Medullary thyroid cancer (patient information)

Thyroid is a butterfly-shaped gland in the neck which makes hormones to help the bodywork normally. Medullary thyroid cancer is cancer that starts in the thyroid gland. Medullary thyroid cancer doesn’t have any early symptoms. With the development of the cancer, usual symptoms include a lump that can be felt through the skin on your neck, hoarseness, difficulty swallowing, pain in the neck and throat and swollen lymph nodes in the neck. Treatments include surgery, radiation therapy, chemotherapy, thyroid hormone therapy or a combination of them.

• Early medullary thyroid cancer does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:

• A nodule, lump, or swelling in the neck
• Pain in the front of the neck
• Hoarseness or other voice changes
• Trouble swallowing
• Breathing problems
• Continuous cough

• Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

• Medullary thyroid cancer can occur in older age groups.
• Other risk factors are a family history of medullary thyroid cancer and chronic goiter.
• There are several types of medullary thyroid cancer:

• Familial medullary thyroid cancer
• Sporadic medullary thyroid cancer

Clinical data have suggested that the development of medullary thyroid cancer is related to several factors.

• A diet low in iodine: Clinical survey show medullary thyroid cancer are more common in areas where people’s diets are low in iodine.
• Radiation: Scientists has proven that radiation exposure is a risk factor for follicular thyroid cancer. Such radiation includes medical treatments and radiation fallout from power plant accidents or nuclear weapons.
• Hereditary conditions: Studies show people with certain inherited medical conditions such as Gardner syndrome, Cowden disease, and familial adenomatous polyposis (FAP) are at higher risk of developing medullary thyroid cancer
• Gender: Contrary to other cancers, follicular thyroid cancers occur more often in women than in men.
• Age: Clinical data show that papillary and follicular thyroid cancer is usually found in people between the ages of 20 and 60 years.

Your doctor will perform a physical exam. This may reveal a lump in the thyroid, or swollen lymph nodes in the neck.

The following tests may be done:

• Calcitonin blood test to check for medullary cancer
• Thyroglobulin blood test to check for papillary or follicular cancer
• Laryngoscopy
• Thyroid biopsy
• Thyroid scan
• Ultrasound of the thyroid
• This disease may also affect the results of the following thyroid function tests:
• T3
• T4
• TSH

Call your health care provider if symptoms of thyroid cancer develop.

In order to diagnose medullary thyroid cancer, your doctor may suggest the following tests:

• Thyroid hormones tests: Thyroid hormones including T3, T4, FT3, FT4 and TSH (thyroid-stimulating hormone) are needed to assess thyroid gland function.
• Fine needle aspiration biopsy: The doctor places a thin, hollow needle directly into the nodule to take out cells and repeats twice or three times to receive samples from several areas of the nodule. Then these cells can be checked under a microscope to see whether cancerous or benign.
• Thyroid gland radio-iodine scan: During this test, the doctors put substances with small amounts of radiation into your body and detect the location of the substances. The test can help locate abnormal cells in the body.
• Computed tomography (CT scan) and biopsy: CT scans are often used to diagnose medullary thyroid cancer. It can help determine the location and size of medullary thyroid cancer and whether they have spread to nearby or distant areas. These are helpful for identifying the stage of cancer and in determining whether surgery is a good treatment option. CT scans can also be used to guide biopsy and a biopsy sample is usually removed and looked at under a microscope.
• Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces very detailed images of soft tissues such as the thyroid gland. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
• Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy which in turn is used to produce the images. PET can provide more helpful information than either CT or MRI scans. It is useful to see if cancer has spread to the lymph nodes and it is also useful for your doctor to locate where cancer has spread.

• Patients with medullary thyroid cancer have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, thyroid hormone treatment, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

• Surgery: Surgery is the main treatment for medullary thyroid cancer. Usually, surgery of removing the tumor and all or part of the remaining thyroid gland is recommended.
• Radiation therapy: It includes radioactive Iodine (Radioiodine) therapy and external beam radiation therapy. Radioactive iodine (RAI) known as I-131 can be taken into the body to destroy the thyroid gland and any other thyroid cells including cancer cells. During external beam radiation therapy, the doctors use high-energy rays to destroy cancer cells or slow their rate of growth.
• Chemotherapy: Chemotherapy is seldom helpful for most types of medullary thyroid cancer.
• Thyroid hormone therapy: This treatment is to take daily pills of thyroid hormone. The aim is to help maintain the body’s normal metabolism (by replacing missing thyroid hormone) and prevent some thyroid cancers from returning.

Directions to Hospitals Treating thyroid cancer

The reasons for the development of medullary thyroid cancer are not clear. Epidemiological data show the following may be helpful:

• Avoidance of diets low in iodine
• Avoidance of radiation exposure

The prognosis of medullary thyroid cancer depends on the following:

• The stage of cancer: the size of the tumor, whether the cancer has spread outside the thyroid gland
• Whether or not the tumor can be removed by surgery
• The patient’s general health

• Injury to the voice box and hoarseness after thyroid surgery
• Low calcium levels from accidental removal of the parathyroid glands during surgery
• Spread of the cancer to the lungs, bones, or other parts of the body

http://www.nlm.nih.gov/medlineplus/ency/article/001213.htm http://www.nlm.nih.gov/medlineplus/thyroidcancer.html

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