Thyroid cancer

What is it?

The thyroid is a small, butterfly-shaped gland low at the front of the neck.^1,5 It makes hormones that control how your body uses energy and help your heart, muscles and digestion work.^1,5 The main types of thyroid cancer are papillary and follicular cancer, medullary cancer, and anaplastic cancer, which is less common and grows fast.^6,3

Anyone can get it, but women get it more often than men: women most often in their early 40s, men in their 70s.⁴ The risk is higher if you are overweight, have had other thyroid problems (such as a goitre, Hashimoto's disease or thyroid lumps), had a lot of radiation, especially as a child, or a close relative has had thyroid cancer.⁴ Medullary thyroid cancer is sometimes caused by a gene change that is passed from parent to child. You may also be more likely to get thyroid cancer if a close family member has had it.^3,4 Losing weight if you need to and drinking less alcohol can lower your chances.⁴

The first signs

Thyroid cancer may not cause signs at first. It is sometimes found during a routine check-up.^1,3

• a lump at the lower front of the neck, usually firm, painless and slow-growing;²
• a hoarse voice that does not get better;^2,1
• trouble swallowing or breathing;^2,1
• pain or a feeling of pressure at the front of the neck.²

Less common signs are a flushed face, loose stools or diarrhoea, weight loss and a cough.² They can have many other causes, but if cancer is the cause, finding it early may make it easier to treat.²

How doctors find out

If your family doctor sends you to a specialist, you may have blood tests, an ultrasound scan of the neck, and a biopsy, where a needle takes a small sample from the thyroid.⁷ You can ask for the sample to be checked by a pathologist with experience of thyroid cancer.³

If you have cancer, CT, MRI or PET scans and a thin camera passed through the nose to check your vocal cords show its size and whether it has spread.⁷ Results usually take about 2 weeks.⁷ A specialist nurse is your main contact.⁷

Current treatment

Surgery to remove all or part of the thyroid is the most common treatment. You may then have hormone tablets or radioactive iodine. Targeted medicines or radiotherapy may be used if the cancer has spread or comes back.Source: NHS

Will it get worse?

Papillary and follicular cancers can usually be cured. Most thyroid cancers are found at the local stage, when the cancer is still only in the part of the body where it started.^3,6 How it goes depends on the type and stage, your age, and whether surgery removed all of the cancer.³ Medullary cancer has a middle outlook, and anaplastic cancer grows and spreads quickly, so the outlook is poorer.^8,3

The cancer can come back, so you have regular check-ups and tests after treatment.^3,9 Advanced thyroid cancer can be very hard to treat and may not be curable; treatment then aims to hold it back, ease symptoms and help you live longer.⁹

Medicines: what helps, and what to watch for

After the whole thyroid is removed, you usually need thyroid hormone tablets to replace the hormones it made.⁹ Some people need them after part of the thyroid is removed too.⁹ The tablets can also lower the chance of the cancer coming back.⁹ Targeted medicines aim to slow or stop the cancer growing. You may have them if the cancer has spread, or if other treatments are not an option or are no longer working.⁹ Chemotherapy is not usually used.⁹

Good to know:

• Your team explains the benefits and side effects of each treatment and helps you manage side effects;⁹

Surgery and radioactive iodine

Surgery is the most common treatment.⁹ The surgeon removes the whole thyroid or part of it, depending on the type and stage, and sometimes lymph glands in the neck.⁹ Surgery to make an opening in the windpipe (tracheostomy) can help you breathe.³

Radioactive iodine is a small dose of radiation that you swallow as a tablet or drink.⁹ Thyroid cells take it up, so it destroys cancer cells left after surgery or ones that have spread; a small test dose may be given first.^3,9 Radiotherapy from outside the body can be used if surgery cannot remove the cancer, or if it comes back or spreads.^9,3

Is there a cure?

Yes, usually, for papillary and follicular cancer.^3,8 Anaplastic thyroid cancer grows and spreads quickly and has a poorer chance of recovery.^3,8 Researchers are testing immunotherapy for thyroid cancer. You can join a clinical trial before, during or after you start treatment.^3,8

Sources

1. MedlinePlus: Thyroid Cancer
2. NHS: Thyroid cancer – Symptoms
3. NCI PDQ: Thyroid Cancer Treatment (PDQ) – Patient Version
4. NHS: Thyroid cancer – Causes
5. NHS: Thyroid cancer – What is thyroid cancer?
6. NCI SEER: Cancer Stat Facts: Thyroid Cancer
7. NHS: Thyroid cancer – Tests and next steps
8. NCI PDQ: Thyroid Cancer Treatment (PDQ) – Health Professional Version
9. NHS: Thyroid cancer – Treatment