CONTENTS What is thyrid?... 2 What des the thyrid d?... 3 What is thyrid cancer?... 3 What causes thyrid cancer?... 4 What are the signs and symptms f thyrid cancer?... 5 Hw is thyrid cancer diagnsed?... 6 The cancer care team... 8 What is staging and grading?... 9 Treatment ptins fr thyrid cancer... 11 SURGERY... 11 Thyrid hrmne replacement therapy... 12 Radiactive idine treatment... 13 Radiatin therapy and Chemtherapy... 14 Fllw-up care... 16 Questins t ask yur cancer care team... 19 2016 Beynd Five 1
WHAT IS THYROID? The thyrid gland lies at the base f the neck. It is shaped like a butterfly and wraps arund the windpipe (trachea) beneath the vice bx (larynx). Its parts include: wings f the butterfly (left and right lbes) bdy f the butterfly (isthmus, jining the left and right lbes) there is a small part that lies ver the vice-bx (pyramidal lbe). When the thyrid is larger than nrmal it is called a gitre. Lumps in the thyrid are called ndules. Mst thyrid ndules are benign but sme can be cancerus. Intrducing the thyrid and surrunding areas 2016 Beynd Five 2
WHAT DOES THE THYROID DO? Glands that release hrmnes int the bld stream are called endcrine glands; thyrid is the largest endcrine gland f the bdy. The thyrid prduces hrmnes that are released int the bld and carried t every tissue in the bdy. There are tw types f thyrid hrmne, tri-idthyrnine (T3) and thyrxine (T4). These hrmnes cntrl the speed at which the cells wrk (metablism), and are imprtant in brain develpment and grwth in children. These hrmnes als determine hw sensitive ther rgans are t endcrine hrmnes. Thyrid hrmne is made in cells called fllicular cells. The amunt f thyrid hrmne in the bld stream is cntrlled by the pituitary gland. The pituitary gland, is a small endcrine gland that sits under the brain. It releases a hrmne int the bld called thyrid stimulating hrmne (TSH). When dctrs rder thyrid tests, they will lk at all three f these hrmnes (T3, T4 and TSH) but TSH is the mst imprtant. T much thyrid hrmne is called hyperthyridism r an veractive thyrid. This can lead t heart palpitatins, truble sleeping, shaky hands, muscle weakness, nervusness r anxiety, feeling ht and prblems with yur menstrual perids. Nt enugh thyrid hrmne is called hypthyridism r an underactive thyrid. This can lead t weight gain, lethargy, intlerance t cld weather, depressin, cnstipatin and prblems with hair lss and dry thyrid. WHAT IS THYROID CANCER? Cancer ccurs when cells becme abnrmal, grw uncntrllably and have the ptential t spread t ther parts f the bdy. These cells build up t frm a mass (r lump). There are fur main types f thyrid cancer, mst f these cme frm the fllicular cells that make the thyrid hrmne: Papillary: This is the mst cmmn type f thyrid cancer (abut 75% f all cases). It tends t grw very slwly, but ften spread t lymph ndes. It can be cured r cntrlled in mst peple and is rarely fatal Fllicular: This accunts fr abut 5-10% cases. It grws slwly and tends t stay in the thyrid, hwever it can spread t the lungs r bnes if diagnsed late. If diagnsed early, mst peple with fllicular thyrid cancer can be treated successfully Anaplastic: This type f thyrid cancer is rare (less than 1%) but these are very aggressive 2016 Beynd Five 3
Medullary: This is different t ther thyrid cancers because they develp in cells called C cells that d nt prduce thyrid hrmne. WHAT CAUSES THYROID CANCER? Dctrs ften can t explain why a persn gets cancer. But we d knw what makes sme cancers mre likely. The tw main causes f thyrid cancer are: being female: In Australia wmen are abut fur times mre likely than men t get thyrid cancer age: while thyrid cancer can ccur at any age, it is mst cmmn in peple aged 40 60 years. Having a diet lw in idine increases risk f thyrid cancer, but this is rare in Australia as idine is added t salt and ther fds. Other factrs that may increase the risk f thyrid cancer are: radiatin: this is a very imprtant risk factr fr thyrid cancer, either because f medical treatment (particularly lw dse radiatin treatment in childhd), r frm envirnmental expsure such as atmic explsins r nuclear fallut having a nn-cancerus (benign) thyrid disease: like an enlarged thyrid (gitre), thyrid ndules (adenmas) r inflammatin f the thyrid (thyriditis), r having ne f these cnditins in yur family A family histry f thyrid cancer r an inherited gene change (mutatin) in the RET ncgene (a prtein cding gene) 2016 Beynd Five 4
WHAT ARE THE SIGNS AND SYMPTOMS OF THYROID CANCER? The signs and symptms f thyrid cancer depend n where the cancer is, its size and hw far it has spread in the bdy. The mst cmmn sign is a lump r swelling in the middle f the neck (where the thyrid is). Lumps in the thyrid are called ndules, but mst ndules are nt cancerus. Sme thyrid cancers can spread t the lymph glands and cause a lump in the side f the neck. Other less cmmn symptms f thyrid cancer are: change in vice due t damage f the vice bx nerve which runs behind the thyrid gland difficulty swallwing due t cmpressin f the swallwing tube (esphagus) difficulty breathing, r shrtness f breath due t invlvement f the windpipe which sits underneath the thyrid gland pressure in the neck when lying dwn. Mst thyrid cancers d nt prduce any symptms and are cmmnly fund incidentally n scans (ultrasund r CT scan) fr ther cnditins. Mst ften these symptms are nt frm thyrid cancer. Hwever, if yu have any f these symptms fr mre than a few weeks, talk t yur dctr as early as pssible. They may be able t help diagnse and treat yu. 2016 Beynd Five 5
HOW IS THYROID CANCER DIAGNOSED? It is imprtant that yur dctr establishes the diagnsis f thyrid cancer, assesses the size f the cancer and whether it has spread t the lymph ndes in the neck r elsewhere in the bdy. T answer these questins, yur dctr will need t d the fllwing things: talk with yu abut yur medical histry. This includes signs yu may have nticed, any health cnditins, medicatins yu are taking and whether yu smke r drink alchl perfrm a physical examinatin by feeling and lking at yur neck and thrat rder diagnstic tests, which may include scans. Thyrid cancer is ften fund when smene has a scan f the neck area. Hwever, there are lts f different tests that can be used t cnfirm a diagnsis f thyrid cancer. Nt everyne will need t have every test fr thyrid cancer. Yur dctr will recmmend tests that are right fr yu. Cmmn tests include: Bld tests: Yur dctr may suggest bld tests t check the levels f certain hrmnes and ther thyrid cancer markers, if required (e.g. calcitnin and CEA r [Carcinembrynic Antigen]). Ultrasund scan: Yur dctr may suggest ultrasund t prduce pictures f the thyrid and nearby lymph ndes, t lk at any ndules (lumps) in the thyrid and als in the lymph ndes. Nasendscpy: Yur dctr will use a very thin flexible tube with a tiny light and camera n it, t check the functin f vcal crds as nerves t yur vice bx may be affected by thyrid cancer. Bipsy: This invlves remving a small piece (sample) frm the cancer. The sample is then examined under a micrscpe t check fr cancer cells. This is ften the nly sure way t tell if yu have cancer. Yur dctr may recmmend: Needle bipsy (als called Fine Needle Aspiratin f FNA): This is used when there is a lump (enlarged lymph nde) in yur neck that culd have cancer cells in it. During the prcedure, yur dctr will take sme cells (a very small sample) frm the lump using a needle. This is dne by a radilgist r pathlgist using an ultrasund t see that the needle is in the right spt. Yu may feel a bit uncmfrtable during the bipsy. Thyrid (radi-istpe) scan: Yur dctr may suggest thyrid scan if bld tests indicate an veractive thyrid. This invlves injecting a small amunt f radiactive liquid (such as idine) int yur arm prir t a gamma camera scan. 2016 Beynd Five 6
CT (Cmputed Tmgraphy) scan: This uses X-rays t take pictures f the inside f the bdy. If the persn has cancer, a CT scan can help the dctr see where it is, measure hw big it is, and determine whether it has spread int nearby rgans r ther parts f yur bdy. MRI (Magnetic Resnance Imaging) scan: This uses magnetic fields t take pictures f the inside f the bdy. This helps the dctr see hw far a cancer has grwn int the tissue arund it. PET (Psitrn Emissin Tmgraphy) scan: This is a whle bdy scan that uses a radiactive frm f sugar which can shw if thyrid cancer has spread elsewhere in the bdy. 2016 Beynd Five 7
THE CANCER CARE TEAM After yu have been diagnsed with thyrid cancer, yur dctr is likely t talk abut yur diagnsis with the cancer care team they wrk with. This is knwn as a head and neck cancer MDT (multidisciplinary team). Yu may be asked t attend an appintment where the MDT talks abut hw best t treat yur cancer, and crdinate yur treatment and care. This team includes experts wh will review the diagnsis and tests perfrmed and cnsider all parts f yur treatment and recvery. The purpse f the MDT is t decide n the best treatment fr yur cancer and t help yu regain the best functin pssible in the lng-term. The cancer care team may include: Endcrinlgists Endcrine surgens Head and neck surgens Nuclear medicine specialists Pathlgists Nurses Psychlgists Scial wrkers specialist in diagnsing and treating disrders f the endcrine system specialist n the thyrid gland, parathyrid glands, adrenal glands and the pancreas specialist dctrs wh remve cancers in the face, muth, thrat and neck. This includes surgens with a backgrund in tlarynglgy (Ear Nse and Thrat), general surgery, maxillfacial surgery, and recnstructive surgery. If surgery is required, the head and neck surgen will carry ut the prcedure. specialist dctr with expertise in interpreting scans such as CT, MRI and PET specialist dctr with expertise in lking at cells under a micrscpe and determining if the persn has cancer healthcare prfessinals wh are experts in the care f peple with cancer, and wrk with all members f the cancer care team. Often, specialist cancer nurses are part f the MDT. They will help t plan and crdinate yur care healthcare prfessinals wh assist peple with wrries abut cping and living with cancer (mental health) healthcare prfessinals wh prvide practical and emtinal supprt t peple living with cancer 2016 Beynd Five 8
WHAT IS STAGING? Once yur dctr has made a diagnsis f cancer, it is imprtant that they assess the extent (r stage) f the cancer. Staging a cancer is imprtant because it helps dctrs t chse the best treatment fr yu. It als gives infrmatin abut the chances f cure. The stage is based n the size f the cancer, whether it has invaded int nearby areas and whether it has spread t lymph ndes in the neck (called lymph ndal metastases) r ther sites in the bdy, such as the lungs, liver r bne (called distant metastases). The TNM (Tumur, Nde, Metastases) system is used t stage cancer. This system is used t summarise infrmatin abut the size f the cancer and whether it has spread t lymph ndes r ther parts f the bdy. THE TNM SYSTEM T stands fr the size f the cancer. A T value can range frm 1 (small and lcalised t the thyrid) cancer) t 4 (invading int ther structures). N indicates whether the cancer has spread t the lymph ndes. Where there is n cancer in the lymph ndes, the N value is 0. An N value can range frm 1 t 3, depending n the size and number f cancerus lymph ndes. M stands fr distant metastases, r whether the cancer has spread t ther parts f the bdy utside the head and neck. An M value can be either 0 (cancer has nt spread t ther parts f the bdy) r 1 (cancer has spread t ther parts f the bdy). Once the values fr T, N and M have been wrked ut, they are cmbined t give an verall scre between 1 and 4. Yur dctr may write this in Rman numerals: I, II, III and IV. Thyrid cancer is very different t ther head and neck cancers, because the stage depends n yur age. Staging is cmplicated but in brad terms the higher the stage, the greater the extent, spread r invasin f the thyrid cancer. It is imprtant t realise that the staging systems fr thyrid cancer is very different t ther cancers and smetimes nt very accurate in predicting the chances f cure fr an individual. This is because a high number f patients with Stage III and IV well-differentiated thyrid cancer (papillary and fllicular) are cured with apprpriate treatment. It is imprtant yu discuss the stage f yur cancer with yur dctrs t understand what it means fr yu. 2016 Beynd Five 9
WHAT IS GRADING? Staging and grading are nt the same. Yur dctr may als be interested in the grade f the cancer. Grading refers t the grwth pattern f the cancer. The grade f the cancer is determined by a pathlgist wh examines the bipsy sample under a micrscpe. The pathlgist determines the grade f the cancer by hw the cells lk. The grade can be used t estimate hw quickly the cancer is likely t grw and spread. Fr thyrid cancers, grading is usually described as either well differentiated (papillary and fllicular) which have a gd prgnsis r prly differentiated (including anaplastic and de-differentiated) which ften have a pr prgnsis. 2016 Beynd Five 10
TREATMENT OPTIONS FOR THYROID CANCER Fllwing a diagnsis f thyrid cancer, yur cancer care team will discuss the treatment ptins including the pssibility f participating in a clinical trial that is suitable fr yu. This is als a gd time t cnsider if yu wuld like a secnd pinin. The mst suitable treatment fr thyrid cancer depends n many things including: whether the cancer has spread persnal factrs (e.g. age, general health and treatment histry) types f treatment available yur preferences fr treatment. Surgery is the main treatment fr peple with thyrid cancer. The aim f treatment is t surgically remve all thyrid cancer cells. Many peple with thyrid cancer als receive radiactive idine and thyrid hrmne replacement. Sme peple will need ther treatments such as radiatin r chemtherapy. Adding anther frm f treatment is knwn as adjuvant therapy. Radiactive idine treatment is a frm f internal radiatin therapy, typically taken in a gel tablet frm (with 1 t 3 days in hspital), t destry any residual thyrid tissue and thyrid cancer cells left behind after surgery. Thyrid hrmne replacement therapy is needed in patients wh have had all f their thyrid remved. This is t replace the thyrid hrmne in the bdy and it may als slw the grwth f any cancer cells t reduce the risk f the cancer cming back. SURGERY The main treatment fr thyrid cancer is surgery. There are a number f peratins that can be used t remve thyrid cancer. The type f peratin used will depend n the size and lcatin f the cancer. HOW CAN I PREPARE FOR SURGERY? Yur dctr will explain details f the surgery, general risks and side effects f surgery. Ask yur dctr if yu have questins. They may recmmend: stpping bld thinners (e.g. aspirin) befre surgery t reduce the risk f bleeding special stckings t reduce the risk f bld clts early mbilisatin (i.e. nt staying bed) t reduce the risk f bld clts and chest infectin antibitics t reduce t risk f wund infectin. If yu smke, it is imprtant that yu cnsider stpping smking befre starting treatment t help reduce the risk f infectin and recver after yur treatment. 2016 Beynd Five 11
SURGICAL PROCEDURES The different ptins that can be used fr thyrid cancer are: Thyridectmy: This is the remval f the thyrid gland frm the neck. If the entire thyrid gland is remved, it is called a ttal thyridectmy. If nly sme f the thyrid gland is remved, it is called a partial r hemi-thyridectmy. Neck dissectin: This invlves remval f lymph ndes frm yur neck. This is imprtant even when there is n sign f cancer in the lymph ndes n yur scan, because there is a risk f micrscpic cancer in the lymph glands f the neck. SIDE EFFECTS OF SURGERY Treatment fr thyrid cancer may lead t a number f side effects. Yu may nt experience all f the side effects. Speak with yur dctr if yu have any questins r cncerns abut side effects. THYROID HORMONE REPLACEMENT THERAPY Thyrid hrmne replacement therapy replaces thyrid in the bdy, after the thyrid gland is remved by surgery. The thyrid hrmne, called thyrxine, is needed by the bdy t maintain health. Thyrid hrmne replacement helps t keep yur bdy s metablism at a nrmal healthy rate. If yu d nt have enugh thyrid hrmne (hypthyridism) yu may have symptms such as weight gain, cnstipatin, brittle and dry hair, sluggishness and fatigue. Heart prblems can ccur in severe cases. T much thyrid hrmne (hyperthyridism) may cause symptms such as weight lss, chest pain, rapid r irregular heartbeat and feeling ht. Fr thyrid hrmne replacement, yur dctr will prescribe a tablet (every day fr the rest f yur life). Yu shuld take the tablet at the same time every day. Speak t yur dctr abut all ther medicatins that yu take, including dietary supplements such as irn and calcium. Yur dctr will suggest bld tests t mnitr yur thyrid hrmne levels, t help them adjust the dse. Dn t stp taking the thyrxine medicatin withut discussing it first with the dctr. Tell yur dctr if yu are pregnant as a higher dse may be needed. The dse f thyrid hrmne needed is different fr every persn and may change as a persn ages. Talk t yur dctr abut any signs t lk ut fr. 2016 Beynd Five 12
Taking thyrxine als helps t reduce the risk f cancer cming back, r recurring, by lwering the thyrid stimulating hrmne made by yur bdy. Lwering the thyrid stimulating hrmne (TSH) by taking thyrxine is called TSH suppressin. A higher dse f thyrxine will be used fr TSH suppressin, if there is a higher risk f the cancer cming back (recurring). Yur dctr will mnitr the level f yur TSH. Smetimes the dse will need t be adjusted, but it is imprtant yu d nt increase yur dse f thyrxine withut speaking t yur specialist. RADIOACTIVE IODINE TREATMENT Radiactive idine can be used as a radiatin treatment fr thyrid cancer, since the thyrid gland in particular takes up idine in the bdy. The cancer cells take up radiactive idine (called idine 131) which causes the cancer cells t die. It is usually given t destry remaining thyrid cells, nt remved by surgery and any that may have spread. Radiactive idine treatment is an ptin fr peple with the papillary and fllicular types f thyrid cancer and ften starts at least 4-5 weeks after surgery. Fr wmen wh are pregnant and thse wh are breastfeeding, radiactive idine treatment is nt suitable. Yur dctr will recmmend stpping radiactive idine treatment, befre starting treatment. 2016 Beynd Five 13
Guide fr peple cnsidering radiactive idine treatment: Preparing fr radiactive treatment: Fr abut 2 weeks befre treatment, yu will need t avid fds high in idine such as seafd, idised salt, sme dairy fd and any fd clured pink with the additive E127. Yu need t have a lw idine diet because t much idine in yur bdy can stp the treatment wrking well. Yur cancer care team will prvide yu with advice n fds t avid. Yu will need t either stp taking thyrid hrmne replacement pills temprarily, r have injectins f thyrid stimulating hrmne (Thyrgen) while taking the hrmne replacement. This is t increase the thyrid stimulating hrmne in yur bdy, and yur cancer care team will discuss the best ptin available fr yu. If yu have the ptin f stpping thyrid hrmne replacement during the preparatin, there may be sme side effects due t hypthyridism such as tiredness. After radiactive idine treatment After the radiactive idine treatment, yu will have a full bdy radi-istpe scan, using a small amunt f radiactive liquid. The scan can help detect if any cancer cells are left r if the cancer has spread. The scan is painless and causes few side effects, and yu will nt be radiactive after the scan. At hme yu may need t cntinue safety measures such as sleeping alne, washing yur clthes separately and preparing yur wn fd. Yu may be advised t sit t pass urine, shut the lid and flush the tilet several times. Yu may be advised t take precautins t avid pregnancy fr a while after treatment, If yu r yur partner want t have a baby after radiactive idine treatment, yu shuld talk t yur dctr fr advice abut suitable timing. RADIATION THERAPY Radiatin therapy is rarely used as the main treatment in thyrid cancer. Smetimes external beam radiatin therapy (X-rays applied frm utside the bdy) may be used after surgery (adjuvant radiatin therapy). Radiatin therapy can be used in the fllwing ways: Adjuvant: This is when radiatin therapy is given after the surgical remval f thyrid cancer t kill cancer cells that may nt have been taken ut during surgery. When used, it usually starts abut 4 weeks after surgery t allw recvery frm surgery. Radiatin therapy treatment usually lasts fr abut 6 weeks. Palliative: In cases where a cure is nt pssible, radiatin therapy is used t relieve symptms f advanced thyrid cancer. Symptms that may require palliative radiatin therapy include pain, bleeding, airway bstructin and swelling. 2016 Beynd Five 14
SIDE EFFECTS OF RADIATION THERAPY The side effects f radiatin therapy start arund tw weeks int treatment and prgress thrugh treatment t peak in the last week just after treatment ends. The side effects start t imprve 2 3 weeks after the end f treatment. Side effects assciated with radiatin therapy depend n: the dse f radiatin therapy the area being treated whether r nt chemtherapy is added t the radiatin therapy. CHEMOTHERAPY Chemtherapy wrks by destrying r damaging cancer cells. Chemtherapy is nt used in mst cases f thyrid cancer. Hwever, it may be required fr peple with advanced thyrid cancer, wh are n lnger respnding t ther treatments. Befre yu start treatment, yur medical nclgist will chse ne r mre chemtherapy medicatin that will be best t treat the type f cancer yu have. 2016 Beynd Five 15
FOLLOW-UP CARE Yu will have regular check-up after yur treatment fr thyrid cancer. It is imprtant t keep up with fllwup meetings, t make sure that if the cancer cmes back, it is caught and treated as early as pssible. If yu have any cncerns between visits, yu shuld cntact yur dctr. At yur fllw-up visit, yur dctr will perfrm a physical examinatin (e.g. feel yur neck). Depending n the type f thyrid cancer, and the risk f cancer returning, yur dctr will recmmend scans and bld tests. The bld tests mnitr the thyrid hrmnes and tumur markers that can indicate if the cancer has cme back (recurred). The scans help t find where any cancer has returned. Yu may have the fllwing tests and scans: Bld tests Thyrid hrmnes and TSH are measured as needed, t check yu are n the right dse f thyrid hrmne replacement and t mnitr thyrid stimulating hrmne (TSH). The dse f thyrid hrmne may be adjusted fr yur needs, including changes with age. TSH is mnitred fr TSH suppressin r lwering. TSH suppressin aims t reduce the risk f cancer cming back, and is used particularly fr patients with a higher risk f recurrence. If yu have been treated fr papillary r fllicular cancer, bld tests will be dne fr thyrglbulin, which is a tumur marker prtein made by thyrid cells. Levels are very lw if the thyrid gland has been remved and may rise if the cancer cmes back. Anti-thyrglbulin antibdies may als be measured. Smetimes the dctr may decide t measure stimulated thyrglbulin, as the test can be mre accurate. The dctr wuld give yu instructins abut any changes in yur medicatin needed befre this test. Calcitnin and a tumur marker prtein called carcinembrynic antigen (CEA) will be measured fr patients treated fr medullary thyrid cancer. Levels may rise if the cancer cmes back. Neck ultrasund An ultrasund f the neck is used t check the area where the thyrid was remved t see if there is any cancer grwing in the thyrid bed. It is als used t check yur lymph glands arund the neck. 2016 Beynd Five 16
Radi-istpe scan A radiistpe scan is used t check f there are any cancer cells in yur bdy. A small amunt f radiactive liquid (e.g. idine-131) is injected int a vein and after abut 20 minutes yu will lie under a gamma camera machine. Yu may need t change yur medicatins befre a radiistpe scan t help the cancer cells take up the radiactive idine and make the test mre accurate. Yur dctr wuld give yu instructins n any changes needed. The scan measures hw much radiactivity has been taken up by the thyrid and als helps t see if the cancer has spread. The scan is painless and has few side effects. Yu will nt be radiactive after the scan. CT, PET r ther scans Yu may have a CT r PET scan if cancer cells are fund elsewhere in yur bdy r if further testing is needed. CT r MRI scans are nt used rutinely. They may be used when the bld tumur markers suggest the cancer has cme back, but it has nt shwn up n the ultrasund r radiistpe scan. These scans may als assist in planning any further surgery. DIET AND NUTRITION It is imprtant fr peple with thyrid cancer t stay well-nurished and t avid unplanned weight lss. If yu can t eat r drink enugh, yu may becme malnurished r begin t lse weight. In this case, yur healthcare team may cnsider feeding yu thrugh a tube fr a perid. Maintaining gd nutritin is imprtant t help: ensure yu get thrugh treatment reduce yur risk f infectin recver mre quickly keep yur strength and energy levels up 2016 Beynd Five 17
What can I d t help my diet and nutritin? T help yur bdy recver frm surgery, yu need t be well nurished. Yu can keep well-nurished and hydrated during and after yur treatment by: eating a diet high in prtein and calries (energy) eating small meals r snacks, mre frequently drinking nurishing fluids, such as milk, milkshakes, smthies r juice. Yur dietitian may als recmmend nutritinal supplement drinks which are high in prtein and energy. Yu may need t make changes t the types f fd yu eat. If yu have a sre thrat, yu may want t avid fds that irritate, such as citrus r vinegar, and hard fds, such as chips r tast. Try t swallw gently and t eat small amunts f healthy, nutritius fd. Fr patients preparing t have radiactive idine treatment Fr abut 2 weeks befre treatment, yu will need t avid fds high in idine such as seafd, idised salt, sme dairy fd and any fd clured pink with the additive E127. Yu need t have a lw idine diet because t much idine in yur bdy can stp the treatment wrking s well. Yur health care team will prvide yu with advice n the fds t avid. Visit the Cancer Cuncil website fr further infrmatin abut diet and nutritin. 2016 Beynd Five 18
QUESTIONS TO ASK YOUR CANCER CARE TEAM Being diagnsed with cancer can be verwhelming and cnfusing. There are a lt f infrmatin and treatment decisins t make at a distressing time fr yu and yur family. T help yu understand everything and get the infrmatin yu need t make decisins abut yur health, cnsider athyridg the fllwing questins t yur cancer care team: Exactly what type f thyrid cancer d I have? Where is it lcated? Why did I get this cancer? What stage is the cancer? What are the chances f cure with treatment? What are my treatment ptins? Which treatment d yu recmmend fr me and why? Have yu discussed my case at a Multidisciplinary Team meeting and what were the recmmendatins? Wh will be part f the cancer care team, and what des each persn d? What are the pssible side effects f treatment in the shrt- and lng-term? Hw can they be prevented r managed? Will the treatment affect my ability t eat, swallw, r speak? Will I need a feeding tube? What will happen if I dn't have any treatment? Hw much will the treatment and/r peratin cst? Will Medicare r my health insurance cver it? What fllw-up tests will I need? Hw ften will they be? Am I suitable fr any clinical trials? What lifestyle changes (diet, exercise) d yu recmmend I make? Wh can I call if I have any prblems r questins? Where can I find emtinal supprt fr me and my family? Is there a supprt grup r psychlgist yu can recmmend? If I wanted t get a secnd pinin, can yu prvide all my medical details? 2016 Beynd Five 19
Yu may want t write specific questins here t ask yur dctr r cancer care team Beynd Five disclaimer: Yu acknwledge and accept that the infrmatin in this factsheet is fr general infrmatin purpses nly. It is nt intended, nr shuld it be relied n, as medical r legal advice, r as a substitute fr cnsultatin with a physician r ther licensed healthcare prvider. Yu agree that if yu have individual healthcare-related questins yu shuld cntact yur dctr prmptly and shuld nt disregard prfessinal medical advice, r delay seeking it, because f infrmatin cntained here. Yu als agree that Beynd Five is nt liable fr any injury r damage t persns r prperty (hwsever caused, including by negligence) arising ut f r related t any use f Beynd Five s patient educatin materials, r fr any errrs r missins. Last updated: 27 Octber 2016 2016 Beynd Five 20