Treatment

Symptoms, Risk and Diagnosis

Siteman’s thyroid cancer program can provide broad-based treatments because of its strong multidisciplinary approach. Each patient with thyroid cancer has his or her situation evaluated during a multidisciplinary conference that includes surgeons, medical oncologists, radiation oncologists, radiologists and pathologist.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Thyroid Cancers

Thyroid cancer typically doesn’t cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:

  • Voice changes like hoarseness
  • Difficulty swallowing
  • Neck and throat pain
  • A swelling in the neck or lump in the throat that can be felt

Risk Factors for Thyroid Cancer

Thyroid cancer occurs more often in people between the ages of 25 and 65 years.

Other risk factors include:

  • Exposure to radiation
  • Radiation treatments to the head and neck during infancy or childhood
  • Having had goiter (enlarged thyroid) or a family history of thyroid disease
  • Being female
  • Having the inherited disorder MEN (multiple endocrine neoplasia)

Diagnosing Thyroid Cancers

Making a diagnosis of a specific type of thyroid cancer may involve different approaches. Depending on the type of cancer, the following tests and procedures may be used:

 

  • History and physical: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities. Pre-treatment evaluation of vocal cord function is also performed in the office.
  • Biopsy: Tissue is sampled to examine for cancer cells; it can often be done with a fine aspiration needle in the physician’s office.
  • Ultrasound: Using sound waves to create images of parts of your body, this imaging technique uses a small, wand-like instrument to generate sound waves as they bounce off the thyroid. The echoes are converted by a computer into a black and white image on a computer screen. This test can help determine if a thyroid nodule is solid or filled with fluid. It can also be used to check the number and size of thyroid nodules and highlight nearby enlarged lymph nodes.
  • CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection of a dye to help the organs or tissues show up more clearly. If a cancer is suspected, the dye isn’t used, as it can delay administration of radioactive iodine after surgery.
  • PET-CT scan (positron emission tomography scan): Radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. During the same session, a CT scan is performed to accurately locate the abnormalities. This test is only used in certain limited situations for thyroid cancer.
  • Thyroid radioiodine scan: Radioactive iodine is swallowed and is absorbed by thyroid tissue or thyroid cancer. After absorption, a small camera placed in front of your neck to evaluate the iodine location. It can also be used post-treatment to check for remaining cancer cells.
  • MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
  • Blood tests: Blood tests can help show if the thyroid is working normally:
    • Thyroid-stimulating hormone (TSH): Testing blood levels of thyroid-stimulating hormone may be used to check the overall activity of your thyroid gland, or the effectiveness of thyroid hormone replacement therapy after surgery.
    • T3 and T4 (thyroid hormones): These are the main hormones made by the thyroid gland. Levels of these hormones may also be measured to get a sense of thyroid gland function.
    • Thyroglobulin: Measuring this protein made by the thyroid gland helps track the effects of surgery. Treatment should lead to a very low level of thyroglobulin in the blood. If it is not low, this might mean that there are still thyroid cancer cells in the body.
    • Calcitonin: This hormone helps control how the body uses calcium. It is made by C cells in the thyroid, the cells that can develop into medullary thyroid cancer (MTC). If MTC is suspected or if you have a family history of the disease, blood tests of calcitonin levels can help look for MTC or its possible recurrence after treatment.
    • Carcinoembryonic antigen (CEA): People with MTC often have high blood levels of this protein.

Staging of Thyroid Cancer

  • Stages for papillary and follicular thyroid cancers are stages I – IV, depending on extent of the disease and age of the patient at diagnosis.
  • For medullary thyroid cancer, stages are from I-IV, depending on size of the tumor and spread.
  • Anaplastic thyroid cancer is all considered Stage IV because of its aggressiveness, and because it has usually spread when it is discovered.

Prognosis

The prognosis (chance of recovery) depends on the following:

  • The size of the tumor
  • Whether the cancer has spread to other parts of the body and where it has spread
  • The type of cancer (based on how the cancer cells look under a microscope)
  • Whether the cancer is primary or has recurred after treatment

Thyroid cancers are best controlled when they are small and can be removed by surgery.  Clinical trials are a good option for getting the latest treatment. For thyroid cancers that have metastasized and no longer respond to radioactive iodine, the standard of care is clinical trials.