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Medullary Thyroid Cancer

more about Medullary Thyroid Cancer

  • Medullary thyroid carcinoma is the third most common type of thyroid cancer.  One third of the cases run in families, one third are associated with a syndrome called multiple endocrine neoplasia (MEN) type 2, and one third occur randomly.
  • It is very important that family members of people with Medullary Thyroid Cancer get screened for the disease.  Also, in people with this type of cancer, they need to be checked for hormonal changes that often occur.
  • Most of these cancers do not pick up iodine, making scanning with radioiodine of little use.
  • Medullary Thyroid Cancer often spreads early, usually before it is detected.  Treatment is preformed by surgically removing the thyroid gland.

  • 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 that is firm, painless, and does not move freely.
  • Most thyroid cancers do not produce any thyroid hormone.  Therefore, most patients with thyroid cancer do not have symptoms of Hyperthyroidism.
  • However, Medullary Thyroid Cancer can secrete a lot of other hormones.  These hormones can cause a variety of symptoms depending on the type of hormone secreted.
  • If the cancer becomes enlarged, or if it spreads to local tissues, it can put pressure on other structures in the neck, causing such symptoms as trouble breathing, trouble swallowing, or a hoarse voice.
  • Lymph nodes in the front part of the neck may be enlarged, but usually not tender to touch.
  • Patients with Medullary Thyroid Cancer often have Diarrhea, flushing, and fatigue.

  • It is not known what causes thyroid cancer.
  • Because Medullary Thyroid Cancer tends to run in families, family members should also be screened.
  • It is important to check for any other hormonal abnormalities.
  • Medullary Thyroid Cancer usually spreads to the surrounding tissues quite early.  In most cases, by the time of diagnosis the cancer has usually spread to local structures in the neck, such as surrounding muscle, the trachea, and local lymph nodes.  Later, this cancer may even spread to the liver, bones, lungs, or adrenal glands.
  • This tumor does not take up iodine, therefore, iodine scans or treatment with radioactive iodine is not an option. (See "Special Information" section below.)
  • Medullary Thyroid Cancer that occurs sporadically usually affects patients in their 60s.  When it occurs as part of an inherited problem, it usually begins earlier, in the 40s.

  • 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.
  • Often, in medullary cancer, there is an elevation of a hormone called Calcitonin.  This can be used to follow the disease and its response to treatment.
  • CEA (Carcinoembryonic antigen) is another substance that is often elevated in people with Medullary Thyroid Cancer.  Its levels may be used to follow the disease and its response to treatment.
  • The levels of Calcitonin and CEA should be measured before thyroid surgery.  The levels can be followed after surgery to assess recovery.  Rising levels suggest that the cancer has returned.
  • 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.
  • Radioiodine scan is not helpful in detecting metastatic Medullary Thyroid Cancer because this type of cancer does not pick up iodine.
  • Chest X-Ray, CAT scan, MRI, or PET 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.
  • The surgical procedure is relatively simple, so there should not be heightened concern.  There are potential complications, and these need to be discussed with the surgeon.
  • Because Medullary Thyroid Cancer has a tendency to spread fairly early to other structures in the neck, repeated neck surgery may be needed to treat any recurrent cancer.
  • However, one of the most common complications is the 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 the surgical removal of the thyroid gland, thyroid hormone replacement will have to be administered for the rest of the patient's life.
  • Radioiodine scans and treatment with radioactive iodine are not options for people with Medullary Thyroid Cancer, because these cancers do not take up iodine.
  • 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.
  • After treatment, the patient 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.
  • The long-term outlook (or prognosis) varies, depending on whether the cancer occurred by chance, or whether it was inherited.  Individuals with cancers that occurred by chance have a 5-year survival rate of about 82%, and a 10-year survival rate of about 69%.
  • Individuals with cancers that were inherited have less aggressive cancers, and therefore have a better long-term prognosis.
  • Women and those under 40 have a better prognosis.

  • Special Information:
    1. Iodine is used by the thyroid gland to make a thyroid hormone.  Doctors can use this to their advantage.  When someone is thought to have any problem with the thyroid, a nuclear medicine scan using radioiodine can be done.  If the thyroid gland is active, it will take up the radioiodine, using it to make a thyroid hormone.  The doctor can then scan the patient and see what areas of the body are taking up the radioiodine.  If the patient has thyroid cancer that takes up the radioiodine, this can be used to treat the cancer, because the patient can then be given radioactive iodine (Iodine 131), which will destroy the cancer.  Whether or not the cancer takes up iodine is very important in both the diagnosis and treatment of thyroid diseases.
    2. Radioactive iodine is usually fairly safe.  However, depending on the dose and the patient's response to the medicine, it can cause side effects, which include stomach inflammation, temporarily low sperm count, low blood count, and, very rarely, Leukemia.
    3. If a lump is detected in the thyroid, 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 patient will then need surgery to remove the cancer. In certain types of thyroid cancer, an iodine scan is done to see if the cancer has spread, and radioactive iodine can be given to destroy any Metastatic Cancer.  However, Medullary Thyroid Cancer does not take up iodine so this is not an option for those with this condition.  After surgery, the patient will have to be followed closely to make sure that the cancer does not come back.  Also, thyroid hormone replacement after the surgery will be needed.
    4. Medullary Thyroid Cancer has a high tendency to run in families.  Children and siblings of those with this type of cancer need to be tested and followed closely.  Also, it is helpful to do genetic testing for a gene called the RET proto-oncogene.  In individuals with the RET proto-oncogene, it is currently recommended that the entire thyroid gland be removed at age 6, because of the high risk of developing thyroid cancer.
    5. One third of patients with Medullary Thyroid Cancer have another disease called MEN Type 2 (it stands for multiple endocrine neoplasia).  Patients with this disease have an increased chance of developing Medullary Thyroid Cancer, Hyperparathyroidism, and Pheochromocytoma.  Therefore, anyone with Medullary Thyroid Cancer should also be checked out for these additional diseases.

more about Medullary Thyroid Cancer

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