Thyroid Cancer Analysis: Newly Diagnosed Thyroid Cancers Thyroid Cancer Cases by Race

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1 Cancer Report 2011

2 2011 Analysis: Thyroid Cancer Figure 1 Newly Diagnosed Thyroid Cancers Number of Cases Years Figure Number of Cases White 65% 2010 Thyroid Cancer Cases by Race Non-White 35% Figure 3 African American/Black 33% Asian Indian or Pakistani 2% Thyroid Cancer Patient Age at Diagnosis in Dr. Paul Weinberger Assistant Professor Medical College of Georgia Department of Otolaryngology/Head and Neck Surgery Georgia Health Sciences University Thyroid cancer arises in the thyroid gland, located in the midline of the neck just under the Adam s apple. The thyroid gland s primary function is to produce thyroid hormone, which regulates the body s overall metabolic rate. Thyroid cancer is the most common endocrine cancer (some 44,670 new cases were diagnosed in the United States in 2010, according to the American Cancer Society), with 75 percent of cases occurring in women. The incidence of thyroid carcinoma has more than doubled in the past three decades from 4.85 cases per 100,000 people to cases per 100,000 people 2, making thyroid cancer the fastest-increasing cancer type in both men and women. The GHS Cancer Center has reflected this trend, treating 252 cases in the past five years (Figure 1). Of the 48 new thyroid cancer patients in 2010, 65 percent were Caucasian, 33 percent African-American and 2 percent another ethnicity (Figure 2). Thyroid cancer affects all ages, with the average age of Georgia Health Sciences Cancer Center patients (51 years) matching national trends (Figure 3) Age Range Most cases are diagnosed when a lump in the neck (thyroid nodule) is discovered by the patient or a primary care physician, or by an imaging study such as CT-scan. While 95 percent of thyroid nodules are not cancerous, any new

3 lump or mass should be evaluated by a physician. Other symptoms can include trouble breathing when lying flat, difficulty swallowing and tightness or pain in the neck or throat. Scientists at GHSU, funded by the American Academy of Otolaryngology, are making great strides toward developing a blood test to diagnose thyroid cancer. The five-year survival rate for thyroid cancer is 97 percent, although, as with many other cancers, the rate varies widely depending on when it is diagnosed. When diagnosed at stage IV, the five-year survival rate is 59 percent nationwide a dramatic improvement from the approximately 30 percent rate just five years ago (Figure 4). 100% Percentage of Cases Figure 4 Stages of Thyroid Cancer Diagnosed Cancer treatment requires a multidisciplinary approach. The Georgia Health Sciences Thyroid and Parathyroid Center includes endocrinologists specializing in diagnosing and managing thyroid and parathyroid disorders and surgeons specializing in thyroid surgery. Diagnosis usually involves fine-needle aspiration, in which a tiny, ultrasound-guided needle is gently inserted into the thyroid nodule. Cells from the nodule are studied microscopically to determine if they are cancerous. Surgery is the treatment of choice for primary thyroid cancers. Patients worldwide come to Georgia Health Sciences Medical Center to benefit from the worldrenowned expertise of Dr. David Terris, who specializes in minimally invasive thyroid surgery. Surgery is often followed by radioactive iodine treatment to destroy any microscopic remnants of tumor cells. This is usually given as a single, oral medication and requires an overnight stay in the hospital. Since surgery and the iodine remove the functioning thyroid gland, patients require an oral replacement thyroid hormone. The GHS Cancer Center has partnered with the National Cancer Institute to decode the genetic basis for over 20 types of cancer, including thyroid cancer. Institutions including Memorial Sloan Kettering, the Dana Farber Cancer Institute and M.D. Anderson Cancer Center are also participating in the project, called The Cancer Genome Atlas (TCGA) 3. This opens the door to a multitude of discoveries concerning the causes and treatments for thyroid cancer. Thyroid cancer remains a daunting adversary, but the GHS Cancer Center and Thyroid/Parathyroid Center provide an ideal partnership to diagnose and treat the disease in a patient- and family-centered environment. Cutting-edge research promises improved diagnosis and treatment. Colon Larynx Bronchus & Lung Hematopoietic & Reticuloendo System Breast Corpus Uteri Prostate Gland Bladder Thyroid Gland 0 I II Stage at Diagnosis III IV Figure 5 NA MCG Health 2010 Analytic Cases: Site by Gender UNK Other Lymph Nodes Female Male Transsexual American Cancer Society Cancer Facts & Figures Atlanta, GA. Page Davies, L. and H.G. Welch, Increasing incidence of thyroid cancer in the United States, JAMA, (18): p The Cancer Genome Atlas. cancergenome.nih.gov. Accessed July 1, 2011.

4 Cancer Registry and Statistical Summary The Cancer Registry collects data and monitors all types of cancer diagnosed and/or treated at Georgia Health Sciences Cancer Center. Its database is a fundamental element of the cancer program, providing the information needed to evaluate and plan cancer services. Cancer data is submitted monthly to the Georgia Comprehensive Cancer Registry and annually to the National Cancer Data Base, both of which pool our data with that of other participating facilities. The resulting statistics illustrate statewide and nationwide trends in cancer incidence, and help clinicians and researchers evaluate treatment efficacy. Nearly 18,000 cases have been added to the registry since its establishment in In 2010, 1,509 analytic and non-analytic cancer cases were added. 1,147 patients were diagnosed and/or initially treated at GHS Cancer Center, and 362 were treated here for cancer recurrence or progression. Males comprised 52 percent of cancer patients diagnosed and/or treated at Georgia Health Sciences Cancer Center in 2010 (589 cases), compared to 48 percent female (557 cases). The top analytic sites are: lung, 15 percent; breast, 13 percent; prostate, 12 percent; blood, 5 percent; thyroid, 4 percent; lymph node, 4 percent; corpus uteri, 4 percent; colon, 3 percent; bladder, 3 percent; and larynx, 3 percent. National top sites are: lung, 15 percent; breast, 13 percent; prostate, 13 percent; colon, 8 percent; and bladder, 5 percent (other sites, 34 percent). The registry staff follows more than 8,000 patients annually to obtain disease status and survival information and maintains a 90 percent follow-up rate. A Cancer Registry Manager and two Registry Services Specialists staff the Cancer Registry. The registry coordinates the facility s cancer conferences and quarterly Cancer Committee meetings, helps prepare for the triennial Commission on Cancer accreditation survey, contributes to the Annual Report and reports data to clinicians and administrators. For more information about the Cancer Registry, call Analytic Cases: Site by Gender Colon Larynx Bronchus & Lung Hematopoietic & Reticuloendo System Breast Corpus Uteri Prostate Gland Bladder Thyroid Gland Lymph Nodes Female Male Transsexual 283 Reference: Cancer Facts and Figures: 2010, American Cancer Society

5 2010 Analysis: Geographic Distribution of Patients Ware Burke Clinch Hall Early Laurens Lee Glynn Floyd Wayne Coffee Bulloch Camden Worth Charlton Liberty Fulton Screven Tift Harris Emanuel Long Bryan Carroll Decatur Troup Grady Wilkes Polk Telfair Dodge Brooks Irwin Jones Chatham Thomas Colquitt Walker Sumter Bartow Dooly Gilmer Tattnall Cobb Echols Elbert Taylor Appling Talbot Mitchell Berrien Baker McIntosh Hart Stewart Rabun Coweta Jasper Fannin Macon Jefferson Wilcox Washington Greene Pierce Hancock Bibb Lowndes Union Crisp Terrell Pike Brantley Marion Twiggs Clay Monroe Upson Heard Murray Miller Gordon Jenkins Gwinnett Walton Effingham Cherokee Putnam Wilkinson Toombs Bacon Morgan Cook Jackson Houston Turner Meriwether Randolph White Banks Warren Oglethorpe Atkinson Butts Johnson Paulding Wheeler Pulaski Lincoln Crawford Jeff Davis Newton Franklin Forsyth Madison Dade Baldwin Calhoun Ben Hill Lumpkin Whitfield Haralson Evans Richmond Columbia Candler Lanier Pickens Dougherty Chattooga Lamar Towns Fayette Dawson Seminole Bleckley Schley Webster Douglas Treutlen Barrow Spalding Taliaferro Muscogee Catoosa Stephens Clayton McDuffie Peach Habersham Oconee Montgomery Quitman Glascock Chattahoochee Rockdale DeKalb Henry Clarke >100 FL NC SC TX AL IL IN LA NY PA VA

6 2010 Analysis: Distribution of Analytic Patients by Cancer Site/Stage Primary Site Stg 0 Stg I Stg II Stg III Stg IV NA Unknown Total ORAL CAVITY & PHARYNX Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Other Oral Cavity & Pharynx Total DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon Excluding Rectum Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Total RESPIRATORY SYSTEM Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus Total BONES & JOINTS Bones & Joints Total SOFT TISSUE Soft Tissue (including Heart) Total SKIN EXCLUDING BASAL & SQUAMOUS Melanoma -- Skin Total BREAST Breast Total

7 Primary Site Stg 0 Stg I Stg II Stg III Stg IV NA Unknown Total FEMALE GENITAL SYSTEM Cervix Uteri Corpus & Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs Total MALE GENITAL SYSTEM Prostate Testis Penis Total URINARY SYSTEM Urinary Bladder Kidney & Renal Pelvis Ureter Total BRAIN & OTHER NERVOUS SYSTEM Brain Cranial Nerves Other Nervous System Total ENDOCRINE SYSTEM Thyroid Total LYMPHOMA Hodgkin Lymphoma Non-Hodgkin Lymphoma Total MYELOMA Myeloma Total LEUKEMIA Lymphocytic Leukemia Myeloid & Monocytic Leukemia Other Leukemia Total Unknown Site Unknown Site Total Grand Total ,092

8 2011 Cancer Conferences Conference Meeting Frequency Physician Contact Administrative Contact Gynecologic Cancer Weekly Sharad Ghamande, MD Luvenia Kelley Interdisciplinary Cancer Weekly E. James Kruse, DO Allison Sabb Head and Neck Cancer Weekly Lana Jackson, MD Ellie Pryor, Pediatric Cancer Monthly Roger Vega, MD Kathleen McCarty Hematology/Pathology Cancer Weekly Kavita Natarajan, MD Helen Smith Urologic Cancer Monthly Ronald Lewis, MD Allison Sabb Thoracic Cancer Weekly Zhonglin Hao, MD Tiffany Thomas Cutaneous Cancer Monthly Amanda May, MD Tiffany Thomas Breast Cancer Weekly Thomas Samuel, MD Nichole Aenchbacher Brain/Spine Cancer Monthly Connie Giller, MD Jamey Motley

9 Cancer Committee Physicians E. James Kruse, MD Surgical Oncology Cancer Committee Chair * James McLoughlin, MD Surgical Oncology Cancer Liaison James Rawson MD Radiology Paul Biddinger, MD Pathology* Todd Merchen, MD General Surgery Amanda May, MD Medical Oncology* Colleen McDonough, MD Pediatric Oncology/Hematology Catherine L. Ferguson, MD Radiation Oncology* Alison Lauber, MD Palliative Services Non-Physician Members Nichole Aenchbacher, RN, BSN Breast Health Navigator Lindsay Baker, RD, LD Cancer Center Dietitian Steven Black, MBA Cancer Services Administrator* Annie Blount, MSW Cancer Center Social Service* Pamela Bourbo, RN, BSN, MPH, OCN, CCRC Cancer Clinical Research Unit Kim Cheely RN, BSN, OCN Hematology/Oncology Nurse Manager Lonnetta Colton, RHIA, CTR Cancer Registry Manager* Kevin Corbin Pharmacy Summer Garrison Judith Giri, PhD Director of Tumor Bank Jack Evans Community Outreach Coordinator/* Communications & Marketing Melissa Jarriel, RHIA, CTR Health Information Managment Services Melanie Kumrow, RN Hematology/Oncology CCOP Nurse Manager* Tracey Slagle, RN, BSN, OCN, Hematology/Oncology Nurse Manager Erica Gollett Steed Planning* Jane Willson Director of Rehabilitation Services Nettie Engels American Cancer Society Patient Advisor Committee Activity Coordinators Cancer Conference Lonnetta Colton Quality Data of Cancer Registry Jim McLoughlin, MD Community Outreach Jack Evans Quality Improvement Erica Gollett-Steed * Position required for accreditation by the American College of Surgeons Commission on Cancer