Healing is a journey best shared, as seen with Julia and her husband, Ian. Julia’s cancer first appeared as a nodule on her thyroid. When an ultrasound showed changes, a biopsy confirmed that she had thyroid cancer. In a rare coincidence, while Julia awaited her results, doctors found a lump in Ian’s neck. Both were diagnosed with thyroid cancer on the left side, with similar tumour sizes. The couple underwent surgery to remove part of their thyroids and have since fully recovered, now enjoying life to the fullest.
Julia’s experience emphasises the need for proactivity. Symptoms like a cough, hoarseness or lump in the neck are often dismissed as flu or fatigue, yet they could signal thyroid cancer, whose prevalence is rising.
According to the National Cancer Registry Programme in India, one in 752 men and one in 285 women will develop this cancer in their lifetime. Awareness and understanding are crucial for timely detection and treatment. Advances in oncology have led to innovative treatment options, offering hope to patients.
What is thyroid cancer?
The thyroid is a butterfly-shaped gland located at the base of the neck, responsible for producing hormones that regulate metabolism, weight, heart rate, blood pressure, and temperature. Thyroid cancer develops from abnormal cell growth in this gland and may initially show no symptoms.
As the disease progresses, it can cause hoarseness, lumps, trouble swallowing, and persistent neck or throat pain. Different types of thyroid cancer include differentiated thyroid cancers, medullary thyroid cancer, and anaplastic thyroid cancer, with papillary thyroid cancer comprising 84% of cases.
Key risk factors include exposure to high levels of radiation, certain inherited genetic conditions, and gender (women are disproportionately affected).
Diagnosis and treatment
Diagnosing thyroid cancer begins with a physical examination, followed by imaging tests such as ultrasound, CT scans, MRI, along with a biopsy. Furthermore, identifying the specific type of thyroid cancer is important, and molecular testing may be performed to detect specific genetic mutations. Once diagnosed, cancer staging is essential to determine the extent of its spread and guide treatment options.
Surgery: The primary treatment for thyroid cancer involves surgical removal of the thyroid gland (thyroidectomy) or a portion of it. The most common surgical approach is by neck incision in a necklace fashion. Another alternative option is robotic scarless surgery, however there is limited experience with this approach. If the cancer has spread, lymph nodes may also be removed. Precision care is important based on the extent of the disease and maintaining the best quality of life.
Radioactive iodine therapy (RAI): In cases of follicular thyroid cancer or advanced papillary thyroid cancer, patients may also undergo RAI after surgery. Most patients may need only one or two doses. This treatment is used to destroy any abnormal thyroid tissues left behind. It may also be used in case of metastatic or recurring cancer.
External beam radiation therapy(EBRT): In some cases, EBRT is used when the cancer has spread, and the above options are not effective. This treatment uses high-energy beams (proton therapy and intensity-modulated radiation therapy) to destroy cancer cells. Advances in this technique allow for precise adjustments to minimise toxicity and spare surrounding healthy tissues.
Targeted therapy: This treatment focuses on specific genetic mutations found in some thyroid cancers. It involves medications that block tumours from forming new blood vessels and inhibit the proteins necessary for cancer growth. This includes drugs such as tyrosine kinase inhibitors (TKIs), which are used to inhibit tumour growth by blocking certain signalling pathways. Enormous progress has been made in BRAF positive anaplastic thyroid cancer in the last few years.
Immunotherapy: Despite being in the nascent stage, the functions of immunotherapy are also being explored in treating thyroid cancer. This form of therapy works by training the body’s immune cells to fight the cancer.
Genetic testing and personalised medicine: Recognising that not all thyroid cancers are the same, genetic testing helps identify unique mutations in aggressive cases (5% to 10%). This information allows doctors to personalise treatment plans based on individual genetic and physical traits, optimising efficacy while minimising side effects.
Effective patient-clinician interactions are crucial for choosing the most suitable treatment options. Familiarity with the latest procedures can alleviate concerns and empower patients on their journey to recovery.
Dr Ashok R Shaha
Head and neck surgeon, Memorial Sloan Kettering Cancer Center, New York