Thyroid cancer affects the gland found under the Adam's apple in the front part of the neck. The thyroid gland takes iodine from the diet and blood and makes thyroid hormone, which is important for many body functions. Different cancers can develop from the two main cells found in the thyroid gland: thyroid follicle cells, which make and store thyroid hormone and a thyroid protein called thyroglobulin, and C cells, which make the thyroid hormone calcitonin.
Many types of tumors can develop in the thyroid gland. Most of these are benign (95 percent), but others are cancerous. Tumors often appear as bumps in the neck, called nodules. Thyroid nodules are very common and can develop at any age. Malignant thyroid tumors include papillary carcinomas (which are highly curable), follicular carcinomas, anaplasic carcinomas (which are rare but very aggressive), poorly differentiated carcinomas, medullary thyroid carcinomas, and thyroid lymphoma.
In 2007, the American Cancer Society estimates that 8,000 men and 25,000 women in the United States will be diagnosed with thyroid cancer. The Cancer Center's Division of Head and Neck Oncology comprises board-certified otolaryngologists who are highly skilled in the diagnosis, treatment, and management of all types of cancers that affect the head and neck. Our co-chief of the Division of Head and Neck Oncology, Christopher M. Shaari, M.D., is one of only a handful of otolaryngologists (head and neck surgeons) in the tri-state area to have completed a fellowship in head and neck microvascular reconstructive surgery. This is used to restore function in patients who have undergone extensive surgical treatments for head and neck cancers. An important goal of surgical treatment for head and neck cancers is to restore as much of the patient's functioning (speech, swallowing, etc.) as possible after surgery. To achieve this, microvascular reconstructive techniques - such as those practiced by Dr. Shaari - may be used. During surgery, Dr. Shaari or another otolaryngologist and a plastic/reconstructive surgeon work together to transplant tissue from a patient's arms or legs to where a cancerous tumor has been removed. The blood vessels of this tissue are connected in the neck to restore functioning to the tissues in the treatment area.
Risk FactorsWomen are three times more likely than men to develop thyroid cancer. Papillary and follicular thyroid cancers occur most often in men and women ages 30 to 50. Other risk factors include:
- a diet low in iodine
- a history of radiation therapy to the head and neck during childhood
- radioactive fallout from nuclear weapons or power plant accidents
- hereditary conditions, such as Gardner's syndrome and familial polyposis
SymptomsSymptoms of thyroid cancer include:
- lumps in the neck
- pain in the neck, sometimes going up to the ears
- trouble swallowing
- breathing problems
- a cough that persists and is not related to a cold
Treatment ServicesThe main treatment for almost all cases of thyroid cancer is surgery to remove the tumor and all or part of the thyroid gland, an operation called a sub-total or near-total thyroidectomy. Surgery may be combined with radioactive iodine therapy, radiation therapy, and/or chemotherapy.
Surgery to remove the tumor and all or part of the thyroid gland is the main treatment for almost all cases of thyroid cancer. If the cancer has spread to nearby lymph glands in the neck, they may also need to be removed. Surgery may be combined with radioactive iodine therapy, radiation therapy, and/or chemotherapy. Because the body cannot make thyroid hormone after the gland has been removed, all patients who have undergone a total thyroidectomy must take thyroid hormone replacement pills for the rest of their lives.
Radioactive Iodine Therapy
Radioactive iodine therapy may be used to destroy any cancerous tissue that was not removed during surgery. It may also be used to treat thyroid cancer that has spread to lymph nodes and other parts of the body.
If the cancer does not respond to radioactive iodine therapy after surgery, radiation therapy may be used to treat local neck recurrences or distant metastases that are causing pain or other symptoms.
Although in the past, chemotherapy has not been very effective against thyroid cancer, newer medications as well as combinations of mediations are now being tested in clinical trials