Thyroid Cancer Awareness: Ask Your Physician To Check Your Neck

Neetu, a young professional, noticed a small lump on the right side of her neck while getting ready for the office. It was a small, firm, and painless growth. She had no other complaints. Her family physician referred her for an ultrasound of the neck and a few blood investigations. Ultrasound showed growth in the thyroid gland. A needle examination was performed on the growth which revealed that she has developed thyroid cancer. This resulted in anxious moments for Neetu as well as her family members. She underwent thyroid surgery followed by radioactive iodine treatment. 10 years later, she is leading a normal life.

The thyroid gland is a butterfly-shaped gland in the neck which weighs around 20 grams. The thyroid gland produces important hormones which control heart rate, metabolism, body temperature, and amount of calcium in the blood. The thyroid gland is made up of two main varieties of cells i.e. follicular cells and para-follicular cells (C cells). Follicular cells secrete thyroxine hormone whereas para-follicular cells secrete calcitonin.

What is thyroid cancer? Different types of thyroid cancers

Thyroid cancer is cancer developing from the cells in the thyroid gland. Various risk factors for thyroid cancer are exposure to radiation and a family history of thyroid issues. Thyroid cancer affects people of all ages, from young children to the elderly. Thyroid cancer is diagnosed considerably more commonly in women than in men.

• The four main types of thyroid cancer are papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer.
• Papillary thyroid cancer is the most common type of thyroid cancer, accounting for roughly 85 percent of all thyroid cancers. The cure rates for this type of thyroid cancer are high, especially if diagnosed early.
• Follicular thyroid cancer comprises approximately 10 percent of thyroid cancers which begins in follicular cells and usually grows slowly. This type of cancer is also highly treatable if diagnosed early enough.
• Medullary thyroid cancer develops from the para-follicular cells (C cells). Nearly everyone with a specific gene mutation develops this rare malignancy.
• An uncommon and aggressive form of thyroid cancer called anaplastic thyroid carcinoma typically affects those over 60. This type of cancer is challenging to cure and spreads quickly.

Increasing incidence of thyroid cancer in India and worldwide

The incidence of thyroid cancer is increasing worldwide. As per the data from National Cancer Registry Programme(NCRP) India, the incidence rate of thyroid cancer has shown an increase of 62% and 48% respectively among women and men respectively. The increase in incidence is attributed to rising awareness among the people and the availability of diagnostic modalities leading to early diagnosis. 

Warning signs and symptoms

Most thyroid cancers present in the form of a small lump/nodule in the neck which is usually firm to hard and generally painless. Some patients may develop hoarseness of voice/difficulty in breathing. No significant weight gain or weight loss is usually noted. A simple neck examination by a medical professional can detect a thyroid nodule. However, 90% of the thyroid nodules are benign and not cancerous. The next investigations ordered are ultrasound of the neck (USG Neck), thyroid function tests (TFTs) followed by needle aspiration i.e. FNAC if required. In some cases, MRI may be ordered for further evaluation.

Although a cancer diagnosis of any kind can be scary, the most common forms of thyroid cancer have a very high long-term survival rate (over 90%), especially when diagnosed early.

Treatment of thyroid cancers

Most thyroid cancers are treated in 2 steps (a) surgery followed by (b) radioactive iodine (Iodine-131) therapy.

(a) Surgery

Most common surgery performed is total thyroidectomy which means the removal of the entire thyroid gland. Additionally, suspicious lymph nodes of the neck are removed during the surgery. The initial surgery is the most important part of the treatment.

(b) Radioactive iodine (iodine-131) therapy

Radioactive iodine or iodine-131 is a radioactive medicine that is given to eliminate (ablate) any remaining thyroid cancer cells that could not be removed during surgery. Radioactive iodine therapy significantly reduces the chances of disease recurrence. This treatment is very well tolerated and does not have major long-term side effects.

Content By: Dr. Ankur Pruthi, DRM, DNB (Nuclear Medicine), Consultant and Head, Manipal Hospital, Dwarka

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