September is Thyroid Cancer Awareness Month!
September’s monthly health awareness blog is about thyroid cancer. According to the CDC, thyroid cancer is uncommon. But recently rates of thyroid cancer have been trending upwards. Today we will discuss the signs and symptoms of thyroid cancer, prognosis, and treatment options. But first, let’s talk about what the thyroid does.
What Does the Thyroid Do?
Your thyroid sits front and center at the base of your neck. The thyroid is a gland that regulates functions from metabolism to heart rate. The thyroid gland is a crucial part of the endocrine system because it controls hormones. Hormones are responsible for regulating things such as metabolism, puberty, growth, and more. The thyroid produces two hormones, called T3 and T4. T3 and T4 work together to control heart rate, blood pressure, temperature, and metabolism.
The pituitary gland, located in the brain, tells the thyroid how much T3 and T4 to secrete. The pituitary gland is like command central for the endocrine system. Each part of the endocrine system is important to maintaining body functions.
What Are the Symptoms of Thyroid Cancer?
Thyroid cancer does not usually have symptoms in the early stages. As the cancer progresses, it may begin to show signs in the neck. Because the thyroid is located so close to the surface in the neck, a bump or swelling may appear. It is important to note that even if you have a bump or swelling in the area around your thyroid, it doesn’t mean it is cancer. In fact, thyroid growths are very common. These growths are called thyroid nodules. Up to 75% of thyroid nodules are benign (non-cancerous). Only around five to ten percent of biopsied nodules are malignant (cancerous). You may have noticed that the math doesn’t quite add up. There is also a third percentage of biopsied thyroid nodules that are indeterminate. Indeterminate means that the results are inconclusive. This percentage is small.
When nodules become large enough they can constrict the airway. This can cause trouble breathing. It can also cause a sensation of tightness in the neck. Thyroid nodules may also cause difficulty swallowing or frequent throat clearing. Since the thyroid is so close to the larynx (voice box), thyroid nodules can cause changes to the sound of your voice. Usually it will cause the voice to sound hoarse. A persistent cough without any signs of a cold can also be caused by thyroid cancer. Pain or tenderness in the neck area around the thyroid can be a sign of thyroid nodules.
What Causes Thyroid Cancer?
Cancer occurs when an abnormal cell develops, and then continues to divide uncontrollably. These abnormal cells grow into a mass called a tumor. Cancer is caused by mutations in the DNA. Mutations are corrected within the cell, most of the time. Sometimes, though, a mutation will grow and begin to multiply before the body can correct it. This is how cancer begins. Mutations are either inherited, caused by carcinogens, or random. Carcinogens are substances that can cause cancer. There is no clear link between specific carcinogens and thyroid cancer. The exact cause of thyroid cancer is unclear.
There are five different kinds of thyroid cancer. The first is papillary thyroid cancer, and it is the most common. It can affect people of all ages. Typically, it occurs in people between the ages of 30 and 50. Second, is follicular thyroid cancer. It is usually found in people over 50. One form of follicular thyroid cancer is called Hurthle cell cancer. Hurthle cell cancer is more aggressive and dangerous than normal follicular thyroid cancer. Third is medullary thyroid cancer. It can be caused by genetics, though the genetic component is rare. Fourth is anaplastic thyroid cancer. It is uncommon and grows very fast. It can be harder to treat than other types of thyroid cancer. Last, we have thyroid lymphoma. Thyroid lymphoma is also uncommon and grows rapidly. It is usually found in older people.
What Are the Risk Factors for Thyroid Cancer?
Women are much more likely than men to develop thyroid nodules and thyroid cancer. Women are more than twice as likely to develop thyroid cancer. Around 35,000 women are diagnosed with thyroid cancer, as opposed to only 12,000 men. Other risk factors for thyroid cancer include radiation exposure and genetic syndromes. The radiation exposure would need to be high to cause thyroid cancer. It can be caused by previous radiation therapy for cancer or nuclear plant disasters. Genetic syndromes can increase risk for thyroid cancer. They are called multiple endocrine neoplasia and familial medullary thyroid cancer.
How is Thyroid Cancer Diagnosed?
There are a few ways to diagnose thyroid cancer. The two most common ways to screen for it are through a physical exam and routine blood tests. Routine blood tests show whether the thyroid is functioning as it should. If the blood work comes back abnormal, your doctor will determine the cause. Since the thyroid is at the base of the neck, it is easy for doctors to feel for any large nodules. If the doctor feels anything unusual, they will likely send you for an ultrasound of your thyroid. If thyroid nodules are found, and if they reach a certain size, your doctor may order something called an FNA. An FNA is a fine needle biopsy. Using an ultrasound as a guide, the needle is inserted into the nodule to collect tissue samples. Samples are sent to be tested for cancer. Again, most nodules are not cancerous.
How is Thyroid Cancer Treated?
Luckily, most cases of thyroid cancer can be cured. There are three surgical options to treat thyroid cancer. The first option is called a thyroidectomy. A thyroidectomy is the complete removal of the thyroid. Thyroidectomy is the most common treatment for thyroid cancer. Sometimes, doctors choose to leave the parathyroid glands. Parathyroid glands are located around the back of the thyroid. This is called a near-total thyroidectomy.
In cases where the thyroid cancer is contained, doctors may choose to do a thyroid lobectomy. A thyroid lobectomy is when only the affected portion of the thyroid is removed. The doctor may decide to remove the lymph nodes in the neck if they are enlarged or show signs of cancer. They are then sent to pathology to test for cancer.
After treating thyroid cancer, you will likely need some combination of therapy. These therapies treat issues caused by thyroid removal and prevent cancer from returning. When the thyroid is removed, it is no longer there to produce vital hormones. These hormones are responsible for critical bodily functions. They must be introduced into the body artificially if the body cannot produce them. Thyroid hormone therapy will be a lifelong necessity. Thyroid hormone therapy serves two purposes. The first is to replace the missing hormones from having the thyroid removed. The second is to prevent TSH production, which can cause any cancer cells that remain to grow.
Another therapy used after thyroid removal is radioactive iodine. Radioactive iodine is given to kill any cancer left behind in the thyroidectomy. Microscopic thyroid cells and cancer cells can be left behind after even the most thorough thyroidectomy. Radioactive iodine treatment is not a longterm therapy. It is usually a short course given by pill or liquid. It is a low risk treatment and does not usually affect other cells. Still, people undergoing radioactive iodine treatment should avoid close contact with people during and after the treatment. It is especially important to be careful around pregnant women and children. Radioactive iodine leaves the body through urine within a few days.
Now let’s move from radioactive iodine to traditional radiation therapy. Traditional radiation therapy is used to treat many types of cancer. It is sometimes in combination with chemotherapy. Radiation is a high intensity beam that pinpoints specific parts of the body to target cancer. Radiation therapy is a longer course treatment than radioactive iodine. Radiation therapy usually lasts about a month and a half, with frequent visits every week.
Although it is an uncommon treatment for thyroid cancer, chemotherapy can be used. Chemotherapy is a common treatment for other types of cancer, but not thyroid cancer. This is because other treatment methods are more effective and less harmful. Some people are unable to undergo surgery, or unable to take radioactive iodine. These people may be good candidates for chemotherapy, usually combined with radiation therapy.
Because the thyroid is located in the neck, it can be difficult to get to some parts of the affected area. When thyroid cancer affects hard to reach areas, doctors may suggest alcohol ablation. Alcohol ablation is ideal for inaccessible small areas affected by thyroid cancer. The doctor will use an ultrasound machine to guide the needle to the right spot for injection. Once the target area is reached, alcohol is injected to kill the surrounding cancer cells. This type of therapy can be a good option for recurrent thyroid cancer.
Lastly, there are some forms of targeted drug therapy. These medications exploit specific weaknesses of cancer cells. The brand names for these medications are Cometriq, Nexavar, and Caprelsa. In cases of advanced thyroid cancer, targeted drug therapy may be used.
What Does Life After Thyroid Cancer Look Like?
Many people achieve full remission from thyroid cancer. Afterwards, people may experience some anxiety about the cancer returning. This is a natural reaction to a cancer ordeal. People who have all types of cancer experience this concern after completing treatment. It’s easier said than done, but focusing on the present can help to relieve anxiety about the future.
After you finish treatment, your doctor will regularly perform follow up tests. These tests will make sure the cancer has not come back or spread to other areas of the body. Screening is an important part of post-cancer care. You will likely have regular screening for the rest of your life. The frequency will lessen as time goes on and your scans continue to come back normal.
It is very important to make sure that life after cancer includes a healthy diet and an active lifestyle. A healthy lifestyle can dramatically improve your risk for cancer in the future. It can also help to reduce stress, improve sleep quality, and boost your immune system. These effects can have a huge impact on your health, regardless of weight management.
How Can I Support Someone Going Through Cancer Treatment?
It is often difficult to know exactly what to say or do to best support someone facing a health crisis. Sometimes, people get uncomfortable because they don’t know what to say or not say. Sometimes, people wonder if sending flowers or food is appropriate. What one person finds comforting may not be comforting to another cancer patient. One person may use humor to get through it. Another may feel that making light of the situation is disrespectful. Everyone is different.
Navigating what to do after a cancer diagnosis is confusing. We understand that. One thing that always comes across as supportive is wearing an awareness ribbon in their honor. It’s a silent show of support, and a visual reminder that they are not alone. Personalized Cause is proud to carry an awareness ribbon for thyroid cancer. You can find the ribbon here.
“Life is mostly froth and bubble, but two things stand like stone: friendship in another’s trials and courage in your own.”