Thyroid cancer is one of the most common cancers of the endocrine system and occurs in all age groups, including children. In India, the number of new cases of thyroid cancer is 13.9 per 100,000 men and women per year. There are four main types of thyroid cancer, Papillary and follicular cancers often are the commonest ones accounting for more than 80-90% of thyroid cancers. The other two types (medullary and anaplastic) are rarer.
- Lump in the neck
- Pain in the lower front part of neck
- Swollen Lymph Nodes in Neck
- Hoarseness of voice
- Trouble in breathing and swallowing
How to Detect?
A successful treatment plan involves adopting a collaborative approach and combining the expertise of head and neck Onco surgeons, endocrinologists and a nuclear physician. However, physical examination, blood tests, thyroid and other scans, thyroid ultrasound, neck ultrasound, Technetium Thyroid Scan and Fine Needle Aspiration Cytology (FNAC) and surgical biopsy should be done to detect thyroid cancer in a patient.
People who are more at risk include: those with a family history of thyroid cancer; age groups below 20 and above 70 years; and those who have had prior head and neck radiation.
As with all cancers, early detection largely increases the chances of complete cure. Most of the time patients experience no symptoms, but on appearance of a neck swelling, change in voice or hoarseness, persistent neck pain, swallowing difficulty, one needs to go for a full check up.
The treatment for thyroid cancer proceeds in three stages:
- surgical removal of the gland (total thyroidectomy)-After thyroidectomy, the patient is advised to refrain from taking thyroid tablets until the low dose radioiodine whole body scan is performed 3-4 weeks later. The patient remains off iodine containing foods (i.e. sea foods, iodised salt) as well.
- radioiodine (I131) scan followed by radioiodine therapy (for remnant thyroid / spread of disease)- Radioiodine is given orally either as a liquid or a capsule. Scan is performed 24-48 hours later. The scan essentially quantifies the amount of residual thyroid tissue in the neck and also evaluates for any known or unsuspected spread of thyroid cancer to lungs, bone or elsewhere. It is a very safe and effective form of therapy for papillary, follicular varieties of thyroid cancer.
- long term monitoring- To monitor progress and rule out any remaining cancerous cells in the body. A patient under surveillance undergoes radioiodine scan six months after the radioiodine treatment along with a specific blood test i.e. serum thyroglobulin and neck ultrasound.
Managing Thyroid Cancer
The management of thyroid cancer is similar in adults and children. Children normally have aggressive forms of the disease, which fortunately respond much better than in adults to the radioiodine treatment. Once the treatment is complete, the patient is prescribed thyroxin which needs to be taken life long.
In today’s practice, key hole surgery is possible in Thyroid surgery. Now a days, it does not involve large incisions, hemithyroidectomy and total Thyroidectomy are done by key hole surgery and only a small incision given to take out the specimen.