What is Thyroid Cancer?

Thyroid cancer is a disease where malignant cells are found in the thyroid gland. This gland produces hormones that are important for regulating your body’s metabolism, which means that if your body lacks this hormone, your metabolism may not be as good as it should be. Unfortunately, thyroid cancer only occurs in about 20,000 individuals in the United States each year.

Though that may seem like many people, it is merely one percent of the population. So, you have a very small chance of actually getting this disease. Unfortunately, females are about three times more likely to get thyroid cancer than males are. The main two cells within the thyroid gland that can become cancerous are the follicular cells and the C cells. Each of these cells develops different types of cancer. Knowing the different types of cancer will help you know how severe cancer can become and the type of treatment that will be required. There are four main types of thyroid cancer that you should be familiar with.

The first type is differentiated thyroid cancer; they develop from the follicular cells in the thyroid, and they look very similar to the healthy cells in the thyroid.

There are three subcategories which are:

• Papillary – When it comes to thyroid cancer, eight out of ten cases are diagnosed with papillary cancer. It is a type of cancer that grows slowly, which means that it will typically become prevalent in only one lobe of the thyroid gland. Treatment is often successful with papillary cancer.
• Follicular – The next most common type is follicular, which makes up about ten percent of cancer cases in the thyroid. It is typically a type of cancer that is found in individuals who lack iodine in their diet. As a result, the cancerous cells will not spread to the lymph nodes, but they can spread to another area in the body. This makes this type of cancer treatment less successful, but it still does not often lead to death.
• Hurthle – This type is rarer than the previous two; in fact, only three percent of the individuals who suffer from this disease will be diagnosed with this type of cancer. Because of its rarity, it is harder to treat as well.

The next type of thyroid cancer that you should know is Medullary thyroid cancer or MTC. About four percent of all cases of thyroid cancer are MTC. This variation develops in the C cells of the thyroid gland, and it is a little more difficult to treat.

There are two subcategories of MTC, which are:

• Sporadic MTC – About 80 percent of all MTC cases are sporadic. This means that it seems to occur in an individual randomly, and there is no family history of the disease.
• Familial MTC – The other 20 percent of MTC sufferers inherit the disease from other family members; in fact, it can be prevalent in several generations. It can also be seen in younger individuals who are barely at the age of adulthood.

Anaplastic is the third type of cancer that can develop in the thyroid. It is a rare form that only makes up about two percent of all of the cases, and sometimes it develops from thyroid cancer that pre-exists in the body. It is a type of cancer that spreads through the body very quickly, making it difficult to treat.

Parathyroid cancer is a type of thyroid cancer that actually develops in the parathyroids, which are small glands attached to the thyroid gland. It is a very rare form of cancer that only affects about 100 Americans each year.

History

One of the first recorded mentions of the goiter or enlarged thyroid gland dates back to 2700 BC when seaweed was mentioned as a treatment that Emperor Shen Nung used. In western medicine, the first mention of the thyroid described it as a way to lubricate the trachea. The function of the thyroid was not widely realized, but in the early 1800s, the first case of thyroid cancer was documented. During the 1820s, treatments that utilized iodine began to be used as a way to minimize the effects of enlarged thyroid. This treatment seemed to minimize the size of the goiters; in fact, it actually decreased the size of the goiter by about 33 percent.

During the late 1800s, David Marine realized that the thyroid could not properly function without enough iodine in the body, so the iodine treatment became more recognized as a way to treat thyroid disease and cancer. However, it wasn’t until the year 1948 that the first fine needle biopsy was done as a way to diagnose the issue that the patient is having with their thyroid. A few years later, it was discovered that thyroid cancer in children was found most often following head and neck irradiation.

Nearly a decade later, medullary thyroid cancer was identified as a new type, which makes up about three percent of the diagnosed cases of thyroid cancer. Since that time, there have been several treatment options have been developed. Today, it is not a fatal disease when treated properly. Several treatments have been developed that make having thyroid cancer a simple irritation that you can easily live with. Thyroid cancer is the fastest-rising type of cancer amongst women in the United States and the second-fastest in men.

A few years ago, Dr. Charis Eng discovered that the individuals who had multiple family members with this disease all had a mutation in the SEC23B gene. However, the unique mutation was not present in the family members who did not have thyroid cancer. This discovery will hopefully lead to further development of the treatments used in thyroid cancer patients.

Risk Factors

Certain factors increase the risk of being diagnosed with thyroid cancer. The exact cause of the disease is unknown, but these factors have been found in patients with this type of cancer.

Let’s take a look at some of the risk factors.

• Gender – Typically, thyroid cancer occurs more often in females than in males, putting them at a higher risk. Women are about three times as likely to be diagnosed with thyroid cancer as men. Keeping that in mind, women also often receive a positive diagnosis for thyroid cancer at a much younger age than most men. The average age for women is 40 to 50 years old, while men often do not get a diagnosis until they are between 60 and 70 years of age.
• Race – Thyroid cancer can affect everyone, but it occurs more frequently in white and Asian individuals.
• Age – About two-thirds of the individuals who have been diagnosed with thyroid cancer have been between the ages of 20 and 55.
• Inherited Genetic Syndromes – Some of the individuals who have genetic syndromes like endocrine neoplasia and familial adenomatous polyposis may also have an increased risk of thyroid cancer. These illnesses may present a genetic predisposition to thyroid cancer.
• Pre-existing Diagnosis of Breast Cancer – Recent studies have determined that you will be at a higher risk for thyroid cancer in the first five years after being diagnosed with breast cancer. The same may also be true for other types of cancer, especially for those who have been receiving extensive radiation treatments.
• Radiation Exposure – Individuals who have been exposed to increased levels of radiation may be at a higher risk of being diagnosed with thyroid cancer. It has been discovered that individuals who survived nuclear reactor accidents in the past, specifically women and children, have a higher risk of getting thyroid cancer. Individuals who were present at Chernobyl have been studied in regards to this theory, and the number of individuals who received a positive diagnosis for thyroid cancer was increased.

Studies have also looked into adults who were given radiation treatments or had radiation exposure as a child. It was discovered that these individuals’ rate of thyroid cancer was also increased.

Medical testing gives you radiation exposure, but the levels you experience during a CT scan or an x-ray are not significant enough to increase your risk.

• Diet – Another risk factor that may increase the risk of thyroid cancer is the type of food that you eat. If you have a diet that lacks iodine, then you may be at a higher risk than those who have sufficient iodine in their diet. In the world’s developed countries, this is not an issue because a lot of food has an iodine additive that will help reduce your risk level. If you do not have enough iodine in your system, it is also possible that radiation exposure will affect you more, which increases your risk of getting thyroid cancer.

Screening

The screening process for thyroid cancer is the same for women, men, or children. Your doctor will first ask you about your medical history, but you will also be asked about your family’s medical history to make sure that there is no cause for concern. If there is a family history of thyroid cancer, your physician will most likely complete a full physical examination that specifically focuses on the thyroid gland.

During this examination, the physician may also check your vocal cords to ensure no irritation or paralysis of the area. During the exam, your doctor may also request that you get blood tests done to verify the levels of thyroid-stimulating hormone in your blood. They may also check for things like the amount of serum calcitonin or carcinoembryonic antigens in your body as well.

Be prepared for a CT scan, an MRI, a PET scan, or an x-ray to be ordered as well to complete the screening process and make sure that you are entirely cancer-free.

The American Thyroid Association recommends completing the following three tests during the screening process.

• Measure the serum thyroid-stimulating hormones (TSH) in your body. If the amount of TSH in your body is below where it should be, then an additional radionuclide thyroid scan should be conducted. This will allow the physician to see images of the thyroid gland. If you have an autonomous nodule, there is no need for additional testing, but if the results come back elevated, more testing may be required.
• An ultrasound can be used to help with the diagnosis as well. This is an especially effective test to perform when nodules are already suspected in the body. The ultrasound is a way for your physician to look at the nodule and see how big it actually is and additional details regarding its size. If enough information cannot be gathered using this method, then a biopsy may be required as well.
• Another type of test that can be done to screen for thyroid cancer is a fine needle aspiration or an FNA. This test is a cost-effective way that your physician can choose to biopsy the nodule. In addition, it is a very accurate method that can help your physician pinpoint the proper diagnosis to treat the disease properly.

In most situations, early detection testing is not an option. Still, suppose thyroid cancer runs in your family’s history. In that case, you can ask your physician to perform a RET, a genetic test that can be done to see if there are any specific mutations you should be concerned about that would put you at a higher risk of getting thyroid cancer.

Symptoms

One thing to note about thyroid cancer is that the symptoms of the illness are not always easy to see.

Let’s take a look at some of the most common symptoms that may cause you to visit your physician before you get a diagnosis.

• Some individuals may notice a lump in their neck that was not previously present. This lump is not always present in those diagnosed with thyroid cancer, but if it is, then it will be located in the front of the neck. The size will vary depending on the individual, so you may be able to see the lump visibly, or it could be a small raised area that you can feel under your skin. It is actually more visible when you swallow, so your friends may notice it on your neck before you do.
• Some individuals may experience swollen lymph nodes. This is because the lymph nodes are located in the neck, so if thyroid cancer spreads to the lymph nodes, you may experience swelling in your neck and underneath your jaw. If your lymph nodes become enlarged when you are not ill or for a long period, then you may want to visit your doctor to make sure that you do not have thyroid cancer.
• Your voice box is located directly under your thyroid gland, so when something is not right with your thyroid gland, your voice can also suffer. For example, if you have a thyroid nodule on your thyroid gland, then there is a chance that it could press against your voice box and cause you to have a faint, hoarse voice. This is typically not why a positive diagnosis of thyroid cancer is made, but it is a possible symptom to watch for.
• Your thyroid gland is also above your windpipe, so if you experience difficulty swallowing or breathing at all, then you need to see a physician. In addition, if you have a thyroid nodule forming that presses down on your trachea or your esophagus, then you can have a more immediate issue that you need to deal with, but it could also mean that the nodule is a sign that you have thyroid cancer.
• If you experience a lot of pain in your neck, it signifies that something is not right in your body. Neck pain is rarely a sign of thyroid cancer, but if you have experienced severe neck pain that has lasted for more than a week, then you may want to see a doctor, especially if you are experiencing more than one of the symptoms that are discussed above.
• Another symptom that you should be aware of is throat pain. It is basically an internal form of neck pain, and it is not often the main factor that clues a physician into the fact that you have thyroid cancer, but it can help them reach a diagnosis when other symptoms are present as well.

Diagnosis and Stages

Once a diagnosis states that you have thyroid cancer, your physician will use your test results to find out where the cancer is located. This is called the stage of the disease and will take all of the test results for the physician to be able to determine the stage that the cancer is in. The staging system for thyroid cancer is called the TNM staging system.

Let’s take a look at the details of the system:

“T” – The first letter in the name refers to the tumor itself.

That letter is typically followed by a number that represents the size of the nodule and the location.

Your physician may also separate the category even more into an “s” for a single tumor, or it may be categorized as an “m” to indicate that there is more than one tumor present.

Here is the “T” stage information:

• TX – cannot be evaluated;
• T0 – no evidence that a tumor exists;
• T1 – two centimeters or smaller; limited to the thyroid;
• T1a – less than one centimeter;
• T1b – one and two centimeters;
• T2 – between two and four centimeters; limited to the thyroid;
• T3 – larger than four centimeters; limited to the thyroid;
• T4 – extended beyond the thyroid; any size;
• T4a – spread to the larynx, trachea, esophagus, recurrent laryngeal nerve, and the surrounding soft tissue;
• T4b – spread beyond the T4a region.

“N” – The middle letter in TNM stands for nodes, the lymph nodes to be exact.

The lymph nodes can be located in the neck and regions of your head, so it is possible that the thyroid cancer could move to this area of your body with ease.

Here is more about this stage:

• NX – cannot be evaluated;
• N0 – no evidence of cancer in the lymph nodes;
• N1 – spread to the lymph nodes;
• N1a – spread to the paratracheal, paratracheal, laryngeal lymph nodes, which is known as the central compartment;
• N1b – spread past the central compartment into the neck and chest sides.

“M” – The “M” stands for metastasis, which means that cancer has moved to other areas of the body.

Here is the staging breakdown:

• MX – cannot be evaluated;
• M0 – has not spread to other areas;
• M1 – has spread to other areas.

The number you see in each of the stages represents the size of the discovered cancerous nodule. Cancer can be categorized from stage one to stage four. The stage varies based on the age of the person diagnosed with thyroid cancer as well. If the patient is under the age of 45, then the staging is a bit different.

There are two stages that cancer can be placed. Stage one means that cancer has not spread to other body areas, while stage two means that it has. The tumors can be any size, and it does not matter whether it has spread to the lymph nodes or not.

Treatments and Drugs

The type of treatment you receive depends greatly on the type of thyroid cancer you have and the stage it has progressed to. Here are some of the most common forms of treatment available to thyroid cancer patients:

Surgery

Most of the individuals who are facing this diagnosis decide to get surgery to remove the cancerous nodule and keep it from spreading. A small incision will be created at the base of your neck to give your surgeon easy access to the thyroid.

There are a few different types of surgery that can be performed.

• The entire thyroid gland can be removed.
• The lymph node and the thyroid can be removed. This is done when the lymph nodes are enlarged. Once they are removed, they will be tested as well to make sure that they do not contain cancerous cells as well.
• If the cancerous region of the thyroid gland is small, then one side of the gland may be removed instead of the entire thyroid gland.

Having surgery is always risky for the patient because it presents a risk of infection.

The parathyroid can be damaged easily during the procedure, and there is even a small risk that your vocal cords could be damaged as well. This can cause vocal cord paralysis as well as difficulty breathing.

Thyroid Hormone Therapy

After you receive surgery to remove cancer, you will need to take levothyroxine, which is a thyroid hormone medication that you will need to take for the rest of your life.

Taking this medication will supply your body with the hormones that your body is no longer receiving because of the removal of your thyroid. It also regulates the amount of thyroid-stimulating hormones that are released from your pituitary gland. This helps prevent cancer from growing back.

Every few months, you will need to get blood tests to check your hormone levels to make sure that you are receiving the proper dosage.

• Radioactive Iodine – This form of treatment uses large amounts of radioactive iodine to destroy healthy thyroid tissue that is remaining in your body. It typically comes in a capsule, but it can also be found in liquid form. The radiation is designed to kill thyroid cancer, but there is a small chance that other cells can also be damaged. Most of the iodine will exit your body naturally after a few days.
• External Radiation Therapy – You can also receive radiation treatment with a machine. This treatment is typically only done for a few minutes a day, but it is given to the patient five days a week for a period of five weeks. This is a great option to consider if the cancer is still alive in your body after cancer has been removed. It will help prevent cancer from spreading further in your body.
• Chemotherapy – is a form of treatment that utilizes chemicals to kill cancer. The medication is given through a vein to kill the cancerous cell in the body quickly. This treatment is typically the last resort for thyroid cancer.
• Alcohol Injections – If the cancer is located in an area of the body that is difficult to reach, then these injections can prove to be a great treatment option.
• Targeted Drug Therapy – Sometimes, medication can be used to target thyroid cancer specifically. Typical drugs that are used in this type of treatment are Cabozantinib, Sorafenib, or Vandetanib.

Coping and Support

Dealing with thyroid cancer can be difficult for both the patient and their loved ones, so there is a lot of support available to help them through this stressful time in life. Hospitals and clinics have individuals available to help them through their emotional and spiritual needs. Of course, the patient’s physical needs are cared for, but sometimes people may feel like there are not a lot of spiritual options that will help them emotionally.

The best thing that can be done to cope with the journey that they need to take to get the proper treatment is to understand what will come next. Research the types of treatments you may be receiving, consider your options, and discuss them with your doctor.

You can find a lot of good information from the American Cancer Society and the American Thyroid Association. If you understand thyroid cancer, you will know what to expect. In addition, doing some research on your cancer stage can help you prepare yourself. Remember, many people survive thyroid cancer, so they can actually be a great source of support as well.

You can ask your doctor for information on local support groups in your area. There are also thyroid cancer survivors that can be found online.

Sites such as the American Cancer Society Cancer Survivors’ Network and the Thyroid Cancer Survivors’ Association can be a great place to start. You had no control over getting thyroid cancer, but you can control the type of treatment you receive to get well again and beat the disease that is currently causing you pain.