includes types of thyroid cancer that start in the cells that produce and store thyroid hormones. These cells are called follicular cells. Differentiated thyroid cancers cells appear similar to healthy cells when viewed under a microscope.
  • Papillary thyroid cancer. most common . any age, but it most often affects people ages 30 to 50. Most papillary thyroid cancers are small and respond well to treatment, even if the cancer cells spread to the lymph nodes in the neck. A small portion of papillary thyroid cancers are aggressive and may grow to involve structures in the neck or spread to other areas of the body.
  • Follicular thyroid cancer. rare type. Usually affects people older than 50. Follicular thyroid cancer cells don’t often spread to the lymph nodes in the neck. But some large and aggressive cancers may spread to other parts of the body. Follicular thyroid cancer most often spreads to the lungs and bones.
  • Hurthle cell thyroid cancer.This rare type of thyroid cancer was once considered a type of follicular thyroid cancer. Now it is considered its own type because the cancer cells behave differently and respond to different treatments. Hurthle cell thyroid cancers are aggressive and can grow to involve structures in the neck and spread to other parts of the body.
  • Poorly differentiated thyroid cancer.This rare type of thyroid cancer is more aggressive than other differentiated thyroid cancers and often doesn’t respond to the usual treatments.
• Anaplastic thyroid cancer.This rare type of thyroid cancer grows quickly and can be difficult to treat. However, treatments can help slow the progression of the disease. Anaplastic thyroid cancer tends to occur in people older than 60. It can cause severe signs and symptoms, such as neck swelling that worsens very quickly and may lead to difficulty breathing and swallowing.
• Medullary thyroid cancer.This rare type of thyroid cancer begins in thyroid cells called C cells, which produce the hormone calcitonin. Elevated levels of calcitonin in the blood can indicate medullary thyroid cancer at a very early stage. Some medullary thyroid cancers are caused by a gene called RET that’s passed from parents to children. Changes in the RET gene can cause familial medullary thyroid cancer and multiple endocrine neoplasia, type 2. Familial medullary thyroid cancer increases the risk of thyroid cancer. Multiple endocrine neoplasia, type 2, increases the risk of thyroid cancer, adrenal gland cancer and other types of cancers.
• Other rare types.Other very rare types of cancer can start in the thyroid. These include thyroid lymphoma, which begins in the immune system cells of the thyroid, and thyroid sarcoma, which begins in the connective tissue cells of the thyroid

The following tests may be used to diagnose thyroid cancer:

• Physical examination
• Blood tests.
  • Thyroid hormone levels
  • Thyroid-stimulating hormone (TSHTg and TgAb)
  • Medullary type-specific tests – Calcitonin and carcinoembryonic antigen (CEA) levels. Presence of RETproto-oncogenes, particularly if there is a family history of MTC.
• Ultrasound.

A biopsy for thyroid nodules will be done in 1 of 2 ways:

• Fine needle aspiration.
• Surgical biopsy.

• Molecular testing of the nodule sample.
• Radionuclide scanning.
• X-ray.
• Computed tomography (CT or CAT) scan..
• Positron emission tomography (PET) or PET-CT scan.
• Thyroid cancer is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland.
• Thyroid nodules are common but usually are not cancer.
• There are different types of thyroid cancer.
• Age, gender, and being exposed to radiation can affect the risk of thyroid cancer.
• Medullary thyroid cancer is sometimes caused by a change in a gene that is passed from parent to child.
• Signs of thyroid cancer include a swelling or lump in the neck.
• Tests that examine the thyroid, neck, and blood are used to diagnose thyroid cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Treatment Option Overview

• Six types of standard treatment are used:
  • Surgery
  • Radiation therapy, including radioactive iodine therapy
  • Chemotherapy
  • Thyroid hormone therapy
  • Targeted therapy
  • Watchful waiting
• New types of treatment are being tested in clinical trials.
  • Immunotherapy
• Treatment for thyroid cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed..

Surgery

Surgery is the most common treatment for thyroid cancer. One of the following procedures may be used:

• Lobectomy
• Near-total thyroidectomy
• Total thyroidectomy
• Tracheostomy: Surgery to create an opening (stoma) into the windpipeto help you breathe. The opening itself may also be called a tracheostomy.

Radiation therapy, including radioactive iodine therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy
• intraoperative radiation therapy.
• Internal radiation therapy uses a radioactivesubstance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Follicular and papillary thyroid cancers are sometimes treated with radioactive iodine (RAI) therapy. RAI is taken by mouth and collects in any remaining thyroid tissue, including thyroid cancer cells that have spread to other places in the body. Since only thyroid tissue takes up iodine, the RAI destroys thyroid tissue and thyroid cancer cells without harming other tissue. Before a full treatment dose of RAI is given, a small test-dose is given to see if the tumor takes up the iodine.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy and radioactive iodine (RAI) therapy are used to treat thyroid cancer.

Chemotherapy

.Thyroid hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In the treatment of thyroid cancer, drugs may be given to prevent the body from making thyroid-stimulating hormone (TSH), a hormone that can increase the chance that thyroid cancer will grow or recur.

Also, because thyroid cancer treatment kills thyroid cells, the thyroid is not able to make enough thyroid hormone. Patients are given thyroid hormone replacement pills. 

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation do. There are different types of targeted therapy:

• Tyrosine kinase inhibitor. Tyrosine kinase inhibitor therapy blocks signals needed for tumorsgrow. Sorafenib, lenvatinib, vandetanib, cabozantinib, selpercatinib, larotrectinib, entrectinib, and pralsetinib
• Protein kinase inhibitor.Protein kinase inhibitor therapy blocks proteins needed for cell growth and may kill cancer cells. Dabrafenib and trametinib are used to treat anaplastic thyroid cancer in patients with a certain mutation in the BRAF gene.

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