Overview of Thyroid Cancer Stages
The thyroid gland is located in the front of the neck and is attached to the lower part of the voice box (larynx) and to the upper part of the windpipe (trachea). It has two sides, or lobes, that are connected by a narrow neck. The thyroid gland produces thyroid hormones, which regulate metabolism, growth, and development and are essential for life.
Diagnosing Thyroid Cancer
Thyroid cancer may be suspected if a small abnormal growth—called a nodule—is found to protrude from the thyroid gland. Since the vast majority of thyroid nodules are benign, diagnostic tests must be conducted to determine if the nodule is malignant or cancerous.
Diagnosing thyroid cancer may involve tests that generate an image of the thyroid, such as ultrasound or PET imaging. A sample of the cells is also typically evaluated under a microscope. The sample may be removed using a needle and syringe or may be removed during surgery to treat the nodule. If initial tests indicate that the nodule is cancerous, a surgery will be scheduled to remove as much of the cancer as possible and to determine the extent of the disease—also called the stage of disease—and whether it has spread outside the thyroid gland.
Tests used to diagnose thyroid cancer include the following:
Ultrasound: Ultrasound uses high frequency sound waves and their echoes to create a two-dimensional image that is projected on a screen. Ultrasound is a simple procedure that may allow doctors to determine if a thyroid nodule is cancerous or benign based on the appearance of the image that is produced. A limitation of ultrasound is that it does not produce a sample of the cells that can be evaluated under a microscope.
Fine needle aspiration: Fine needle aspiration is a technique that uses a needle and syringe to withdraw a sample of the cells from a thyroid nodule. The cells can then be evaluated under a microscope to determine if they are cancerous or benign. Since many thyroid nodules are benign, this technique provides a minimally invasive way to determine if surgery is necessary.
Positron emission tomography (PET): Unlike techniques that provide anatomical images, such as X-ray or ultrasound, PET scans show chemical and physiological changes related to metabolism.
Before a PET scan, a patient will receive an injection of a drug that has a biological element—called an isotope—attached to it. The isotope becomes visible when a small amount of radiation is passed through the body. The most active cells take up more of the drug, allowing the doctor to see which areas are more active—a possible sign of cancer.
The radiation from a PET scan is roughly equivalent to what is administered in two chest X-rays. After the scan is complete, the radiation does not stay in the body for very long.
PET scans are covered by Medicare for the diagnosis of thyroid cancer.
Types of Thyroid Cancer
Cancer may arise from different cells of the thyroid gland. By evaluating a sample of the cancer under a microscope, doctors can determine the type of thyroid cancer. There are four main types of thyroid cancer:
Papillary: Papillary tumors are the most common form of thyroid cancer, accounting for more than 70% of all cases. Papillary cancers are typically irregular or solid masses that arise from otherwise normal thyroid tissue. More than half of papillary cancers have spread to lymph nodes in the neck. However, papillary cancers rarely spread to distant locations in the body. Papillary cancers typically occur in younger patients (30-50 years) and are commonly associated with a prior exposure to radiation. Patients with papillary cancer are highly curable with currently available treatment techniques.
Follicular: Follicular cancers account for a smaller percentage of all thyroid cancers (approximately 15%) and rarely occur after radiation exposure. Follicular cancers are more aggressive; they tend to invade blood vessels rather than lymph nodes, and distant spread is therefore more common. Potential sites of distant spread include the lung, bone, brain, liver, bladder, and skin. Patients over 40 have more aggressive disease that is more difficult to treat. Nonetheless, most follicular cancers are very curable.
Medullary: There are two subtypes of medullary thyroid cancer: sporadic and familial. Sporadic almost always occurs on both sides of the thyroid gland. Familial tumors may be malignant or benign and may be associated with a variety of symptoms.
Approximately half of medullary thyroid cancers have spread to lymph nodes. Prognosis depends on the extent of disease at diagnosis—especially spread to lymph nodes—and the ability to completely remove the cancer with surgery.
Anaplastic: Anaplastic thyroid cancer is a rare disease that may also be called undifferentiated cancer. This type of thyroid cancer is very aggressive, grows rapidly, and commonly extends beyond the thyroid gland. It typically occurs in older patients and is characterized by extensive spread in the neck area and rapid progression. Patients typically die of their disease within months of diagnosis.
Stages of Thyroid Cancer
Following a diagnosis of cancer, the most important step is to accurately determine the stage of cancer. Stage describes how far the cancer has spread. Identifying the stage of cancer is important because each stage of cancer may be treated differently.
Stage I-II: Stage I-II thyroid cancers are generally confined to the thyroid, but many include multiple sites of cancer within the thyroid. Thyroid cancer that has spread to nearby lymph nodes is still considered to be in stage I-II when the patient is younger than 45 years of age as the presence of cancer in the lymph nodes does not worsen the prognosis for these younger patients.
Early stage thyroid cancer is very treatable and many patients are cured with surgery alone.
Stage III: Stage III thyroid cancer is greater than 4 cm in diameter and is limited to the thyroid or may have minimal spread outside the thyroid. Lymph nodes near the trachea may be affected. Stage III thyroid cancer that has spread to adjacent cervical (neck) tissue or nearby blood vessels has a worse prognosis than cancer confined to the thyroid. However, lymph node metastases do not worsen the prognosis for patients younger than 45 years.
Stage III thyroid cancer is also referred to as locally advanced disease.
Stage IV: Stage IV thyroid cancer has spread beyond the thyroid to the soft tissues of the neck, lymph nodes in the neck, or distant locations in the body. The lungs and bone are the most frequent sites of distant spread. Papillary carcinoma more frequently spreads to regional lymph nodes than to distant sites. Follicular carcinoma is more likely to invade blood vessels and spread to distant locations.
Recurrent: Thyroid cancer that has recurred after treatment or progressed with treatment is called recurrent disease.
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Stage I-II Thyroid Cancer
Overview
Most stage I-II thyroid cancers are confined to the thyroid, but many include multiple sites of cancer within the thyroid. Thyroid cancer that has spread to nearby lymph nodes is still considered to be in stage I-II when the patient is younger than 45 years of age as the presence of cancer in the lymph nodes does not worsen the prognosis for these younger patients.
Early stage thyroid cancer is very treatable and many patients are cured with surgery alone.
About this Treatment Information
The following is a general overview of treatment for stage I-II thyroid cancer, which may consist of surgery with or without radiation therapy. Combining two treatment techniques has become an important approach for increasing a patient's chance of cure and prolonging survival.
In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Circumstances unique to each patient's situation influence which treatment or treatments are utilized. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.
Surgical treatment of thyroid cancer may consist of removing all or part of the thyroid. Surgery to remove the entire thyroid is called a total thyroidectomy . Partial removal of the thyroid is called a lobectomy . The choice of procedure depends on age of the patient and the size of the cancer. Patients treated with these two procedures appear to experience similar durations of survival, but different rates of surgical complications and varying risk for a recurrence of their cancer in the thyroid area.
Total thyroidectomy: Thyroid cancer often affects both lobes of the thyroid, necessitating the removal of the entire thyroid. Patients who are at a high risk of cancer recurrence are also treated with total thyroidectomy.
Total thyroidectomy is associated with a greater risk of side effects. The thyroid produces and releases a hormone—called parathyroid hormone—that is important for maintaining calcium levels in the blood. Without a functioning thyroid, blood calcium levels become abnormally low, causing a variety of symptoms that typically include weakness and muscle cramps and tingling, burning, and numbness in the hands. This condition is called hypoparathyroidism. This complication may be reduced if a small amount of thyroid tissue is left, a procedure that may be referred to as a near-total thyroidectomy.
A total thyroidectomy is a very specialized procedure and is best executed by a skilled surgeon who has performed this operation many times. The thyroid is in close proximity to the voice box and there is a risk of injuring the nerve and thus function of the voice box. Surgical complications such as this are less common when specialized procedures are performed by an experienced surgeon.
Lobectomy: Select patients may be able to have only part of their thyroid removed. This approach is associated with a reduced risk of complications—including problems with blood calcium levels discussed above—but may be associated with a higher risk of local-regional cancer recurrence, which is cancer in or near the thyroid. Lobectomy does not appear to be associated with a higher risk of cancer recurrence in areas that are distant from the thyroid, such as bones or lungs, a circumstance which is associated with a worse prognosis.
In general, young patients (20-40 years) with isolated cancers that are small (less than 1 cm) and no history of radiation exposure may be treated with a lobectomy. However, the decision between surgical procedures is very individualized and may depend on other factors.
Regardless of whether a patient has a lobectomy or has the entire thyroid gland removed, they will receive supplemental thyroid hormone for the rest of their lives. Thyroid hormone is produced by the thyroid gland and is critical for maintaining metabolism. Supplemental thyroid hormone serves two purposes: to maintain hormone levels in the absence of a functioning thyroid and to suppress further growth of the gland and thus the cancer. The pituitary gland located in the brain produces a hormone that stimulates the thyroid to grow—called thyroid stimulating hormone (TSH). In the presence of thyroid hormone, TSH remains low and removes the stimuli to any remaining cancer cells.
Radioactive iodine is a well-established treatment for thyroid cancer and other thyroid conditions. Iodine is a natural substance that the thyroid uses to make thyroid hormone. The thyroid gland collects the radioactive form of iodine just as it would the non-radioactive iodine. Since the thyroid gland is the only area of the body that uses iodine, radioactive iodine does not travel to any other areas of the body, and the radioactive iodine that is not taken up by thyroid cells is eliminated from your body, primarily in urine. It is therefore a safe and effective way to treat thyroid conditions.
Research indicates that treatment with radioactive iodine improves survival for some patients, specifically those with cancer that has spread to nearby lymph nodes or to distant locations in the body. Many patients with stage I-II thyroid cancer do not require radioactive iodine treatment. However, older patients and those with larger cancers, spread to lymph nodes or other areas, or more aggressive cancers may benefit from this therapy.
Strategies to Improve Treatment of Early Stage Thyroid Cancer
The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of stage I-II thyroid cancer will result from the continued evaluation of new treatments in clinical trials.
Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community's understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician.
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Overview
Stage III thyroid cancer is greater than 4 cm in diameter and is limited to the thyroid or may have minimal spread outside the thyroid. Lymph nodes near the trachea may be affected. Stage III thyroid cancer that has spread to adjacent cervical tissue or nearby blood vessels has a worse prognosis than cancer confined to the thyroid. However, lymph node metastases do not worsen the prognosis for patients younger than 45 years.
Stage III thyroid cancer is also referred to as locally advanced disease.
About this Treatment Information
The following is a general overview of treatment for stage III thyroid cancer. Cancer treatment may consist of a combination of surgery, radioactive iodine treatment, and radiation therapy. Combining two or more of these treatment techniques has become an important approach for increasing a patient's chance of cure and prolonging survival.
In some cases, participation in a clinical trial utilizing new approaches to treating thyroid cancer may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Circumstances unique to each patient's situation influence which treatment or treatments are utilized. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.
Combination Therapy for Stage III Thyroid Cancer
Patients with locally advanced thyroid cancer have a higher risk of cancer recurrence. Typically, cancer recurs because there are small amounts of cancer that have spread outside the thyroid gland and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests.
To help reduce the risk of cancer recurrence, patients with stage III thyroid cancer typically receive a combination of treatments in an attempt to eliminate as much cancer as possible.
Surgery for Stage III Thyroid Cancer
Surgery for stage III thyroid cancer typically consists of removing the entire thyroid—a procedure called a total thyroidectomy—plus removal of affected lymph nodes. Researchers from Italy have reported that including aggressive surgery in the initial treatment of patients with locally advanced thyroid cancer improves survival.
Total thyroidectomy is associated with a side effect called hypoparathyroidism, which is a low level of a hormone that is normally released from the thyroid called parathyroid hormone. Parathyroid hormone is important for maintaining calcium levels in the blood. Without a functioning thyroid, blood calcium levels become abnormally low, causing a variety of symptoms that typically include weakness and muscle cramps and tingling, burning, and numbness in the hands. This condition is called hypoparathyroidism.
Radioactive Iodine Treatment
Iodine is a natural substance that the thyroid uses to make thyroid hormone. The radioactive form of iodine is collected by the thyroid gland in the same way as non-radioactive iodine. Since the thyroid gland is the only area of the body that uses iodine, the radiation does not concentrate in any other areas of the body. The radioactive iodine that is not taken up by thyroid cells is eliminated from the body, primarily in urine. It is therefore a safe and effective way to test and treat thyroid conditions.
Research indicates that treatment with radioactive iodine improves survival for patients with thyroid cancer that has spread to nearby lymph nodes or to distant locations in the body.
Strategies to Improve Treatment of Thyroid Cancer
The development of more effective cancer treatments requires that new and innovative  therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of stage III thyroid cancer will result from the continued evaluation of new treatments in clinical trials.
Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community's understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the treatment of stage III thyroid cancer include the following:
Radiation Therapy after Surgery
Radiation therapy uses high-energy rays to damage cells so that they are unable to grow and divide. Without the ability to replenish themselves, the cancer cells die. Similar to surgery, radiation therapy is a local treatment used to eliminate cancer cells in the area where the rays are focused, but cannot kill cancer cells that have already spread throughout the body.
External beam radiation therapy (EBRT): Conventional radiation therapy that is delivered with a machine that directs several high-energy beams at the area of the cancer is called EBRT.
Results from a clinical trial indicate that patients with locally advanced thyroid cancer treated with EBRT after surgery are less likely to experience cancer recurrence in or near the original site of cancer, which is called local-regional recurrence. When researchers directly compared treatment with and without EBRT, only 8% of patients treated with EBRT experienced a recurrence of their cancer compared to more than half (51%) of patients treated with surgery alone. Approximately nine out of 10 patients treated with EBRT survived 10 years or more after treatment without their cancer progressing in the thyroid area, compared to less than four out of 10 for the patients treated with surgery alone.
Intensity-modulated radiation therapy (IMRT): IMRT allows radiation to be delivered more precisely with the use of the following advanced techniques:
- Three-dimensional scans of the cancer help determine where the radiation should be targeted.
- A rotating device delivers radiation from every point around the cancer, rather than only a few points as with conventional radiation therapy.
- Special blocking devices—called leaves—direct the radiation away from sensitive organs and toward the cancer.
IMRT appears to reduce the chance of injury to healthy body structures that are near the cancer while delivering higher doses of radiation to the cancer. In the treatment of thyroid cancer, this means that sensitive cells in the neck area—such as the cells that line the throat—may be spared from radiation damage, reducing side effects and improving quality of life.
Preliminary findings reported by researchers in New York suggest that IMRT is an effective treatment for select cases of thyroid cancer. However, long-term research is needed to confirm these findings. IMRT may be available through a clinical trial.
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Overview
Stage IV thyroid cancer—also called metastatic disease—has spread beyond the thyroid to the soft tissues of the neck, lymph nodes in the neck, or distant locations in the body. The lungs and bone are the most frequent sites of distant spread. Papillary carcinoma more frequently spreads to regional lymph nodes than to distant sites. Follicular carcinoma is more likely to invade blood vessels and spread to distant locations.
The prognosis for patients with distant metastases is poor.
About this Treatment Information
The following is a general overview of treatment for stage IV thyroid cancer. Cancer treatment may consist of surgery, radioactive iodine treatment, radiation, chemotherapy, or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patient's chance of cure and prolonging survival.
In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Circumstances unique to each patient's situation influence which treatment or treatments are utilized. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.
Combination Therapy for Stage IV Thyroid Cancer
Treatment for stage IV thyroid cancer is usually a combination of treatment techniques including surgery and radioactive iodine treatment.
Surgery for stage IV thyroid cancer typically consists of removing the entire thyroid, a procedure called a total thyroidectomy.
Total thyroidectomy is associated with a side effect called hypoparathyroidism, which is a low level of a hormone that is normally released from the thyroid called parathyroid hormone. Parathyroid hormone is important for maintaining calcium levels in the blood. Without a functioning thyroid, blood calcium levels become abnormally low, causing a variety of symptoms that typically include weakness and muscle cramps and tingling, burning, and numbness in the hands. This condition is called hypoparathyroidism. This complication may be reduced if a small amount of thyroid tissue is left, a procedure that may be referred to as a near-total thyroidectomy.
Radioactive Iodine Treatment
Iodine is a natural substance that the thyroid uses to make thyroid hormone. The radioactive form of iodine is collected by the thyroid gland in the same way as non-radioactive iodine. Since the thyroid gland is the only area of the body that uses iodine, the radiation does not concentrate in any other areas of the body. The radioactive iodine that is not taken up by thyroid cells is eliminated from the body, primarily in urine. It is therefore a safe and effective way to test and treat thyroid conditions.
Research indicates that treatment with radioactive iodine improves survival for patients with thyroid cancer that has spread to nearby lymph nodes or to distant locations in the body.
However, some patients with progressive metastatic disease do not take up iodine in their thyroid cells. Treatments are more limited for these patients and they may benefit from participating in a clinical trial evaluating new, innovative approaches to treating thyroid cancer.
Strategies to Improve Treatment of Thyroid Cancer
The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of stage IV thyroid cancer will result from the continued evaluation of new treatments in clinical trials.
Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community's understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the treatment of stage IV thyroid cancer include the following:
Intensity-modulated radiation therapy (IMRT): IMRT allows radiation to be delivered more precisely with the use of the following advanced techniques:
- Three-dimensional scans of the cancer help determine where the radiation should be targeted.
- A rotating device delivers radiation from every point around the cancer, rather than only a few points as with conventional radiation therapy.
- Special blocking devices—called leaves—direct the radiation away from sensitive organs and toward the cancer.
IMRT appears to reduce the chance of injury to healthy body structures that are near the cancer while delivering higher doses of radiation to the cancer. In the treatment of thyroid cancer, this means that sensitive cells in the neck area—such as the cells that line the throat—may be spared from radiation damage, reducing side effects and improving quality of life.
Preliminary findings reported by researchers in New York suggest that IMRT is an effective treatment for select cases of thyroid cancer. However, long-term research is needed to confirm these findings. IMRT may be available through a clinical trial.
Chemotherapy: Chemotherapy uses drugs that kill rapidly dividing cells, a hallmark of cancer. Cancer chemotherapy may consist of single drugs or combinations of drugs. It can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
Doctors have observed that chemotherapy may help relieve symptoms of advanced thyroid cancer and may increase survival of some patients.
Surgery to remove metastases: Surgery to remove metastases from thyroid cancer has been shown to benefit some patients. In a clinical trial, metastases from thyroid cancer were removed from the mediastinum (area behind the breast bone), lung, bone, kidneys, and brain of 29 patients with advanced thyroid cancer. All patients were also treated with multiple radioiodine treatments. External-beam radiation therapy, chemotherapy, and other measures to relieve symptoms of the cancer were used.
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Overview
Thyroid cancer that has returned after treatment is called recurrent disease. Most cases of recurrent thyroid cancer occur in the neck region, but some also have distant metastases, or cancer that has spread to distant locations in the body. The most common site of distant metastasis is the lung.
About this Treatment Information
The following is a general overview of treatment for recurrent thyroid cancer. Cancer treatment may consist of radioactive iodine treatment, surgery, radiation, chemotherapy, or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patient's chance of cure and prolonging survival.
In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Circumstances unique to each patient's situation influence which treatment or treatments are utilized. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.
Treatment for Recurrent Thyroid Cancer
Treatment for recurrent thyroid cancer depends on many factors, including prior treatment, the cell type that is now cancerous, whether the cells will respond to radioactive iodine treatment, site of recurrence, and other individual considerations.
Surgery is often a key component of treatment for recurrent thyroid cancer, followed by repeated radioiodine treatments.
However, some patients with recurrent disease are resistant to radioactive iodine treatment, meaning their thyroid cells do not take up the iodine. Treatments are more limited for these patients, and they may benefit from participating in a clinical trial evaluating new, innovative approaches to treating thyroid cancer.
Surgery
If patients with recurrent thyroid cancer have not already had their thyroid removed, they will likely undergo a total thyroidectomy to remove the rest of their thyroid and any other cancer in the neck region. Patients who have had their thyroid removed also often have recurrent cancer in the neck region and will undergo surgery to have as much of the cancer as possible removed.
Radioactive Iodine Treatment
Iodine is a natural substance that the thyroid uses to make thyroid hormone. The radioactive form of iodine is collected by the thyroid gland in the same way as non-radioactive iodine. Since the thyroid gland is the only area of the body that uses iodine, the radiation does not concentrate in any other areas of the body. The radioactive iodine that is not taken up by thyroid cells is eliminated from the body, primarily in urine. It is therefore a safe and effective way to test and treat thyroid conditions.
Research indicates that treatment with radioactive iodine improves survival for patients with thyroid cancer that has spread to nearby lymph nodes or to distant locations in the body.
Strategies to Improve Treatment of Thyroid Cancer
The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of recurrent thyroid cancer will result from the continued evaluation of new treatments in clinical trials.
Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community's understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the treatment of recurrent thyroid cancer include the following:
Surgery to remove metastases: Surgery to remove metastases from thyroid cancer has been shown to benefit some patients. In a clinical trial, metastases from thyroid cancer were removed from the mediastinum (area behind the breast bone), lung, bone, kidneys, and brain of 29 patients with advanced thyroid cancer. All patients were also treated with multiple radioiodine treatments. External-beam radiation therapy, chemotherapy, and other measures to relieve symptoms of the cancer were used.
Chemotherapy: Chemotherapy uses drugs that kill rapidly dividing cells, a hallmark of cancer. Cancer chemotherapy may consist of single drugs or combinations of drugs. It can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
Doctors have observed that chemotherapy may help relieve symptoms of advanced thyroid cancer and may increase survival of some patients.
Intensity-modulated radiation therapy (IMRT): IMRT allows radiation to be delivered more precisely with the use of the following advanced techniques:
- Three-dimensional scans of the cancer help determine where the radiation should be targeted.
- A rotating device delivers radiation from every point around the cancer, rather than only a few points as with conventional radiation therapy.
- Special blocking devices—called leaves—direct the radiation away from sensitive organs and toward the cancer.
IMRT appears to reduce the chance of injury to healthy body structures that are near the cancer while delivering higher doses of radiation to the cancer. In the treatment of thyroid cancer, this means that sensitive cells in the neck area—such as the cells that line the throat—may be spared from radiation damage, reducing side effects and improving quality of life.
Preliminary findings reported by researchers in New York suggest that IMRT is an effective treatment for select cases of thyroid cancer. However, long-term research is needed to confirm these findings. IMRT may be available through a clinical trial.
References:
Hay ID, Grant CS, Bergstralh EJ, et al. Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 1998;124(6):958-64.
Rosa Pelizzo M, Toniato A, Boschin IM, et al. Locally advanced differentiated thyroid carcinoma: a 35-year mono-institutional experience in 280 patients. Nucl Med Commun. 2005;26(11):965-8.
Keum KC, Suh YG, Koom WS, et al. The role of postoperative external-beam radiotherapy in the management of patients with papillary thyroid cancer invading the trachea. International Journal of Radiation Oncology Biology Physics. 2006;Mar14:[Epub ahead of print].
Podnos YD, Smith D, Wagman LD, Ellenhorn JD. Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid. Surgery. 2005;128(6):1072-6.
Rosenbluth BD, Serrano V, Happersett L, et al. Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer . International Journal of Radiation Oncology Biology Physics. 2005;63(5):1419-26.
De Besi P, Busnardo B, Toso S, et al. Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. Journal of Endocrinology Investigation. 1991;14(6):475-80.
Pak H, Gourgiotis L, Chang WI, et al. Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. Journal of Surgical Oncology. 2003;82(1):10-8.
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