Treatment

Treatments

At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important. (Symptoms, Risk, and Diagnosis of thyroid cancers tab)

As part of a research medical center, Siteman Cancer Center and Barnes-Jewish Hospital have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

Surgery and Other Procedures

Voice and Vocal Nerve Preservation: The thyroid gland is wrapped around the voice box, airway and vocal cord nerves. These structures can be affected by cancer or its treatment. Siteman’s head and neck surgeons offer expertise in voice and vocal nerve preservation for thyroid cancer patients.

Lobectomy removes only the side of the thyroid where the cancer is found. Lymph nodes in the area may be taken out (biopsied) to see if they contain cancer.

Near-total thyroidectomy removes most of the thyroid except for a small part.

Total thyroidectomy removes the entire thyroid.

Lymph node dissection removes lymph nodes in the neck that contain cancer.

After the thyroid gland is removed, many patients are treated by a radiation oncologist who uses radioactive iodine to kill any residual cancer cells. Patients then take synthetic thyroid hormone to replace the hormone formerly produced by their thyroid gland and to keep the body from stimulating the growth of any new cancer cells. Follow-up often can be done by scanning with low doses of radioactive iodine, a study that is made more efficient and comfortable for patients by treating them with newly available synthetic thyroid-stimulating hormone before the scan.

Radiation Therapy

Radioactive iodine: Patients are given a capsule that contains radioactive iodine. Because the thyroid takes up iodine, the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells. Radioactive iodine is not useful in the treatment of medullary thyroid cancer.

IMRT (Intensity modulated radiation therapy) is an advanced form of external beam radiation therapy that allows radiation specialists to shape, or conform, radiation doses to the exact three-dimensional shape of a tumor, making the technology ideal for use on irregularly shaped tumors located in various places throughout the body. In IMRT, radiation specialists also can vary the amount of radiation in each beam targeted at the tumor. They also can turn the radiation on and off during treatments. The precise control and flexibility of IMRT minimizes the amount of radiation going to surrounding healthy tissue and is often used for head and neck cancers, including thyroid cancer.

Our radiation oncologists have recently been involved in several important clinical trials testing the usefulness of IMRT. One is aimed at studying the troublesome problem of dry mouth, which results from radiation damage to the salivary glands. Preliminary data in this study shows that IMRT can substantially spare the glands and preserve patients’ eating and drinking functions.

Chemotherapy

Targeted therapy: An FDA-approved tyrosine kinase inhibitor is commonly used to slow cancer growth for patients with unresectable recurrent disease or cancer that has traveled to other body areas.

Hormone Therapy: Oral hormones can stop cancer cells from growing. In treating thyroid cancer, hormones can be used to stop the body from making other hormones that might make cancer cells grow, or to supplement thyroid needs after removal of the thyroid gland.

Standard Treatments for Medullary Thyroid Cancer

Cancer from the parafollicular cells of the thyroid, or medullary cancer, is rarer and is often associated with the inherited MEN2 syndrome. Siteman has extensive experience in treating medullary cancer, and has pioneered several aspects of its management. This disease requires meticulous removal of the thyroid gland and the lymph nodes around it, but radioactive iodine is not useful for treatment. Sometimes, external beam radiation is used after surgery. For targeted treatments, there are two new FDA-approved tyrosine kinase inhibitors for medullary cancer.

For patients who have been operated on previously, Siteman surgeons have developed a new technique. Using a minimally invasive procedure called laparoscopy, they first look for undetected spread of cancer to the liver, and if none is present, they examine the lymph nodes of the neck and remove any tumor in the nodes. Thyroid cancer patients with the MEN2 genetic mutation also can develop tumors of the adrenal glands and parathyroid glands, and Siteman’s research has demonstrated the best ways to evaluate and treat these problems.

Standard Treatments for Anaplastic Thyroid Cancer

Anaplastic thyroid cancer is a rare aggressive disease. Treatment frequently includes radiation given twice a day, with or without chemotherapy. In some cases radiation would be given without chemotherapy. For rare patients who have operable disease and no distant metastases, surgery may be done before radiation and chemotherapy.

The standard of care for the treatment of metastatic thyroid cancer that no longer responds to radioactive iodine is clinical trials. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.