Education

Thyroid Cancer is not the good cancer.

Thyroid cancer continues to be a a drastically underfunded and misunderstood cancer diagnoses in the United States. In 2017, the American Cancer Society estimates 56,870 new cases of thyroid cancer will be diagnosed in the United States this year, a slight decrease from 2016, based on the 2017 American Cancer Society’s publication “Cancer Facts & Figures 2017.” The disease is expected to claim more lives in 2017, with an estimated 2,010 deaths predicted, which will be a 1.5% increase from 2016.

Although thyroid cancer does not discriminate and is diagnosed each year in men, women, children, and older Americans, thyroid cancer has an outsize impact on young womens’ health. Roughly 75% of all patients diagnosed with thyroid cancer are women, and roughly half are aged 50 or younger. It is the 5th leading cancer diagnosis for women, and is the most commonly diagnosed cancer among women aged 20 to 34.

Thyroid cancer diagnosis has tripled in the past three decades, and funding for the disease has not kept up. It is often wrongly represented as “the good kind of cancer.” But as the powerful message in the video below demonstrates, thyroid cancer is NOT the good kind of cancer.

Overview

Thyroid cancer is a disease in which abnormal cells grow in the thyroid gland. The abnormal cells mutate, causing them to grow quickly and multiply, and they don’t repair themselves or die, as normal cells do. The collection of abnormal cells results in a tumor. Not all tumors are malignant (cancerous); some can be benign (non-cancerous). If the abnormal cells in the thyroid spread to other parts of the body, the cancer is said to have metastasized.

The thyroid gland is butterfly-shaped and located at the front of the neck just below the voice box. It is responsible for producing hormones that are sent to virtually every part of the body. It has two principal types of cells: follicular cells produce thyroid hormones which regulate metabolism and C cells (also known as parafollicular cells), make calcitonin, a hormone that helps regulate the body’s calcium levels. There are different types of thyroid cancer, depending on which cells are affected.

Symptoms

Many thyroid cancer patients do not detect any symptoms early on. Sometimes, a patient can feel a lump in their neck, which is often not painful. A doctor may also find a lump when doing a routine exam. Other symptoms can include any of the following:

  • Swollen lymph nodes in neck
  • Pain in neck, ears, or throat
  • Trouble swallowing
  • Trouble breathing or wheezing
  • Changes to the voice, including hoarseness
  • Frequent cough not accompanied by other obvious illness

Doctors check the thyroid by palpating (touching and feeling) the neck area where it is located. If swelling or a lump is detected, he or she may order a blood test, ultrasound, radioiodine scan, or a biopsy. A biopsy is a procedure in which a small piece of tissue is removed from the thyroid so its cells can be tested.

Types

There are four primary types of thyroid cancer.

Papillary thyroid cancer: Constituting approximately 80% of all thyroid cancers, papillary thyroid cancer is the most common type. It develops from the follicular cells and usually grows very slowly. Although it can occur at any age, it most commonly found in those aged 30-50. Papillary thyroid cancer usually has a good prognosis and is usually not fatal.

Follicular thyroid cancer: As its name suggests, follicular thyroid cancer also develops from the follicular cells. It constitutes only 10% of thyroid cancers, usually affecting those over the age of 50 or people from countries with iodine-deficient diets. One subtype of follicular thyroid cancer is called Hurthle cell, which is less common but also potentially much more aggressive.

Medullary Thyroid Cancer:  Medullary thyroid cancer (MTC) develops from the C cells. It often causes the thyroid to release too much calcitonin and a protein called carcinoembryonic antigen (CEA) into the blood, which can be detected through simple blood tests. MTC constitutes approximately 4% of all thyroid cancers. The peak onset age for MTC ranges from 30-60, depending on the subtype; however, there are children being diagnosed too.

Anaplastic Thyroid Cancer:  Constituting less than 2% of all thyroid cancers, anaplastic thyroid cancer is the rarest type. It is very difficult to treat as it tends to grow and spread very quickly. It is also the one type of thyroid cancer whose cells don’t look like normal thyroid cells when examined under a microscope. It is most commonly found in those aged 60 and over.

More about Medullary Thyroid Cancer and its Subtypes

Nikki Ferraro founded Bite Me Cancer after being diagnosed with medullary thyroid cancer. Medullary thyroid cancer (MTC) is the third most common type, and is more commonly found in females than males, except for the cases of inherited cancers.

MTC usually originates in the upper central lobe of the thyroid. During the early stages of the disease, it can spread to the lymph nodes in the neck; in late stages, it may spread to more distant organs.

Treatment for MTC typically entails surgically removing the thyroid gland and surrounding lymph nodes and tissue in the neck. Unlike other forms of thyroid cancer, MTC does not respond to radioactive iodine therapy. Recurrence of MTC can be detected by checking calcitonin and CEA levels in the blood.

MTC has a much lower cure rate than the differentiated thyroid cancers (papillary and follicular), although one that is higher than anaplastic thyroid cancer.

Subtypes

Sporadic MTC: Almost 80% of MTC is sporadic, meaning it is not genetically transferred. Familial MTC refers to types of MTC which are genetically transferred.  Women are more likely

Multiple Endocrine Neoplasia (MEN) II:  MEN II is a type of inherited MTC in which additional glands in the endocrine system also form a tumor or are overactive. It can occur at any age and affects men and women equally. MEN II further subdivides into two types

  • MEN II-A (Sipple Syndrome): Syndrome is a medical term for conditions occurring in groups of three, although not all patients will experience all of them. MEN II-A usually entails, in addition to tumors in the thyroid gland, tumors in the adrenal glands (which produce important hormones such as adrenaline), and overactive parathyroid glands (which help regulate calcium levels in the blood). The disease is passed to offspring through a defect in a gene which controls the growth of endocrine tissues.
  • MEN II-B: MEN II-B shares two of its three conditions with MEN II-A: tumors in the thyroid and adrenal glands. Its third condition entails tumors in the mouth, digestive problems, as well as muscle, joint, and spinal problems. MEN II-B can be both familial and sporadic (may be inherited or not).

Inherited Medullary Carcinoma without Associated Endocrinopathies: Inherited MTC without associated endocrinopathies is a form of medullary thyroid cancer that is not associated with other conditions. It is the least aggressive form of MTC.

Recent FDA Approved Drugs for Medullary Thyroid Cancer

On November 29, 2012, the FDA approved Cometriq (cabozantinib) to treat metastasized medullary thyroid Cancer. Read more.

On April 6, 2011, the FDA approved vandetanib (trade name Caprelsa), the first chemotherapy drug for the treatment of medullary thyroid cancer. Read more.

Recent FDA Approved Drugs for Differentiated (Papillary and Follicular) Thyroid Cancer

On February 13, 2015, the FDA approved the drug Lenvima (lenvatinib) to treat progressive, differentiated thyroid cancer in which radioactive iodine therapy did not prevent progression. Read more.

On November 22, 2013, the FDA approved the drug Nexavar (sorafenib) to treat cases of metastic differentiated thyroid cancer in which radioactive iodine is no longer effective. Read more.

Clinical Trials for Thyroid Cancer

Information about clinical trials for thyroid cancer can be found on the following websites:

Sources Consulted

  1. “Thyroid Cancer.” Mayo Clinic. April 2014. http://www.mayoclinic.org/diseases-conditions/thyroid-cancer/basics/definition/con-20043551.
  2. “Thyroid Cancer.” American Cancer Society. March 4, 2015. http://www.cancer.org/acs/groups/cid/documents/webcontent/003144-pdf.pdf.
  3. “Thyroid Cancer.” American Thyroid Association. http://www.thyroid.org/thyroid-cancer/.
  4. “Thyroid Cancer Statistics.” Net. May 5, 2015. http://www.cancer.net/cancer-types/thyroid-cancer/statistics.
  5. James Norman. “Thyroid Cancer: Medullary Cancer.” Endocrineweb. June 12, 2015. http://www.endocrineweb.com/conditions/thyroid-cancer/thyroid-cancer-medullary-cancer.
  6. “Thyroid Cancer Guide.” WebMD. November 14, 2014. http://www.webmd.com/cancer/tc/thyroid-cancer-topic-overview.
  7. “Multiple Endocrine Neoplasia Type 2.” Net. November, 2015. http://www.cancer.net/cancer-types/multiple-endocrine-neoplasia-type-2.
  8. Press Announcements. US Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm?Page=4.

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