Posts Tagged ‘Goitre’

How is staging determined for thyroid cancer?

If the diagnosis is thyroid cancer, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to learn whether the cancer has spread and, if so, to what parts of the body.
Staging is based on the results of the physical exam, biopsy, and imaging tests, ultrasound, CT scan, MRI, chest x-ray, and/or nuclear medicine scans.
The TNM method is the most universally used staging method and applies to both papillary and follicular thyroid cancers.
- T indicates the size of the main (primary) tumor and whether it has grown into nearby areas.
- N describes the extent of spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells that are important in fighting infections. Cells from thyroid cancers can travel to lymph nodes in the neck and chest areas.
- M indicates whether the cancer has spread (metastasized) to other organs of the body. If there is distant metastases, M = 1, if the cancer has not spread outside of the neck region, M = 0.

Based on these three categories, the cancer is assigned a Stage of 1, 2, 3 or 4. Stage 1 is the least advanced form of cancer with the best prognosis, and Stage 4 is the most advanced category.

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Overview of Typical Thyroid Cancer Treatment

Females are more likely to have thyroid cancer at a ratio of three to one. Thyroid cancer can occur in any age group, although it is most common after age 30, and its aggressiveness increases significantly in older patients. The majority of patients present with a nodule on their thyroid that typically does not cause symptoms.
Thyroid cancer is usually diagnosed by sticking a needle into a thyroid nodule or removal of a worrisome thyroid nodule by a surgeon.

- The removed thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign (95-99% of all nodules that are biopsied) or malignant (less than 1% of all nodules, and about 1-5% of nodules that are biopsied).
- The pathologist decides the type of thyroid cancer: papillary, follicular, mixed papilofollicuar, medullary, or anaplastic.
- The entire thyroid is surgically removed; sometimes this is done during the same operation where the biopsy takes place. He/she will assess the lymph nodes in the neck to see if they also need to be removed. In the case of anaplastic thyroid cancer, your doctor will help you decide about the possibility of a tracheostomy.
- About 4-6 weeks after the thyroid has been removed, the patient will undergo radioactive iodine treatment. This is very simple and consists of taking a single pill in a dose that has been calculated for the patient. – The patient goes home and avoids contact with other people for a couple of days (so they are not exposed to the radioactive materials).
- A week or two after the radioactive iodine treatment the patient begins taking a thyroid hormone pill. No one can live without thyroid hormone, and if the patient doesn’t have a thyroid anymore, he or she will take one pill per day for the rest of their life. This is a very common medication.
- Every 6-12 months the patient returns to his endocrinologist for blood tests to determine if the dose of daily thyroid hormone is correct and to make sure that the thyroid tumor is not coming back. The frequency of these follow up tests will vary greatly from patient to patient.
- Endocrinologists are typically quite good at this and will typically be the type of doctor that follows this patient long-term.