Thyroid cancer is among the most curable

WEDNESDAY, AUGUST 8: Any diagnosis of cancer can be frightening, but one of the first things you should know about thyroid cancer is that it is also one of the most curable. This disease develops in the cells of the thyroid gland which is located on the front part of the neck below the thyroid cartilage (Adam’s apple). The gland is shaped like a butterfly or bowtie and consists of two lobes, one on each side of the trachea (windpipe), connected by an isthmus.

Although the thyroid generally weighs little more than an ounce, it is one of the largest endocrine glands in the body. Endocrine glands secrete hormones directly into the bloodstream and the thyroid secretes triiodothyronine (T3), tetraiodothyronine or thyroxine (T4), and calcitonin. These hormones regulate body temperature, metabolism, blood pressure and many other body functions.

Thyroid cancer can occur at any age, but is more common after age 30. According to the American Cancer Society, females are three times more likely to be diagnosed than men. While there are some known risk factors, in most instances the cause is unknown. Risk factors include exposure to radiation eg. from radiation therapy to the head or neck, or from a nuclear disaster.  Other risks include history of an enlarged thyroid (goitre), thyroid nodules, family history of the disease, or other rare genetic conditions. Most thyroid cancers are detected in the earlier stages by patients themselves or by health professionals during a physical exam. Symptoms may include a lump or swelling in the neck, swollen lymph glands in the neck, difficulty with swallowing, persistent cough, persistent pain in the neck or throat, hoarseness or other vocal changes.

There are four main types of thyroid cancer, each with subtypes and their own characteristics, and each type is treated differently. Papillary carcinoma is the most common and accounts for roughly 80 per cent of all thyroid cancers. It is slow growing, but may spread to the lymph nodes or other parts of the body. Follicular carcinoma is the second most prevalent representing 10 to 15 per cent of cases. This type does not usually spread to the lymph nodes, yet will spread to the lungs and bones.  Medullary and Anaplastic are much rarer types accounting for approximately 5 per cent and 1 per cents respectively; these grow and spread very quickly.

Biopsy

As mentioned, thyroid cancer may be suspected due to symptoms or clinical findings. To confirm the diagnosis, a biopsy is usually performed. Imaging studies ie. ultrasound, CT scan or MRI may also be completed. These tests allow the doctors to see the actual size of the tumour and whether or not it has spread. Once the specific type is identified, the tumour is given a stage between one and four, and the patient will be given treatment options. Genetic testing should automatically be done when the Medullary type is diagnosed.  Family members, including children who are identified with this genetic change may be advised to have the gland removed before cancer occurs, as the likelihood is extremely high.

According to ThyCa (Thyroid Cancer Survivors Association), tumours classified as Stage One or Two are considered “low risk” and have a very good outcome. Those classified as Stage Three or Four are considered “high risk” and may be harder to cure or have a higher incidence of recurrence.  The staging system is different for paediatric patients and those under age 45 years versus older adults.

When the health care team plans an individual’s treatment, several factors are considered, specifically the type of cancer, the stage, the general health of the patient as well as the patient’s wishes. Surgery is the most common treatment; either a single lobe (hemithyroidectomy) or the entire thyroid (total thyroidectomy) is removed. When the latter occurs, patients need to take thyroid medication for the rest of their lives. Normally, for best results, two methods of treatment are chosen. Other treatments include radioactive iodine treatment, thyroid hormone therapy, external beam radiation therapy, and chemotherapy. Deciding what is best may be confusing for patients and their families, so it is always a good idea to get a second opinion.

During consultations, ensure that you get your questions answered and do take advantage of assistance and support systems available.

Bermuda Cancer and Health Centre, in partnership with the Canadian Cancer Society, offers a free telephone and online cancer information service to all residents including cancer patients, friends and family members, as well as health professionals. When you dial 232-2247, you will be connected directly to a caring and knowledgeable information specialist who can answer questions on all types of cancer, treatments, side effects, support, clinical trials, and much more. These specialists have access to the most up-to-date information on your cancer type, but do not replace your health care team. The same confidential assistance is available on the website www.ccis.bm. Service is available Monday to Friday from 10am to 6pm.  Don’t forget to visit the well stocked Library and Resource Centre located on the ground floor at our Point Finger Rd location. Books and DVD’s may be checked out at the front desk, Monday to Friday from 7:30am to 6pm, and on select Saturdays from 9am to 1pm.

Rhonda J. Smith-Simmons is Education Officer for the Bermuda Cancer and Health Centre.