Papillary Thyroid Cancer: Signs and Symptoms, Diagnosis, and Treatment Options
What is Papillary Thyroid Cancer?
Papillary cancer of the thyroid, also known as papillary thyroid carcinoma, is the most common type of thyroid cancer (70% of all thyroid cancers are papillary) with more than 10,000 new diagnosed cases per year in the United States. Although common, it is one of the most treatable types of cancer with more than 80% success rate. This type of cancer result from an uncontrollable development of cells within the thyroid gland.
Signs, Symptoms, and Diagnosis
Generally, this type of cancer is asymptomatic. It is normally discovered during a doctor visit by palpation of the thyroid gland. In many instances the doctor will notice a lump on the thyroid gland with no pain for the patient or the patient may feel an enlarged thyroid gland. However, not all enlarged thyroid glands are a sign of papillary thyroid carcinoma. Sometimes the doctor will feel a lump in the lymph nodes near the thyroid gland since this type of cancer is know to spread easily to lymph nodes.
When a patient is suspected to have a cancer of the thyroid gland a simple procedure, called fine needle aspiration biopsy (FNA) is ordered. In FNA a small needle is used to extract fluid from within the gland. This fluid is subject to a histopathology study to determine if a thyroid cancer exists. Ultrasound imaging and nuclear scans can also be used to diagnose papillary thyroid cancer.
Treatment Options
Surgery is the most effective treatment for papillary thyroid cancer. Surgery removes the tumor (or tumors) and in many instances represents a total cure for the cancer. There is considerable debate to the extent of which the gland should be removed. Some surgeons believe that total removal will prevent recurrence. Others think that removing only one lobe of the gland is enough to treat the cancer. The surgeon will make the decision during surgery as to whether to remove it partially or totally.
When the papillary thyroid carcinoma has spread to lymph nodes (it is usual) surgical removal of these enlarged lymph nodes is needed. The procedure is called modified radical neck dissection and implies the complete removal of the lymph nodes on one side of the neck. Chest x-rays are also prescribed since the lungs are one of the most common places where this type of cancer spreads to.
Radioiodine therapy (use of radioactive iodine as a cancer radiation treatment) is performed after a couple of months of thyroid removal. This treatment will kill cancerous cells that may remain after surgery. Radioiodine therapy may be repeated after 6 months depending of individual responses and follow-up. Also, hormone replacement therapy (taking levothyroxine, a thyroid hormone) is prescribed for life for people who have had thyroid surgery due to papillary thyroid cancer.
References:
Rosenthal, MS (2008). The Thyroid Sourcebook. McGraw Hill Professional
Rosenthal, MS (2002). Thyroid Cancer Book. Trafford Publishing, 2002