What Is The Follow
Periodic follow-up examinations are essential for all patients with thyroid cancer, because the thyroid cancer can returnsometimes several years after successful initial treatment. These follow-up visits include a careful history and physical examination, with particular attention to the neck area. Neck ultrasound is an important tool to view the neck and look for nodules, lumps or cancerous lymph nodes that might indicate the cancer has returned. Blood tests are also important for thyroid cancer patients. Most patients who have had a thyroidectomy for cancer require thyroid hormone replacement with levothyroxine once the thyroid is removed . The dose of levothyroxine prescribed by your doctor will in part be determined by the initial extent of your thyroid cancer. More advanced cancers usually require higher doses of levothyroxine to suppress TSH . In cases of minimal or very low risk thyroid cancer, it is typically recommended to keep TSH in the normal range. The TSH level is a good indicator of whether the levothyroxine dose is correct and should be followed periodically by your doctor.
In addition to routine blood tests, your doctor may want to check a whole-body iodine scan to determine if any thyroid cancer cells remain. These scans are only done for high risk patients and have been largely replaced by routine neck ultrasound and thyroglobulin measurements that are more accurate to detect cancer recurrence, especially when done together.
External Beam Radiation Therapy For Papillary Thyroid Cancer
Papillary thyroid cancer treatment with external beam radiation therapy is not commonly required or indicated. The planning and implementation of radiation therapy is beyond the goals for this website. However certain principles must be emphasized. Radiation therapy is not a substitute for incomplete surgery. What is meant by that is all the papillary thyroid cancer in the neck must be completely and effectively removed. Whenever feasible, papillary thyroid cancer patients should be reduced down to microscopic remaining neck disease, at most, also sparing voice box and swallowing tube function. Radiation therapy should not be given as a substitute for incomplete surgery. As a general rule, choosing to treat a papillary thyroid cancer with external beam radiation is a commitment that the surgeon believes that no meaningful re-operation will be feasible in the future and therefore radiation therapy is required to help control the papillary thyroid cancer remaining in the neck. In these circumstances, external beam radiation therapy is quite effective. Papillary thyroid cancer radiation therapy is also associated with significant short term and long term complications and effects that should not be taken lightly. :1083-91)
The Potential Downside Of Finding More Thyroid Cancers
Like other cancers, thyroid cancer isnt one disease. There are several different types of thyroid cancer , and each type can have very different prognoses. For example, few people with anaplastic thyroid cancer, a very rare but aggressive type, will live for even a year. But almost everyone diagnosed with a small papillary thyroid cancer will be alive 5 years after diagnosis.
In fact, past autopsy studies have shown that many people die withnot froma small papillary thyroid cancer.
You can die with a cancer never knowing you had it, Dr. Davies said. If these cancers are found by chance, any intervention can potentially be overtreatmentthat is, therapy for a cancer that would have stayed the same or sometimes even gotten smaller, and never caused any symptoms.
And overtreatment not only carries the risk of side effects without any benefit to the patient, but it can also include substantial financial costs.
The most common side effect from surgery to remove part or all of the thyroid gland is a lifelong need for thyroid hormone replacement therapy, which can have its own side effects. Most people feel fine, but some might not feel as well as they did before surgery, Dr. Haymart said.
Surgery to remove thyroid cancer also has the potential to damage vocal cord functions or nearby glands that control calcium levels in the body, she explained.
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Diagnosis Of Papillary Thyroid Cancer
- There are approximately 64,000 new thyroid cancers diagnosed in the United States annually
- The diagnosis of papillary thyroid cancer accounts for approximately 85% of all thyroid cancers
- The diagnosis of papillary thyroid cancer is most common in women between the ages of 30 to 50
- The diagnosis of papillary thyroid cancer may occur at any age including infants, children and later years of life
- The diagnosis of papillary thyroid cancer effects women three times more frequently than it does men
- The diagnosis of papillary thyroid cancer is the fifth most common cancer affecting women in the United States
Value And Rationale For C
With the current practice of intense postoperative surveillance searching for even miniscule disease, the efforts to achieve thorough lymph node dissection are worth serious consideration. Because therapeutic lymph node dissection is virtually unanimously supported, the focus of debate has revolved around what is termed prophylactic dissectionremoving nodes even when not grossly abnormal in the judgment of the surgeon. Also, until recently, few in Western countries have supported lateral jugular lymph node dissection . Therefore, C-VI prophylactic node dissection has attracted considerable attention and investigation. The reasons to undertake routine C-VI lymph node dissection include:
- Preoperative US in the initial cervical exploration is nearly blind to the detection of LNM in C-VI
- Surgeons cannot reliably differentiate innocent from LNM in many cases
- LNMs occur in up to 50% of patients operated on for PTC
- Missed LNM are typically found along the recurrent laryngeal nerve in the trachea-esophageal groove, a potentially dangerous location if reoperation becomes necessary
- Dissection would logically lead to reductions in relapse and consequently reoperation
- C-VI dissection can be accomplished safely, although this is a major statement of contention
- Disease staging could be changed for patients over 45 years, from stage I to stage III, with potential for additional treatment implications
- RAI is unreliably effective in cleaning up residual macroscopic LNM.
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Nuclear Features Of Papillary Carcinoma
Although the initial diagnostic criterion for the diagnosis of papillary thyroid carcinoma was the presence of papillary growth pattern, in the latter half of the last century, nuclear criteria for the diagnosis became important as well. In the past few decades, the nuclear features have become the diagnostic hallmark of the tumor and growth pattern is of lesser or minimal importance. Indeed, the WHO definition of papillary thyroid carcinoma reflects this.
The nuclei of papillary cancer have been described as clear, ground glass, empty, or Orphan Annie eyed., These nuclei are larger and more oval than normal follicular nuclei and contain hypodense chromatin. In papillary cancer, these nuclei often overlap one another . Although cleared nuclei are characteristic of papillary carcinoma, autoimmune thyroiditis, particularly Hashimoto’s disease, often shows similar nuclear changes., Intranuclear inclusions of cytoplasm are often found. Another characteristic of the papillary cancer nucleus is the nuclear groove. Nuclear grooves may be seen in other thyroid lesions including Hashimoto’s disease, adenomatous hyperplasia, and diffuse hyperplasia as well as in follicular adenomas .
Papillary carcinoma nuclear features . Papillary carcinoma nuclear features are illustrated .
How Is It Treated
If the cancer is very small, your doctor may suggest you just keep an eye on it with regular ultrasounds. When you do need treatment, it’ll likely go like this:
Surgery. In most cases, your doctor removes the entire thyroid, along with any lymph nodes that look to be problems.
If the cancer is small, you might choose to have only part of your thyroid removed. Even in this case though, many doctors think it’s better to take it out completely. It can make follow-up care work better and lower the chances that cancer comes back.
Radioactive iodine ablation. Surgery alone may cure the cancer, so not everyone needs this step. After the operation, your thyroid gets tested. The results will help you and your doctor decide if you might need RAI ablation to keep cancer from returning.
This is typically a one-time treatment where you take a pill with radioactive iodine. Any leftover thyroid cells take in the iodine, which then kills them. It doesn’t usually have side effects, since only thyroid cells soak it up.
You typically get RAI ablation if you had nodules bigger than 4 centimeters or if the cancer:
- Grows beyond the thyroid
- Moves into the lymph nodes
- Spreads to another part of your body
Thyroid hormone pills. You start taking these after surgery. It gives your body the thyroid hormones that you no longer make on your own, since your thyroid has been removed. You’ll typically take one pill a day for the rest of your life.
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Papillary Thyroid Cancer Surgery For Spread Of Cancer To Lymph Nodes Along The Side Of The Neck
- Just the presence of enlarged lymph nodes does not mean papillary thyroid cancer has spread and does not require additional surgery
- A procedure called an anterolateral neck dissection , in untreated patients, should only be performed in instances where an ultrasound with fine needle aspiration has confirmed papillary thyroid cancer spread to lymph nodes in the side of the neck
- The papillary thyroid cancer anterolateral neck dissection is not the same neck dissection as for other cancers that occur in the neck. Papillary thyroid cancer spreads to particular areas of the neck called levels. Removing just some of the lymph nodes has been called “cherry picking” and is the wrong surgery! A papillary thyroid expert surgeon trained and experienced to perform modified neck dissections specifically for thyroid cancer is needed to prevent recurrent or persistent disease.
- The anterolateral neck dissection, in skilled hands, spares all critical nerves, muscles, and blood vessels which are not directly involved with cancer . It ads approximately 40 minutes of surgery to remove the lymph nodes and fatty tissue.
Looking For More Of An Introduction
If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net:
- ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to thyroid cancer. This free fact sheet is available as a PDF, so it is easy to print.
Thenext section in this guide is Statistics. It helps explain the number of people who are diagnosed with thyroid cancer and general survival rates. Use the menu to choose a different section to read in this guide.
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Enhancing Healthcare Team Outcomes
Papillary thyroid cancer is ideally managed by an interprofessional team that consists of an endocrinologist, general surgeon, oncologist, radiation oncologist, nuclear medicine physician, internist, pharmacists, and specialty care nurses. The majority of patients present to the primary provider or nurse practitioner with a painless mass in the neck. Once the FNA is performed, the patient should be referred to an oncologist and a surgeon. Patients need to know that the sole treatment for PTC is surgery. Patients treated with radioactive iodine need to be educated about this therapy and warned about the potential adverse effects. Following surgery, the patient requires long term monitoring for recurrence. Most patients require long term thyroid hormone replacement. Specialty care nurses in oncology assist with treatment, monitor and educate patients, and provide updates to the team.
With early diagnosis and prompt treatment, the prognosis for most patients is excellent.
Use Of Radioactive Iodine And Papillary Thyroid Cancer
Thyroid cells are unique in that they have the cellular mechanism to absorb iodine. The iodine is used by thyroid cells to make thyroid hormone. No other cell in the body can absorb or concentrate iodine in a similar fashion than does the thyroid. Physicians can take advantage of this fact and give radioactive iodine to patients as a treatment option for papillary thyroid cancer. The use of iodine as a cancer therapy was the first targeted therapy ever developed for any type of human cancer.
There are several types of radioactive iodine, with one type being highly toxic to cells. Papillary thyroid cancer cells absorb iodine therefore, they can be destroyed by giving the toxic isotope . Again, not everyone with papillary thyroid cancer needs this treatment, but those with larger tumors, tumors that have spread to lymph nodes or other areas including distant sites, tumors that are aggressive microscopically may benefit from this treatment.
Radioactive iodine therapy is particularly effective in children with thyroid cancer which has spread extensively to lymph nodes and even to distant sites in the body such as the lungs. Although in theory, radioactive iodine is a very attractive treatment approach for papillary thyroid cancer, its use has decreased over the years except for the specific indications as described above.
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Risks Of Thyroid Surgery
The two most common risks of thyroid surgery include damage to the parathyroid glands or the recurrent laryngeal nerves, structures that are directly attached to the thyroid gland.
- Parathyroid glands: There are four parathyroid glands, two attached to the back of each thyroid lobe. They are about the size of a pencil eraser or pea. The parathyroid glands control the level of calcium in the body. Damage to the parathyroid glands can affect calcium levels and cause significant health risks if left untreated.
- Recurrent laryngeal nerve : The RLN is very thin, about the diameter of a piece of angel hair pasta. The RLN controls the vocal cords and helps protect the airway so food, liquid or other items do not enter the lungs.
The risks of thyroid surgery can be decreased by having the operation performed by an experienced surgical team that completed at least 30 thyroid surgeries per year. The surgeons at the Pediatric Thyroid Center at CHOP perform more than 75 thyroid surgeries a year. The permanent complication rate for thyroid surgery patients at CHOP is less than 2 percent significantly lower than the national average.
When Should I See My Healthcare Provider About Papillary Thyroid Cancer
If youve been diagnosed with papillary thyroid cancer, youll need to see your healthcare team regularly to monitor your treatment progress. Youll also need long-term monitoring every six to 12 months to look for cancer recurrence for at least five years.
If you had your thyroid removed and/or had radioactive iodine therapy as part of treatment, youll need to take thyroid hormone medication for the rest of your life. Your healthcare provider will want to monitor your thyroid hormone levels throughout your life to make sure your medication dosage is working for you.
A note from Cleveland Clinic
Receiving a cancer diagnosis is unsettling, regardless of the type. The good news is that papillary thyroid cancer often has an excellent prognosis. Your healthcare team will work with you to determine the best treatment plan for you.
Last reviewed by a Cleveland Clinic medical professional on 06/28/2022.
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Recurrence Of Thyroid Cancer
Although thyroid cancer recurrence is not common, there are many treatment options available if it happens. If a cancer recurrence is detected in the neck lymph nodes, the best course of action is usually an operation to remove the affected node or additional treatment with RAI ablation. In order to determine the best treatment for recurrent thyroid cancer, it is critical to work with an experienced team of thyroid specialists.
Treatments For Thyroid Cancer
Treatment for thyroid cancer depends on the type of thyroid cancer you have and how far it has spread.
The main treatments are:
- surgery to remove part or all of the thyroid
- radioactive iodine treatment you swallow a radioactive substance that travels through your blood and kills the cancer cells
- external radiotherapy a machine is used to direct beams of radiation at the cancer cells to kill them
- chemotherapy and targeted therapies medicines used to kill cancer cells
After treatment, you’ll have follow-up appointments to check whether the cancer has come back.
Read more about how thyroid cancer is treated.
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What Is The Survival Rate For Papillary Thyroid Cancer
Papillary thyroid carcinoma is the most common thyroid cancer. About 80% of all thyroid cancers cases are papillary thyroid cancer. This type of cancer has a high cure rate 10-year survival rates for all patients with papillary thyroid cancer estimated at over 90%. Cervical metastasis are present in 50% of small papillary carcinomas and in more than 75% of the larger papillary thyroid carcinomas.
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When To Get Medical Advice
See a GP if you have symptoms of thyroid cancer. The symptoms may be caused by less serious conditions, such as an enlarged thyroid , so it’s important to get them checked.
A GP will examine your neck and can organise a blood test to check how well your thyroid is working.
If they think you could have cancer or they’re not sure what’s causing your symptoms, you’ll be referred to a hospital specialist for more tests.
Find out more about how thyroid cancer is diagnosed.
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How Is Thyroid Cancer Managed Or Treated
Treatments for thyroid cancer depend on the tumor size and whether the cancer has spread. Treatments include:
- Surgery: Surgery is the most common treatment for thyroid cancer. Depending on the tumors size and location, your surgeon may remove part of the thyroid gland or all of the gland . Your surgeon also removes any nearby lymph nodes where cancer cells have spread.
- Radioiodine therapy: With radioiodine therapy, you swallow a pill or liquid containing a higher dose of radioactive iodine than whats used in a diagnostic radioiodine scan. The radioiodine shrinks and destroys the diseased thyroid gland along with cancer cells. Dont be alarmed this treatment is very safe. Your thyroid gland absorbs almost all of the radioiodine. The rest of your body has minimal radiation exposure.
- Radiation therapy: Radiation kills cancer cells and stops them from growing. External radiation therapy uses a machine to deliver strong beams of energy directly to the tumor site. Internal radiation therapy involves placing radioactive seeds in or around the tumor.
- Chemotherapy: Intravenous or oral chemotherapy drugs kill cancer cells and stops cancer growth. Very few patients diagnosed with thyroid cancer will ever need chemotherapy.
- Hormone therapy: This treatment blocks the release of hormones that can cause cancer to spread or come back.