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Intro for Physicians
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Thyroid cancer is the fastest increasing cancer in both men and women. It is the most common endocrine cancer. Thyroid cancer is a cancerous tumor or growth located within the thyroid gland.
Thyroid cancer is one of the few cancers that has increased in
incidence rates over recent years. It occurs in all age groups from
children through seniors.
- The American Cancer Society estimates that there will be about 60,220 new cases of thyroid cancer in the U.S. in 2013. Of these new cases, about 45,310 will occur in women and about 14,910 will occur in men. About 1,850 people (1,040 women and 810 men) will die of thyroid cancer in 2013.
especially in the early stages of thyroid cancer, do not experience
symptoms. However, as the cancer develops, symptoms can include
a lump or nodule in the front of the neck, hoarseness or difficulty
speaking, swollen lymph nodes, difficulty swallowing or breathing,
and pain in the throat or neck.
- There are several
types of thyroid cancer: papillary, follicular, medullary, anaplastic,
follicular thyroid carcinomas are referred to as well-differentiated
thyroid cancer and account for 80–90% of all thyroid cancers. Variants
include tall cell, insular, columnar, and Hurthle cell. Their treatment
and management are similar. If detected early, most papillary and
follicular thyroid cancer can be treated successfully.
carcinoma (MTC) accounts for 5-10% of all thyroid cancers.
is easier to treat and control if found before it spreads to other
parts of the body. There are two types of medullary thyroid cancer:
sporadic and familial. Genetic testing (of the RET proto-oncogene
should be performed in all patients with MTC to determine whether
there are genetic changes that predict the development of MTC. In
individuals with these genetic changes, removal of the thyroid during
childhood has a high probability of being curative.
carcinoma is the least common and accounts for only 1–2% of all thyroid
cancer. This type is difficult to control and treat because it is
a very aggressive type of thyroid cancer.
for thyroid cancer include surgery, radioactive iodine treatment,
external beam radiation therapy, and chemotherapy. In most cases,
patients undergo surgery to remove most of the thyroid gland, and
are treated with thyroid hormone replacement therapy. For those
with papillary and follicular thyroid cancer, the dose of thyroid
hormone replacement is usually high enough to suppress thyroid stimulating
hormone (TSH) well below the range that is normal for someone not
diagnosed with thyroid cancer, to help prevent the growth of cancer
cells while providing essential thyroid hormone to the body.
with thyroid cancer include a family history of thyroid cancer,
gender (women have a higher incidence of thyroid cancer), age (the
majority of cases occur in people over 40, although thyroid cancer
affects all age groups from children through seniors), and prior
exposure of the thyroid gland to radiation.
While the prognosis
for most thyroid cancer patients is very good, the rate of recurrence
can be up to 30%, and recurrences can occur even decades after the
initial diagnosis. Therefore, it is important that patients get
regular follow-up examinations to detect whether the cancer has
re-emerged. Monitoring should continue throughout the patient’s
- Periodic follow-up
examinations can include a review of the medical history together
with selected blood tests appropriate for the type of cancer and
stage of treatment (TSH, thyroglobulin, CEA, and calcitonin levels),
physical examination, and imaging techniques (ultrasound, radioiodine
whole body scan, chest X-ray, CT, MRI, PET, and other tests).
January 21, 2013