Sunday, February 25, 2024

Where Does Thyroid Cancer Spread To

A Study Of 16 Pathologically Confirmed Cases Over 25 Years

Mayo Clinic explains thyroid cancer

Division of Medical Oncology, Mayo Clinic and Foundation, Rochester, Minnesota

Fax: 284-1803

Ian D. Hay M.D., Ph.D.

Division of Endocrinology and Metabolism, Mayo Clinic and Foundation, Rochester, Minnesota

Division of Medical Oncology, Mayo Clinic and Foundation, Rochester, Minnesota

Fax: 284-1803

Ian D. Hay M.D., Ph.D.

Division of Endocrinology and Metabolism, Mayo Clinic and Foundation, Rochester, Minnesota

The Tnm Staging System

The American Joint Committee on Cancer created the system thatâs most often used to describe the stages of thyroid cancer. Itâs called the âTNMâ system, and it focuses on these three things:

  • T — What is the size and extent of the main, or primary, tumor?
  • N — Has the cancer spread to nearby lymph nodes? .
  • M — Has the cancer spread, or metastasized, to other areas of the body or organs, namely the lungs, liver, and bones?

After your doctor runs tests to find out what type of thyroid cancer you have, theyâll add a number to each letter listed above. The higher the number, the more advanced is that aspect of the cancer. .

Next, your doctor will group this information into stages. These are represented by the Roman numerals I through IV. For the most advanced cases, the letters âA,â âBâ and âCâ also are used to indicate how far the cancer has spread.

What type of cancer you have, as well as your age, will have some bearing on your stage.

Hereâs what each stage of thyroid cancer means, grouped by types:

Surgery For Papillary Thyroid Cancer

Papillary thyroid cancer is treated with surgery. It is important to understand that the best chance of cure is to have an expert thyroid cancer surgeon from the beginning. A surgeon who performs surgery for papillary thyroid cancer on a daily basis has a higher cure rate than a surgeon who performs thyroid surgery several times per week, or does other types of thyroid surgery . Surgery for thyroid cancer has become very specialized, so it is important for you to be comfortable with your choice of surgeon.

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Genetic Testing For Men And Fmtc

Genetic testing is now the mainstay in the diagnosis of the FMTC syndromes. RET proto-oncogene mutations have been discovered in each of the MTC syndromes. The RET proto-oncogene is a receptor tyrosine kinase whose exact function and role in these syndromes has not been elucidated. Patients with MEN 2A have germline RET mutations resulting in substitutions of conserved cysteine residues in exons 10 and 11. All patients with MEN 2B have a germline mutation resulting in a threonine-for-methionine substitution in codon 918 of exon 16. Mutations are described in exons 13 and 14 in patients with FMTC.

Genetic screening with sensitive PCR assays for germline RET mutations is routinely performed in at-risk patients. Children of parents known to have MEN or FMTC are tested for RET mutations to guide therapy and future genetic counseling. In addition, patients presenting with sporadic MTC should undergo RET mutational analysis to rule out new spontaneous germline mutations, which should prompt the testing of offspring for similar mutations.

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Metastasis At Initial Presentation

Thyroid Cancer Treatment (Adult) (PDQ®)Patient Version

In patients where metastatic disease was diagnosed at initial presentation, the predominant sites were the bones , followed by lungs , brain and lymph nodes . The diagnosis of metastasis in the bones and lungs was confirmed by biopsy, which showed widely invasive follicular carcinoma in all cases. In two cases, the metastasis was diagnosed by a craniotomy and dural resection of the tumour. All patients with pelvic and spinal involvement underwent posterior stabilisation and fusion of the spine and fixation of the hip. Craniotomy and tumour resection was performed in two cases.

Following diagnosis of metastasis, 9 of the 12 patients underwent a total thyroidectomy. Three patients declined thyroid surgery and one of these chose to have no further treatment. All of the nine total thyroidectomy patients had adjuvant high dose radioiodine ablation. Two other patients also received radioactive iodine the first was a lobectomy patient and the second patient did not have surgery. Of the eleven patients who received RAI, three underwent three further ablation procedures with a mean cumulative dose of 600900mCi. One patient who had nodal metastasis and who underwent neck dissection along with total thyroidectomy developed further lung metastasis.

Thyroglobulin levels dropped from a mean of 9,405.9ng/ml before treatment to 1,478.0ng/ml . Following treatment, thyroid stimulating hormone was suppressed in three patients .

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Patient Characteristics And Histology

The basic conditions of the patients are shown in Table 2. Of the 22 patients, 12 were male and 10 female . The mean patient age was 54.5 years at BM diagnosis. Fourteen patients presented other previous and/or synchronous distant metastases: lung , bone , liver , skin . The mean interval time between diagnosis of the first metastasis and BM was 2 years for these patients.

Table 2 Individual clinical findings of patients with BRAIN metastases from DTC.

Fourteen patients had papillary carcinoma, six patients had follicular carcinoma and two patients were unknown. Stages were pT0-2 for 12 patients, pT3-4 stage for eight patients, and unknown for two patients. Nodal involvement was present for 17 patients, absent for three patients, and unknown for two patients. Twelve patients had histological confirmation that the brain lesions were of thyroid origin through biopsy or resection. Nine cases showed vascular invasion, while 10 cases showed no invasion. Three cases were unknown. Necrosis was absent in all cases. Moderate nuclear atypia was observed in 6 cases, where as in 14 cases it was severe. BRAF mutation was found in 9 cases, while 7 cases were not. Six cases were unknown. Seven of 9 cases with BRAF mutation showed vascular invasion, which occurred in only 2 of 7 cases of patients without BRAF mutation.

When To See A Healthcare Provider

If you feel a new swelling or lump in your neck, or if an imaging test incidentally reveals a thyroid growth, its important to schedule an appointment with your healthcare provider right away.

During your appointment, your healthcare provider will:

Depending on the results of these tests, your primary care or family healthcare provider may refer you to a healthcare provider who specializes in thyroid care . An endocrinologist may take another look at the thyroid nodule with ultrasound in his or her office and perform a fine-needle aspiration biopsy to see whether cancer cells are present.

Thyroid Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare providers appointment to help you ask the right questions.

The diagnosis of thyroid cancer has been on the rise both in the United States and worldwide, due in large part to the sophistication of high-resolution imaging tests. In other words, these thyroid nodules that would never have been found years ago are now being identified.

While the majority of these small nodules end up not being cancer, determining which ones are is keyâthis is because most thyroid cancers are curable, especially those that are small and have not spread.

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What Is The Thyroid Gland

Your thyroid gland is one of many glands that make up your endocrine system. Endocrine glands release hormones that control different bodily functions.

The pituitary gland in your brain controls your thyroid gland and other endocrine glands. It releases thyroid-stimulating hormone . As the name suggests, TSH stimulates your thyroid gland to produce thyroid hormone.

Your thyroid needs iodine, a mineral, to make these hormones. Iodine-rich foods include cod, tuna, dairy products, whole-grain bread and iodized salt.

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Impact Of The Site Of Metastasis At Presentation On Prognosis

My Thyroid Cancer journey pt. 3 || Cancer spread? Thyroid function? Post surgery update!

A comparison between patients with distant metastasis at various sites is illustrated in Table 3. There was no significant difference in age and gender between the groups. However, a higher frequency of bone metastasis was observed in black adults while Asian/Pacific Islanders were more prone to brain metastasis . In patients with a single metastatic site, lung was the preferential site of distant metastasis in thyroid cancer patients, followed by bone metastasis . In contrast, the brain was more likely to present with concomitant metastatic sites, such as the lung and liver . Death was the highest in patients with brain metastasis , followed by and liver , lung , and bone metastases. In contrast, mortality was reported in 26.9% of patients with distant LN metastasis . In metastatic patients, thyroid cancer-specific death accounted for 73.2%. Mortality due to non-cancer causes was reported in 19.8% mainly due to respiratory disorders , heart diseases , and septicemia .

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New Uchicago Medicine Research Sheds Light On Outcomes As Cases Increase Dramatically

Thyroid cancer survivors report poor quality of life after diagnosis and treatment compared with other patients who are diagnosed with more lethal cancers, according to new research from the University of Chicago Medicine.

The findings, published Dec. 11 in the journal Thyroid, shed light on a rarely studied outcome for a growing group of patients who are expected to soon account for 10 percent of all of American cancer survivors.

Thyroid cancer patients have a nearly 98 percent five-year survival rate, according to the National Cancer Institute. More than 95 percent survive a decade, leading some to call it a good cancer. But those successful outcomes mean few thyroid cancer survivorship studies have been conducted.

UChicago Medicine researchers Briseis Aschebrook-Kilfoy, PhD, assistant research professor in epidemiology, and Raymon Grogan, MD, assistant professor of surgery, are trying to address that data gap. Together, they lead the North American Thyroid Cancer Survivorship Study .

For their most recent research, Aschebrook-Kilfoy and Grogan recruited 1,174 thyroid cancer survivors 89.9 percent female with an average age of 48 from across the U.S. and Canada. Participants were recruited through the thyroid cancer clinics at UChicago Chicago Medicine, the clinics of six other universities, as well as through thyroid cancer survivor support groups and social media.

The researchers will continue to track participants to further understand this data.

What Kind Of Treatment Will I Need

There are many ways to treat thyroid cancer but surgery is the main treatment. The treatment plan thats best for you will depend on:

  • The stage of the cancer
  • The chance that a type of treatment will cure the cancer or help in some way
  • Other health problems you have
  • Your feelings about the treatment and the side effects that come with it

Depending on the type and stage of your thyroid cancer, you may need more than 1 type of treatment.

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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.

What Are Some Other Papillary Thyroid Cancer Treatments

Thyroid Cancer Treatment (Adult) (PDQ®)Patient Version

The other surgical option for patients with papillary thyroid cancer is a total thyroidectomy . An expert pre-operative evaluation of the papillary thyroid cancer patient is required to determine whether there is any involvement of the lymph nodes in the neck. In most circumstances, the involvement of neck lymph nodes can be determined prior to the thyroid surgery procedure. When there is evidence that the papillary thyroid cancer has spread to lymph nodes in the neck, surgical approaches to the central and lateral neck lymph nodes should be performed.

When neck lymph nodes are involved with papillary thyroid cancer, either during the evaluation of the papillary thyroid cancer or during surgery for the papillary thyroid cancer, the recommended operation is a total thyroidectomy.

Often, other characteristics of the tumor that can be seen under the microscope which may have an influence on whether the surgeon should remove the entire thyroid .

The surgical options are covered in greater detail in our article on for thyroid cancer. A more detailed discussion of thyroid surgery for the thyroid gland and lymph nodes of the neck can be found here.

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Thyroid Cancer In Patients Younger Than 45

The prognosis of a patient under the age of 45 with a differentiated thyroid cancer is good. The thyroid cancer staging system takes this information into account, and classifies these cancers simply into two groups based on whether they have spread to distant organs:

Stage 1: The primary tumor can be any size and the cancer may or may not have spread to lymph nodes. Distant sites in the body are not affected.

Stage 2: The primary tumor can be any size and the cancer may or may not have spread to lymph nodes, but cancer cells have spread to distant areas of the body.

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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Characteristics Of Metastatic Cohorts

A total of 212,651 thyroid cancer patients from the SEER database were reviewed and only those with known metastasis were included in the analysis . Baseline characteristics of thyroid cancer patients with and without metastasis are demonstrated in Table 1. The median age of patients with metastasis at initial presentation was 65.38 ± 15.95 years compared to 50.25 ± 15.64 years in non-metastatic cohorts. Distant metastasis was reported in 1819 patients at the time of diagnosis. Lung was the most common site of metastasis, reported in 1290 patients , followed by bone metastasis . The incidence of metastasis to the liver and brain accounted for 8.3% and 4.7%, respectively. Distant lymph node metastasis was found in only 67 patients . A total of 1341 metastatic thyroid cancer patients presented with single organ involvement, while 478 patients had MODM at the time of initial diagnosis. Involvement of two, three, and four metastatic sites was observed in 383, 74, and 19 patients, respectively . The median follow-up for the entire patient cohort was 34 months . Of 1035 pediatric thyroid cancer patients, only 22 presented with single organ distal metastasis in the liver and were alive at the end of the follow-up period. Mortality was reported for other reasons in seven non-metastatic pediatric cases.

Certain Factors Affect Prognosis And Treatment Options

Thyroid Cancers

The prognosis and treatment options depend on the following:

  • The age of the patient at the time of diagnosis.
  • The type of thyroid cancer.
  • The stage of the cancer.
  • Whether the cancer was completely removed by surgery.
  • Whether the patient has multiple endocrine neoplasia type 2B .
  • The patients general health.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

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What About Other Treatments I Hear About

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.

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