Thyroid cancer

The thyroid gland (derived from thyreos- Greek- Shield-like), as we all know, is butterfly-shaped in front of your neck below the adam’s apple. It secretes thyroid hormones which are essential to regulate our body metabolism.

It is a hub of constant hormonal activity with ebbs and flows – production and secretion of hormones. So it is not surprising, that in all this hormonal melee’, the balance gets thrown off, quite often, and the thyroid follicular cells can start multiplying abnormally. An abnormal clump of cells forms a nodule or lump in the thyroid.

Thyroid Cancer is the most common endocrine cancer. Even though the diagnosis of cancer is terrifying, thyroid cancer is an exception among that, it is one of the cancers which is treatable and has an excellent prognosis.

It usually presents as an asymptomatic lump in the front of the neck which is noticed by either a family member and brought to the person’s notice or by the person while looking in the mirror. Recently quite a few thyroid nodules are being diagnosed incidentally as a result of a scan done for some other purpose.

Thyroid cancer is more common in people with exposure to radiation, a family history of thyroid cancer, and age > 40yrs. But majorly, we do not yet know, why only certain individuals end up with thyroid cancer.

The most common type is Papillary thyroid cancer which has the best prognosis followed by Follicular type.Other less common ones are – Anaplastic and Medullary – which carry a poor prognosis.

Let us take our discussion further in the format of FAQ’s, for better understanding:

5 FAQs about thyroid cancer:

I have been diagnosed with a thyroid lump. Do I have cancer?

A lump in the thyroid  can mean two things:

First is generalized enlargement, called Goiter, which can occur most commonly in the setting of iodine deficiency.

The second is a Lump or a nodule.

A thyroid nodule is an abnormal growth or lump in the thyroid gland. It may be cancerous or non-cancerous.

Facts about thyroid nodules:

1.They are quite common, about 5 % of women and 1 % of men have a thyroid nodule on routine check-ups. And it is estimated up to 50% develop thyroid nodules by the age of 65 yrs.

2.More than 90% of these nodules are non-cancerous. Special caution in children and teenagers -up to 30 % can be cancerous.

3.Early-stage is painless and usually has no symptoms.

‘Red flag’ signs:

1.Recent onset change or hoarseness of voice

2. Difficulty in breathing or swallowing

3.Abnormal swollen gland – Lymph node.

If you feel if you have any of the above signs, contact your doctor immediately.

In all probability, the nodule is mostly benign and it will need no further treatment if the rest of the investigations confirm it to be a benign nodule.

I have been diagnosed with a thyroid nodule. I am completely flustered, what do I do next?

Relax. Finding a nodule can be alarming. The good news is, the majority are not cancerous.

The next step is to consult your physician or your family doctor.

The doctor will take a detailed history – for example, exposure to radiation in childhood, family history of thyroid cancer, and a focussed clinical examination.

An Ultrasound of the thyroid and neck will be needed to know more about the nodule. A thyroid function test will also be done simultaneously to assess the status of the thyroid.

And once your thyroid US reports come in – depending on a standardized score – 1 to 5, the need for further needle testing will be decided upon.

FNAC-Fine needle aspiration cytology – a small needle is inserted and few cells are aspirated for study.This also has a scoring system (1to 6)to categorize and aid in planning treatment if needed.

The report says that it is suspicious and my doctor says I need surgery. Is surgery really necessary?

Your FNAC report may have come out as score between 3 and 6. Scores of 3 and 4 have a 15 to 20 percent chance of it being cancer .If it is 5 and 6,  the chance of it being cancer is > 50 %.

There is no other sure way to know if the nodule is cancer or not , hence surgery has been advised.

Advanced Molecular gene classifiers have been approved recently, for score 3 and 4, to avoid surgery in such cases, but such tests are costly and are not widely available.


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What are the types of surgery I can expect?

Hemi-thyroidectomy – Removal of the affected lobe with isthmus (middle part of the thyroid gland )

Total thyroidectomy – Removal of both lobes and isthmus.

Both are accepted standard procedures and if done by an experienced surgeon in a good center, the expected complications are negligible.

Thyroid Cancer

What next after surgery, Do I need Radioactive iodine, Is it harmful to my body?

Surgery alone is curative in most cases. Radioiodine is indicated in certain patients with high-risk factors.

The safety of radio iodine depends on its dosage. It is completely safe in low doses. As dosage increases, there is a need for isolation for a week or so, to allow the radioactivity to wear off and get excreted.

Your doctor and his team will decide on whether you are a candidate who will benefit from radioiodine and will suggest accordingly.

Further treatment is in the form of life-long thyroxine supplementation which helps in controlling the disease as well.

Conclusion:

Basic knowledge about cancer always helps to dispel fears and misinformation and helps in empowering the patients and only bridging the knowledge gap can take us closer towards identifying cancer early and provide the best treatment, with the effort to help the patient back to their old self at the earliest. Please contact your qualified health care provider in case of any doubts, let us together bring down the knowledge gap and build a healthy future.

Dr Bharath V M, the author, is a Consultant – Surgical Oncology, at the KIMS Health Cancer Centre

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