Understanding Thyroid Cancer

Size: px

Start display at page:

Download "Understanding Thyroid Cancer"

Asher Cunningham
5 years ago
Views:

1 Understanding Thyroid Cancer Recorded on: July 25, 2012 Christine Landry, M.D. Surgical Oncologist Banner MD Anderson Cancer Center Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. Hello. I m Andrew Schorr for Banner MD Anderson Cancer Center. We re talking about thyroid cancer which affects about 48 thousand Americans each year, more often, women. A specialist in that is surgical oncologist Christine Landry. She s at the Banner MD Anderson Cancer Center in Gilbert, Arizona. Dr. Landry, thank you so much for being with us. Thank you for having me. Dr. Landry, so thyroid cancer, first of all, a lot of people aren t really clear on where is the thyroid gland. Where is it? The thyroid gland is on the neck, right here, and it overlies the trachea, your breathing tube. Okay. And how big is it? It s about eight centimeters in size length-wise and distance, about three centimeters in size. So when you have a physical and your doctor checks right where we think the Adam s apple is, is that where the thyroid is?

2 Just below that area, yes. I see. Okay. So thyroid cancer, how would somebody even know maybe they had it? What would be a reason that somebody might come in and get checked for it? Well, often their primary care physician or the patient themselves, they feel a nodule in their neck, so they see their primary care physician who would then order an ultrasound to take a better look at the thyroid gland to see if there s any nodules. Other symptoms they can have would be hoarseness, difficulty swallowing. Sometimes they have difficulty breathing, but most of the time most patients do not have any major symptoms. Would you feel a lump in your neck? You could. Sometimes they may. Usually feeling it with your fingers or sometimes a hard time swallowing. Well, feeling anything like that or being told it s a cancer is scary. Tell us about the most common type of thyroid cancer and what the treatment is. The most common type of thyroid cancer is papillary thyroid carcinoma, and that comprises approximately 80 percent of all thyroid cancers. And the primary treatment is to remove the thyroid gland, and after that patients will require thyroid hormone therapy, and sometimes patients require radioactive iodine. Now, this gland is pretty accessible to you as a surgeon, so all surgery is significant but I wouldn t think that it s not like having heart surgery. 2

3 No, it s not like having heart surgery. The major risks of surgery would include low calcium from injury to the parathyroid glands or hoarseness from injury to the recurrent laryngeal nerves in the neck which lie right next to the thyroid gland. Those are the most common complications. So is this a long surgery if you have this procedure? It depends on the extent of cancer if there is cancer involved. It could range anywhere from an hour and a half to three hours. Now, you mentioned about follow-up, potentially having radioactive iodine and then you take medicines as well. What happens after the surgery for most people? After the surgery we wait for the final pathology to come back in the specimen. We look at the size of the tumor if lymph nodes are involved. All patients will require thyroid hormone-suppression therapy if they have papillary thyroid cancer or follicular thyroid cancer. But because we take the thyroid gland everybody needs thyroid hormone to function. So for patients that have more advanced disease we do also consider radioactive iodine therapy. But typically people would take some thyroid pill for the rest of their lives. Right. They take one pill every morning, long-term. Now, I mentioned at the outset that it s more common in women. Do we have any idea why? You know, we re really not sure why women more commonly develop thyroid cancer. We do know one risk factor is exposure to radiation to the head and neck or if someone was exposed to an automatic bomb. Other risk factors include hereditary conditions, but that s more associated with medullary thyroid cancer. 3

4 And what about age? I read that women of childbearing age, it may show up then. It can happen at any age with younger women as well as older women and gentlemen. The prognosis is better if patients are diagnosed younger. What about family history? So if your mom had thyroid cancer would that put you at higher risk? I would say you are at higher risk if your mom had medullary thyroid cancer because that s associated with certain hereditary or genetic syndromes such as multiple endocrine neoplasia type 2. But that s one of the less common or least common. That s correct. That comprises approximately five percent of all thyroid cancer, so it s relatively rare. Now, what about if somebody has thyroid cancer, is there any connection with other cancers, either ones they previously had, or if they have had the surgery and all the treatment should they worry others just because they had the thyroid cancer earlier in life? Well, it depends on the type of thyroid cancer diagnosed. Papillary thyroid cancer has been associated with certain genetic conditions that may predispose patients to developing colon cancer. If patients had medullary thyroid cancer they certainly may be at risk for developing other endocrine tumors that are associated with multiple endocrine neoplasia type 2 for example. Dr. Landry, if someone has been treated for thyroid cancer what s the typical follow-up? 4

5 Generally we follow them every six months with an ultrasound and some labs to include thyroglobulin and thyroglobulin antibody, and over time we decrease that frequency to every year and even every two years after a significant period of time. For people who have been treated for the typical, most common thyroid cancers then, I get the impression they can go on with a full life. Generally the prognosis for thyroid cancer is quite good. Even if patients have evidence of thyroid cancer in the lymph nodes in the neck the prognosis is very good. That s all good news. And as far as somebody doing something to prevent it, obviously avoid radiation exposure, but otherwise it s just something that you can t prevent, but if it s detected let s say at a routine physical and they re feeling a nodule in your neck or you have that hoarseness you mentioned or difficulty swallowing, then you proceed and see maybe even a subspecialist such as yourself. Yes. Yes. A subspecialist is important. It s important to go to a surgeon that does high-volume thyroid surgery. There have been some studies that show patients have a better outcome. Okay. Well, we re glad we have a subspecialist at Banner MD Anderson and that you ve given us your expertise today. Dr. Christine Landry, thank you so much for being with us. Thank you for having me. Andrew Schorr for Patient Power and Banner MD Anderson Cancer Center. Remember, knowledge can be the best medicine of all. Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. 5

What is Thyroid Cancer?

Thyroid Cancer What is Thyroid Cancer? The thyroid is a gland at the base of the throat near the trachea (windpipe). It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin