Q: I have papillary thyroid cancer. My thyroid has been removed. Nine lymph nodes were removed and 4 are malignant. I am going to have radioactive iodine therapy. What else do I need to know? How long can I expect to live?
A: The thyroid is a gland that sits toward the front of the neck. The thyroid makes hormones that affect heart rate, body temperature, energy level and calcium in the blood.
There are several types of thyroid cancer. Papillary and follicular thyroid cancers are the most common making up about 80-90% of all thyroid cancers. These two types tend to grow slowly and can be treated successfully if detected at an early stage. Medullary thyroid cancer makes up about 5-10 percent of all thyroid cancer cases. Anaplastic thyroid cancer makes up about 1-2 percent of all thyroid cancers making it the least common.
The American Cancer Society estimates that in 2002 about 20, 700 new cases of thyroid cancer will be diagnosed in the U.S. Of these new cases, about 15,800 will be diagnosed in women and 4,900 in men.
Treatment for thyroid cancer, except for anaplastic thyroid cancer, is very effective. More than 90% of patients treated for papillary or follicular thyroid cancer will live for 15 years or longer.
Scientists do not know the exact cause of thyroid cancer. There are however, a few risk factors that make a person more likely to develop this type of cancer. A diet low in iodine, head or neck radiation in childhood, radioactive fallout, hereditary conditions, being female and age.
Thyroid cancers that are in the early stages often do not cause symptoms. But, as it grows, thyroid cancer can produce the following signs and symptoms: a lump in the neck, pain in the throat or neck, hoarseness, trouble swallowing, difficulty breathing, hoarseness or persistent cough.
The following exams and tests are used to diagnosis thyroid cancer: physical exam, blood tests for levels of thyroid-stimulating hormone, ultrasound, radionuclide scanning and biopsy.
There are many treatment options for thyroid cancer. Surgery is the main treatment for all types of thyroid cancer. Because thyroid cancer can spread to nearby lymph nodes, several lymph nodes near the thyroid may be removed. Radioactive iodine therapy (I-131) is used to destroy any thyroid tissue that is left over after surgery and to treat any cancer that has spread to the lymph nodes. Radioactive iodine therapy is now standard practice in treating those who have thyroid cancer that has spread to the neck. It is recommended that you discontinue thyroid hormone pills for 1-2 weeks before treatment.
Based on the information you provided, the surgery and I-131 therapy are appropriate treatments. In addition to the surgery and I-131 therapy, hormone treatment is usually part of the treatment plan. After your thyroid has been removed, your body can no longer make the thyroid hormone it needs, so you will need to take thyroid hormone tablets. Thyroid hormone is also used to suppress TSH, which may promote the growth of thyroid cancer cells.
Other treatment options include external bean radiation therapy and chemotherapy. External beam radiation therapy is mainly used to treat people with advanced thyroid cancer that does not respond to I-131. Chemotherapy is sometimes used when thyroid cancers no longer respond to other standard treatments.
Follow up care after treatment for papillary thyroid cancer is very important. You should have a physical exam every 6 months, periodic chest x-rays, blood tests to check for thyroglobulin levels and yearly I-131 scans.
