Thyroid Cancer – Diagnosis and Treatment
Diagnosis
Doctors use several tools and steps to find out if a person has thyroid cancer. These steps help spot cancer early and guide treatment choices.
The process usually begins with a physical exam. Doctors then use different types of tests to learn more.
How Doctors Assess The Spread of Thyroid Cancer
Staging plays a key role in diagnosis. It shows how much cancer is in the body and where it has spread. Doctors gather details from many tests to figure out the stage of the thyroid cancer.
Key Parts of Thyroid Cancer Staging:
- Tumor Size: How big is the main cancer in the thyroid?
- Lymph Nodes: Has cancer spread to the nearby lymph nodes?
- Metastasis: Has cancer traveled to other parts of the body, like the lungs or bones?
- Type of Thyroid Cancer: Is it papillary, follicular, medullary, or another kind?
- Age: For some types, age changes the stage assignment.
Stages of Thyroid Cancer
Doctors assign thyroid cancer stages as numbers, usually between 1 and 4:
| Stage | What it Means |
|---|---|
| 1 | Cancer in the thyroid, small size, has not spread |
| 2 | Larger size, or may have very limited nearby spread |
| 3 | May involve nearby lymph nodes |
| 4 | Has spread to distant lymph nodes or organs (metastasis) |
Doctors combine information from several sources to assign a stage:
- Physical Exam: The doctor checks the neck for lumps or enlarged lymph nodes.
- Ultrasound: Sound waves show the thyroid and nearby lymph nodes. This test finds small growths that may not be felt by hand. It also shows if cancer may have spread.
- CT, MRI, or PET Scans: These imaging tests show if the cancer is outside the thyroid or affects other parts, such as the chest or head.
- Biopsy: Doctors examine a small sample of thyroid tissue or lymph node cells under a microscope to confirm cancer and look at cell types.
- Radioactive Iodine Scan: This scan shows if thyroid cancer cells remain in the body after surgery and if they have spread.
- Blood Tests: These tests check thyroid hormone levels and can find markers like calcitonin for medullary thyroid cancer.
- Genetic Tests: For medullary thyroid cancer, doctors may use genetic testing to find inherited causes.
Types of Thyroid Cancer and Staging Differences
Papillary and follicular thyroid cancers are called “differentiated cancers.” Their stage depends on tumor size, spread, and the patient’s age.
- Papillary Thyroid Cancer: This is the most common type. If the cancer is small (less than 4 centimeters) and only in one part of the thyroid, it is usually a lower stage. If it has spread to lymph nodes or outside the neck, the stage is higher.
- Follicular Thyroid Cancer: Doctors stage this type using size and spread. If it moves into blood vessels, the risk of spread is higher.
- Medullary Thyroid Cancer: This type needs special blood tests and sometimes genetic tests. Doctors also use calcitonin and Carcinoembryonic Antigen (CEA) levels to see if there is cancer in the body.
- Anaplastic Thyroid Cancer: This aggressive type spreads quickly and is often diagnosed at stage 4.
Lymph Nodes and Thyroid Cancer
Lymph nodes are small glands found throughout the body. Thyroid cancer can spread to lymph nodes in the neck.
Doctors use ultrasound and sometimes biopsy of lymph nodes to check for spread. If cancer is in the lymph nodes, more extensive surgery may be needed.
Staging Table Example: (For Differentiated Thyroid Cancer)
| Age | Stage 1 | Stage 2 | Stage 3 / 4 |
|---|---|---|---|
| Under 55 | Any size, spread or no spread | Cancer outside the thyroid | Not usually assigned |
| 55+ | Small, no spread | Large, may spread to lymph nodes | Distant spread (lungs, etc) |
Tests Used to Stage Thyroid Cancer
Physical Exam and History
The doctor feels the neck for lumps or swelling. The doctor also checks for changes in voice, swallowing, or breathing.
Ultrasound
Ultrasound shows nodules in the thyroid and if they look suspicious. It also finds enlarged lymph nodes near the thyroid.
Blood Tests
Blood tests measure thyroid hormone levels like TSH and T4. Special markers like calcitonin or CEA are used for medullary thyroid cancer.
Biopsy
Doctors use a thin needle to collect cells from the thyroid nodule. Ultrasound often guides the needle for better accuracy.
Radioactive Iodine Scan
Doctors may ask you to swallow a small amount of radioactive iodine. A camera then shows where the iodine goes in the body. Cancer cells that take up the iodine appear on the scan.
Imaging Tests
- CT and MRI: These tests give detailed images and help find cancer in lymph nodes or other organs.
- PET Scan: Sometimes used for aggressive or hard-to-find cancers.
Genetic Testing
Doctors may test for gene changes passed down in families, especially for medullary thyroid cancer. Results can help with diagnosis, treatment choice, and letting family members know their risk.
Example: How Staging Works
If someone has a small papillary thyroid cancer only in the thyroid, doctors call this stage 1 or 2. If the same cancer spreads to lymph nodes in the neck, it could be stage 3. If it goes to the lungs or bones, that is stage 4.
For medullary thyroid cancer, doctors look at blood markers like calcitonin and CEA to check for remaining cancer or spread after surgery.
Tips for Patients
- Ask for clear explanations about your stage and what it means.
- Write down test results and questions for your doctor.
Table: Common Terms in Staging
| Term | What it Means |
|---|---|
| Nodule | Lumps in the thyroid gland. |
| Lymph nodes | Small glands that may hold cancer cells. |
| Metastasis | Cancer spread beyond the original site. |
| Biopsy | Small tissue sample for lab check. |
| TSH/T4 | Hormones that show thyroid function. |
| Calcitonin | Marker for medullary thyroid cancer. |
Treatment
Monitoring Instead of Immediate Treatment
For certain very small thyroid tumors, especially papillary microcarcinomas, doctors do not always start treatment right away. These small cancers often grow slowly and may not spread.
Some people and their care teams choose to watch the tumor carefully through regular check-ups. Active monitoring might include blood tests and neck ultrasounds once or twice per year.
If the cancer shows signs of change or begins to grow, doctors may recommend more active methods. Some people never need more treatment if the tumor remains stable.
Surgical Approaches
Doctors often use surgery to manage thyroid cancer that needs intervention. The type of surgery depends on the size, location, and type of cancer, as well as if cancer cells have spread and the patient’s preferences.
Main surgical options include:
| Surgery Type | Purpose |
|---|---|
| Total or near-total thyroidectomy | Removes all or most of the thyroid gland |
| Thyroid lobectomy | Removes one half of the thyroid |
| Lymph node removal | Takes out lymph nodes in the neck if cancer has spread |
Surgeons usually operate through an incision in the lower neck, often placed where it heals with a less visible scar.
Risks include bleeding, infection, injury to the parathyroid glands (which regulate blood calcium), and possible nerve damage to the vocal cords, which can affect the voice.
Most people recover within two weeks, but doctors may advise limiting vigorous activities for a longer period.
After removing the thyroid, doctors use blood tests to look for markers made by healthy thyroid or cancer cells, like thyroglobulin and calcitonin. Regular testing continues to check for recurrence.
Thyroid Hormone Medication
When doctors remove all or much of the thyroid, the body can no longer make enough thyroid hormones. Most people will need medication to replace these hormones, usually taken as a daily pill.
Thyroid hormone treatment serves two key purposes:
- Replacing Lost Hormones: Keeps the body functioning normally.
- Preventing Cancer Recurrence: Sometimes, doctors give higher doses of hormones to lower the amount of TSH from the pituitary gland, which can stimulate any remaining cancer cells to grow. This is called suppressive therapy and is especially considered for people at higher risk of recurrence.
Once doctors find the right dose, most people feel normal and have few or no side effects.
Using Radioactive Iodine
Doctors can treat some types of thyroid cancer, especially differentiated cancers like papillary and follicular, with radioactive iodine after surgery. This treatment helps destroy tiny amounts of thyroid tissue or cancer cells that may still be in the body.
Doctors usually give radioactive iodine as a pill or liquid to swallow. Thyroid cells mainly absorb the iodine, leaving most other tissues alone. This treatment does not work for all types of thyroid cancer, such as anaplastic or medullary types.
Possible side effects of radioactive iodine:
- Dry mouth
- Pain in the mouth
- Swelling or soreness in the eyes
- Changes in taste or smell
The radioactivity leaves the body through urine, usually in a few days. To reduce risks to others, doctors may ask patients to avoid close contact with people, especially pregnant women and children, for a short time after treatment.
Alcohol Ablation for Small Areas
Doctors may use alcohol ablation for small pockets of thyroid cancer cells. They use a thin needle, guided by ultrasound, to inject alcohol straight into these areas. This tends to shrink or destroy the cancer in that spot.
Doctors may use this technique for people with small recurring cancers, often in the lymph nodes, especially when surgery is not an option or preferred.
It’s less common as a first treatment but can help if there are only a few cancer spots that need to be treated.
Options for More Serious or Advanced Cancer
When thyroid cancer is more aggressive or has spread beyond the thyroid, doctors may use additional treatments.
Targeted Medicines
Doctors use targeted medicines to focus on specific molecules or pathways that cancer cells use to grow and survive. Some drugs target certain genes or proteins present in cancer cells. Others block the blood supply tumors need to get nutrients.
- Types: Pills or infusions
- Testing: Sometimes, doctors run specialized lab tests on the cancer to find out which drugs might work best.
External Radiation
Doctors can use machines to direct high-energy rays at the cancer from outside the body.
They mostly use this treatment if surgery and radioactive iodine have not worked, or if the cancer has spread to places where these other treatments do not reach.
Chemotherapy
Doctors use chemotherapy medicines to kill rapidly growing cells, including cancer. They do not often use chemotherapy for most thyroid cancers, but may consider it for more aggressive or less common types, such as anaplastic thyroid cancer.
Palliative and Symptom Management
When doctors cannot cure thyroid cancer, treatments may focus on relieving symptoms and improving quality of life. Palliative care is important and is available at every stage, including alongside active cancer treatments.
Palliative care may include:
- Pain relief
- Support for swallowing or breathing problems
- Emotional and social support for the patient and family
This care helps manage issues related to the cancer or side effects from treatment.
Ongoing Checks After Treatment
After you finish treatment, your doctor will schedule regular follow-up care to watch for signs of cancer returning.
This care usually includes:
- Blood tests to check thyroglobulin; for medullary thyroid cancer, doctors also check calcitonin and carcinoembryonic antigen levels.
- Neck ultrasound exams.
- Other imaging tests if needed.
General schedule for follow-up:
| Time after treatment | Type of follow-up |
|---|---|
| Every 6-12 months | Blood tests, neck ultrasound |
| As needed | Additional imaging, adjustments to hormone therapy |
Doctors use follow-ups to find returning cancer early, when it is easier to treat.
Coping and support
Facing thyroid cancer can be tough, both physically and emotionally. You may need time to adjust and find ways to manage stress. Learning more about thyroid cancer can lower anxiety.
Keep notes on your diagnosis, including cancer type, stage, and treatment options. You can find reliable information at trusted organizations like the National Cancer Institute.
This helps you understand your options and make informed choices. Connecting with others who have similar experiences can offer comfort and useful advice. Support groups, both in person and online, give you a place to share and learn.
The American Cancer Society Cancer Survivors Network and the Thyroid Cancer Survivors’ Association provide spaces for people to talk and share stories. Maintaining control over your daily health habits can help you feel better.
Eat a healthy diet, exercise regularly, and get enough sleep to support your mind and body. Stress reduction activities, such as deep breathing or walking outside, can make daily life easier.
| Coping Steps | Examples |
|---|---|
| Learn about cancer | Keep notes, ask questions |
| Find support | Support groups, online networks |
| Healthy routines | Eat well, sleep enough, regular exercise |
| Stress management | Deep breathing, hobbies, nature walks |
Getting Ready for Your Visit
Steps to Prepare Before Your Appointment
Prepare ahead to get the most out of your doctor’s visit. Here are some steps to consider:
Preparation List
- Ask about any special rules for your visit. When you schedule, check if you need to fast or change your routine.
- Write down your symptoms, even those that seem unrelated.
- Record important personal details. Note any life changes or stress that might affect your health.
- List all medications, vitamins, and supplements you take, with or without a prescription.
- Bring someone with you. A friend or family member can help you remember information.
- Prepare questions in advance. Write down your main questions so you remember to ask them.
Sample Table: What to List Before Your Visit
| Category | Examples |
|---|---|
| Symptoms | Neck swelling, hoarseness, fatigue |
| Medicines/Supplements | Thyroid tablets, vitamin D, ibuprofen |
| Life Changes/Stress | Moving, job change, recent illness |
| Key Questions | See below |
Questions to Think About
Put your most important questions at the top of your list.
For example:
- What kind of thyroid cancer do I have?
- What is the stage of my cancer?
- Which treatment options are best, and what are their pros and cons?
- Will treatment affect my daily life or work?
- Should I get a second opinion or see a specialist?
- How soon should I begin treatment?
Ask any other questions that come up during your visit. Getting the information you need is important.
Tip: Keep your notes and medication lists in a folder or on your phone so you have them ready when you need them.
Questions Your Doctor Might Ask You
The doctor will likely have questions for you. Being ready to answer can help keep the visit focused.
Here are some things your doctor might ask:
- When did you first notice symptoms? What were they?
- Do symptoms come and go, or are they always present?
- How strong or bothersome are the symptoms?
- Does anything make you feel better or worse?
- Have you had radiation therapy in the past?
- Have you ever lived or worked near a nuclear accident site?
- Is there a history of thyroid, goiter, or endocrine cancers in your family?
- Do you have any other health issues?
- What medications or supplements do you take now?
- What information have other health professionals given you?
Example Conversation:
| Doctor Might Ask | Be Ready To Tell |
|---|---|
| When did your symptoms start? | Date, changes, what you first noticed |
| Are your symptoms continuous? | Yes/No, details about when they happen |
| Have you had radiation therapy? | Yes/No, explain what kind and when |
| Any family cases of thyroid issues? | Mention family medical history |
