generally presents as a nodule, lump, or mass in the
thyroid. Less commonly, a swollen gland or lymph
node in the neck may be the initial manifestation of
The thyroid is a butterfly-shaped gland located
at the base of your neck, just below your Adam's
apple. Although the thyroid gland is small, it
produces hormones that regulate every aspect of your
metabolism, from your heart rate to how quickly you
Sometimes you may develop one or more solid or
fluid-filled lumps in your thyroid, called nodules.
The great majority of these nodules are noncancerous
(benign) and cause no symptoms. Approximately 5
percent of nodules are malignant.
For most of these people, the prognosis is
excellent. The most common types of thyroid cancer
can often be completely removed with surgery. What's
more, five-year survival rates are among the highest
of any type of cancer - more than 90 percent.
Signs and symptoms
Most often, you won't have signs and symptoms in the
early stages of thyroid cancer, but as the cancer grows, you may
experience one or more of the following:
lump sometimes growing rapidly in the front of your neck, just
below your Adam's apple
Hoarseness or difficulty swallowing
Swollen lymph nodes, especially in your neck
in your throat or neck, sometimes spreading up to your ears
Having one or more of these symptoms doesn't necessarily
mean you have thyroid cancer. Other conditions including a benign
thyroid nodule, an infection or inflammation of the thyroid gland, or a
benign enlargement of the thyroid (goiter) can cause similar problems,
all of which are highly treatable.
Your thyroid gland is composed of two lobes that resemble
the wings of a butterfly separated by a thin section of tissue called
the isthmus. The thyroid takes up iodine from food you eat and uses it
to manufacture two main hormones, thyroxine (T-4) and triiodothyronine
(T-3). These hormones maintain the rate at which your body uses fats and
carbohydrates, help control your body temperature, influence your heart
rate and regulate the production of protein. Your thyroid gland also
produces calcitonin, a hormone that regulates the amount of calcium in
The thyroid contains two main types of cells. Follicle
cells make the thyroid protein thyroglobulin and produce and store
thyroxine and triiodothyronine. Other cells, called C cells (parafollicular
cells), produce calcitonin. Distinguishing between these cells is
important because each can give rise to different types of cancer.
Papillary and follicular cancers develop in follicle
cells. They account for the great majority of thyroid cancers, can
usually be completely removed with surgery and generally result in an
excellent prognosis. Medullary cancer, on the other hand, arises in the
thyroid's C cells and is generally more aggressive and harder to treat
than papillary and follicular cancers.
Descriptions of the types of thyroid cancer follow:
Papillary cancer (papillary carcinoma, papillary adenocarcinoma).
This is the most common type of thyroid cancer. It develops from
thyroid follicle cells and usually appears as a single mass in one
lobe of the thyroid. Anyone, including children, can develop
papillary cancer, but it's most common in women who are between 30
and 50 years of age. Although most papillary cancers grow slowly,
they often spread to the lymph nodes early in the course of the
disease. This usually doesn't affect the outlook for recovery, which
is generally excellent when the cancer is small and its spread
limited to the lymph nodes in your neck. The prognosis isn't as
positive for people with very large tumors or in the rare cases when
papillary cancer has invaded tissues other than the lymph nodes. But
even papillary tumors that have spread to the lungs or bone often
can be successfully treated with radioactive iodine (radioiodine).
Follicular cancer (follicular carcinoma, follicular adenocarcinoma).
Follicular tumors don't usually spread to the
lymph nodes but are likely to invade the veins and arteries within
the thyroid. From there, they may spread to organs such as your
lungs and bone.
Anaplastic cancer (anaplastic carcinoma).
This rare form of thyroid cancer is sometimes called
undifferentiated cancer because it looks very different from normal
thyroid tissue under a microscope. It appears to develop from an
existing, undiagnosed papillary or follicular cancer. Anaplastic
cancer is extremely aggressive, spreads rapidly to the lymph nodes
and trachea, and then to other organs, especially the lungs and
bone. For that reason, it's often not curable surgically by the time
it's diagnosed. Unfortunately, other therapies, such as radiation,
aren't usually successful in controlling anaplastic cancer.
Medullary cancer (medullary carcinoma).
Rather than arising from follicle cells, this type of thyroid cancer
develops in calcitonin-producing C cells. Medullary tumors usually
make calcitonin along with carcinoembryonic antigen (CEA) a
protein produced by certain cancers. Both are released into the
bloodstream and can be detected by blood tests. But in many cases,
medullary cancer may spread to the lymph nodes or other organs
before a lump is detected or blood tests are performed.
There are three main types of medullary cancer: sporadic, multiple
endocrine neoplasia, type II (MEN 2), and familial. Sporadic tumors
make up the great majority of medullary cancers. They primarily
affect people between the ages of 40 and 60 and are not inherited.
2 medullary cancers, on the other hand, are passed from one
generation to the next and usually appear much earlier in life than
other thyroid cancers. In addition to thyroid tumors, people with
MEN 2 usually have tumors in other endocrine glands, such as the
adrenal or parathyroid glands.
2 has two subtypes, MEN 2A and MEN 2B. People with MEN 2A often
develop adrenal gland tumors (pheochromocytomas) and tumors of the
parathyroid glands four glands that sit behind the thyroid and
produce a hormone that helps maintain the proper balance of calcium
and phosphorus in the body. Although these associated tumors are
usually benign, they can lead to serious complications. Adrenal
gland tumors, for example, can cause high blood pressure, while
parathyroid tumors can contribute to dangerously high levels of
calcium as well as to osteoporosis and kidney stones.
People with MEN 2B also have adrenal gland tumors, but not
parathyroid gland problems. Instead, they develop benign nerve
tissue growths (neuromas), mainly on their tongues, the underside of
their eyelids and in the intestine. They may also have thick lips
and thickened eyelids. The thyroid cancer that occurs in people with
MEN 2B syndrome is particularly aggressive and usually develops at a
very young age.
Familial medullary cancers are inherited, but unlike MEN 2 cancers,
affect only the thyroid gland. They are usually slower-growing than
MEN 2 tumors, and they primarily affect people who are in their 40s
This rare type of cancer doesn't develop from thyroid follicular
cells or C cells. Instead, it starts in immune system cells called
lymphocytes. Although most lymphomas begin in the lymph nodes, some
occasionally appear in other organs, such as the thyroid.
causes thyroid cancer?
Healthy cells grow and divide in an orderly way. This
process is controlled by DNA the genetic material that contains the
instructions for every chemical process in your body. When DNA is
damaged or altered, changes occur in these instructions. One result is
that cells may begin to grow out of control and eventually form a tumor
a mass of malignant cells.
In the case of thyroid cancer, DNA damage can occur from
exposure to environmental contaminants such as radiation, from the aging
process, or, in medullary cancers, from genetic causes:
This is the cause of most papillary cancers and anaplastic cancers,
which may not appear for decades after exposure. Children who
received high doses of radiation to treat conditions such as acne,
enlarged tonsils and scalp infections between the 1920s and 1950s
are at higher risk of thyroid cancer and thyroid nodules than are
those who didn't receive these treatments. Also at high risk of
thyroid cancer are people who have been exposed to radioactive
particles from atomic weapons tests and nuclear power plant
accidents such as the 1986 Chernobyl disaster in the former Soviet
greatest cancer risk comes from a component of fallout called iodine
131, a radioactive isotope of naturally occurring iodine that
concentrates in the thyroid gland. Iodine 131 is especially harmful
to children, whose thyroid glands are still developing. In Ukraine
and Belarus, the regions most immediately affected by the Chernobyl
accident, at least 2,000 cases of thyroid cancer in children and
adolescents have been linked to iodine 131. Most children were
exposed when they consumed milk, fruits and vegetables contaminated
Familial medullary cancer and MEN 2 medullary thyroid cancers result
from a genetic defect a mutation of a gene that controls cell
growth (oncogene) called RET. The mutation is inherited, and each
child of a parent with the defect has a 50 percent chance of
inheriting it as well. Before the discovery of the RET gene, people
with a family history of medullary thyroid cancer were screened
using tests that measure levels of calcitonin and carcinoembryonic
antigen. Now, genetic testing allows doctors to discover an
inherited tendency to thyroid cancer much earlier before symptoms
ever develop. About 90 percent to 95 percent of people with the RET
mutation go on to develop cancer. A few families who don't have the
RET genetic defect also develop and pass on medullary thyroid cancer
and MEN 2.
Genetic testing is controversial, especially when a disease can't be
prevented or successfully treated. But medullary thyroid cancer can
be prevented by surgically removing the thyroid gland (thyroidectomy)
before problems occur. Children at risk of MEN 2A may have this
surgery around age 7 or 8 and children at risk of MEN 2B as early as
1 year of age. You can live a normal life without a thyroid gland,
although you must take thyroid hormones for life to replace those
your thyroid would ordinarily produce. And because MEN 2 is a
syndrome involving other types of tumors, children who have their
thyroid glands removed still need to be monitored for other
you have a family history of medullary thyroid cancer, consider
talking to a genetic counselor. He or she can explain the advantages
and disadvantages of genetic testing and the risks and benefits of
Thyroid cancer >
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