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Papillary Thyroid Cancer

more about Papillary Thyroid Cancer

  • Papillary thyroid carcinoma is the most common type of thyroid cancer.  It is three times as common in women as in men and it is more frequent in older people.  Most Papillary Thyroid Cancers secrete a substance known as thyroglobulin that can be used to track the cancer's progress and response to treatment.  Most of the time, it is found as a single lump in the thyroid gland, though sometimes it can also be found in a Goiter with multiple nodules (or lumps).  Most of these cancers pick up iodine, which helps in the diagnosis and treatment process.  This type of thyroid cancer is the least aggressive.  It spreads through the lymph system.  Therefore, quite often, it has metastasized (spread to other parts of the body) before it is detected.  Treatment is with surgical removal of the thyroid gland and/or radioactive destruction of any of the cancer that either was not removed or that has spread to other parts of the body.

  • Most people with thyroid cancer usually have painless swelling of the thyroid gland.
  • The thyroid gland may be swollen all over, but most often it is just one area of the gland that is swollen.  Often, there is a nodule (or lump) present, which is firm, painless, and does not move very freely.
  • Most thyroid cancers do not produce any thyroid hormone.  Therefore, most people with thyroid cancer do not have symptoms of Hyperthyroidism.
  • Lymph nodes in the front part of the neck may be enlarged but, usually, not tender to touch.
  • Sometimes, if the cancer becomes very big, it can put pressure on some of the other structures in the neck.  This can lead to trouble swallowing, trouble breathing, or hoarse voice.  This depends on the size of the cancer, how quickly it is growing, and its location.

  • It is not known what causes thyroid cancer.
  • However, some believe that there may be inherited factors that increase the chance of developing the cancer.
  • Children who were exposed to radiation to the neck area have a higher risk of developing Papillary Thyroid Cancer as adults.
  • Also, children who were exposed to radioactive iodine (such as after a nuclear accident or explosion) have a higher risk of developing Papillary Thyroid Cancer.
  • People with certain other diseases such as Cowden's disease or adenomatous polyposis coli have a higher risk of developing thyroid cancer.
  • Papillary Thyroid Cancer spreads via the lymph system.  Therefore, by the time of diagnosis, most people have cancer that has spread to other parts of the body.  The most common areas of metastasis are to the other half of the thyroid gland, to the lymph nodes, or to the lungs.
  • This tumor does take up iodine. Therefore, iodine scans or treatment with radioactive iodine is an option.  See "Special Information" section below.

  • The history, symptoms, and examination can help lead the doctor in the right direction.
  • However, the main way to make a diagnosis is by removing a piece of the thyroid gland and examining it under the microscope to see if there is any cancer present.  This is usually done via a process known as FNA (fine needle aspiration), in which a needle is used to remove a sample of the lump.
  • As stated above, in most cases of thyroid cancer, the tumor does not produce any thyroid hormone.  Therefore, most people with thyroid cancer have normal thyroid tests.
  • A substance called thyroglobulin is usually elevated in most metastatic (cancer that has spread to other parts of the body) Papillary Thyroid Cancers.  This substance can be measured and then used to track the cancer's response to treatment as well as to detect any recurrence of the cancer.  However, many other things can cause the thyroglobulin level to be elevated and the doctor will have to make sure that the measurements are accurate.
  • An Ultrasound of the neck is also helpful in determining the size of the cancer and to see if it has spread to other areas within the neck.
  • If metastatic Papillary Thyroid Cancer is felt to be present, then a radioiodine scan can be done to show the extent of spread.
  • Chest X-Ray, CT scan, or MRI scan can also be helpful in detecting any metastatic disease.

  • Treatment for almost all thyroid cancers begins with surgical removal of the thyroid gland.  Usually, the entire thyroid gland is removed.  In a few cases, only part of the thyroid gland is removed.  The best surgical option should be discussed with your doctors.
  • Surgery, if done by a skilled physician, usually is fairly safe.  There are potential complications and you should discuss these with your surgeon.
  • However, one of the most common complications is accidental removal of the parathyroid gland because it is located very close to the thyroid gland.  If this happens, it is not life threatening as long as it is detected early and the parathyroids are replaced quickly.
  • Immediately after surgical removal of the thyroid gland, thyroid hormone replacement will have to be started and it will have to be continued for the rest of the person's life.
  • About 3-4 months after surgery, the person needs a radioiodine scan of the entire body.  This is done to see if there is any metastatic disease.  If metastatic disease is present, they will need radioactive iodine treatment in order to destroy the remaining cancer.
  • Prior to the radioiodine scan, thyroid hormone replacement will have to be stopped.  This will help improve the quality of the scan and also help improve treatment results if the person does have metastatic disease.
  • Also, stopping the thyroid hormone replacements will allow better measurements of the thyroglobulin level.  Remember, as mentioned earlier, this is a substance made by some tumors.  The level of thyroglobulin, therefore, can be used to follow the person's response to treatment as well as to detect if the cancer comes back.
  • In some people, a medicine called Thyrotropin can be used to help increase the uptake of the radioiodine by the cancer.  Talk to your doctor to see if this is an option.
  • If the thyroid cancer has spread to the bone, then radiation therapy may be needed.
  • If the cancer has spread to the brain, then gamma knife radiation (a special type of radiation treatment) will be needed.
  • Once the person has been treated with the radioactive iodine, a repeat radioiodine scan is done a few days later to see if there is any residual cancer.
  • After the person has been treated, they will need to be followed very closely with periodic physical exams, neck exams, and chest X-Rays.  The doctor will also have to make sure that the person is receiving the correct amount of thyroid hormone replacement.
  • About 8-12 months after the person has completed treatment, they will need a repeat iodine scan to make sure that there is no residual cancer and to make sure that the cancer has not come back.  Once again, before this scan, the thyroid hormone replacement will have to be stopped to improve the results of the scan.
  • Also, at the same time, the thyroglobulin level will need to be checked.  If the thyroglobulin level is still increased and the iodine scan is normal, then other types of tests such as MRI, Ultrasound, or thallium-201 scan may need to be done.  Please talk to your doctor about this.
  • People with Papillary Thyroid Cancer need to have at least 2 normal iodine scans before they are considered to be in remission.
  • The long-term outlook (or prognosis) is fairly good in people with Papillary Thyroid Cancer.  People less than 45 years, those with disease that has not spread, and those with smaller tumors have a better prognosis.  5-year survival in those people is above 95%.
  • People with cancer that was bigger than 1cm and had only part (rather than all) of the thyroid gland removed have a much higher chance of death from the cancer.
  • People who do not get treated with radioactive iodine also have a much higher risk of death from the cancer.
  • Men have a higher risk of having the tumor come back.

  • Special Information
    1. In a few rare cases, Papillary Thyroid Cancer that has been present for a long time can change into Anaplastic Thyroid Cancer and become very aggressive.
    2. Iodine is used by the thyroid gland to make thyroid hormone.  Doctors can use this fact to their advantage.  When someone is thought to have any problem with his or her thyroid gland, a special type of scan can be done.  It is a nuclear medicine scan using radioiodine.  Basically, the person is given radioiodine.  If the thyroid gland is active, it will take up the radioiodine and use it to make thyroid hormone.  The doctor can then scan the person and see what areas of the body are taking up the radioiodine.  Also, if the person has thyroid cancer that takes up the radioiodine, then this can be used to treat the cancer.  The person can be given radioactive iodine (131I), which will destroy the cancer.  Therefore, whether or not the cancer takes up iodine is very important in both the diagnosis and treatment of thyroid diseases.
    3. Radioactive iodine is usually fairly safe.  However, depending on the dose and the person's response to the medicine, it can cause side effects, which include stomach inflammation, temporary low sperm counts, low blood counts, and very rarely Leukemia.
    4. You have been given a lot of information so far.  But it is quite simple.  If a lump is detected in the thyroid gland, the first thing to do is to determine whether or not it is cancer.  If cancer is present, then blood tests and X-Rays will need to be done.  The person will then need to have surgery to remove the cancer.  Once this done, then an iodine scan will be done to see if the cancer has spread.  If Metastatic Cancer is present, then radioactive iodine is given to destroy the cancer.  After, that the person will have to be followed to make sure that the cancer does not come back.  Also, the person will need to be on thyroid hormone replacement after the surgery.

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