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Thyroid cancer
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Thyroid cancer

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CANCER

Head or Neck

 

Screening and diagnosis

Although you sometimes may see or feel a lump (nodule) in your thyroid yourself — usually just to the lower right or left of your Adam's apple — it's more likely your doctor will discover a lump during a routine medical exam. You're usually asked to swallow while your doctor examines your thyroid because the thyroid moves up and down during swallowing, making nodules easier to feel.

Sometimes a thyroid nodule is detected as an incidental finding when you have an imaging test to evaluate another condition in your head or neck. Nodules detected this way are usually too small to be found during a physical exam.

To help determine whether a nodule is malignant, you may have one or more of the following tests:

  • Blood tests. If your doctor suspects medullary cancer, you may have tests that check for high levels of calcitonin in your blood. Other tests can provide information about the function of your thyroid gland. For example, you may have a test that measures thyroid-stimulating hormone (TSH), a hormone made by the pituitary gland that regulates thyroid hormones.

  • Thyroid scan. This was once the primary way of assessing thyroid nodules. During the test, a radioactive isotope is injected into the vein on the inside of your elbow. You then lie on a table while a special camera produces an image of your thyroid on a computer screen. The length of the scan varies, depending on how long it takes the isotope to reach your thyroid gland. The disadvantage of a thyroid scan is that it can't distinguish between malignant and benign nodules. You're also exposed to a small amount of radiation during the test.

  • Fine-needle aspiration (FNA) biopsy. This test is generally considered the most sensitive for distinguishing between benign and malignant thyroid nodules. During the procedure, your doctor places a thin needle through your skin and into a nodule and removes a sample of cells. Several passes are usually needed to obtain tissue from different parts of the nodule. If you have more than one nodule, your doctor is likely to take samples from as many as possible. Sometimes your doctor may use ultrasound to help guide the placement of the needle. The samples are then sent to a laboratory and analyzed under a microscope. Only a small percentage of biopsied nodules are malignant. This diagnosis is based on the characteristics of individual cells and patterns in clusters of cells that are different from normal thyroid tissue. In some cases, a pathologist can determine specific types of cancer from an FNA biopsy sample.

  • Surgical biopsy. Occasionally, an FNA doesn't provide a definitive diagnosis. In that case, your doctor may operate to remove the nodule, which is then examined in a pathology laboratory.

Staging tests
If you receive a diagnosis of thyroid cancer, you're likely to have tests to help determine whether the cancer has spread (metastasized) — a process known as staging. The stage of cancer helps your doctor determine the best course of treatment and the outlook for your recovery. The staging tests you have may vary, depending on the type of thyroid cancer.

  • Papillary and follicular cancers. A radioactive iodine thyroid scan is commonly used to stage papillary and follicular thyroid cancers. But unlike most tumors, which are staged before treatment, your doctor is likely to remove the primary tumor along with part or all of your thyroid gland before the test. That's because normal thyroid tissue would absorb most of the radioactive iodine from the scan, making metastatic cells hard to detect. Prior to this surgery, your doctor may recommend an ultrasound examination of your neck to determine if the cancer has spread to your lymph nodes.

  • Medullary thyroid cancer. Because thyroid C cells don't absorb iodine, thyroid scans aren't used to stage medullary cancer. Instead, you may have imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI). A CT scan uses split-second computer processing and X-ray beams to produce detailed cross-sectional images of your internal organs. This test exposes you to more radiation than conventional X-rays do, but in most cases, the benefits outweigh the risks. MRI, on the other hand, uses a powerful magnetic field and radio waves — not X-rays — to produce images of your body. Sometimes you may have an octreotide scan — a test that uses a radioactively tagged hormone to check for the spread of medullary cancer.

Screening tests
If you have medullary cancer, make sure that everyone in your immediate family — children, parents, siblings, aunts and uncles — is screened for the disease. In the past, doctors used a screening test that stimulated the thyroid gland to produce calcitonin. People with high calcitonin levels were considered at risk of medullary cancer. Now, DNA testing, which checks a blood sample for a genetic defect, is considered a more accurate screening method.

If you have medullary thyroid cancer but don't test positive for the RET gene, it's still important that your close family members should have their calcitonin levels tested. This is generally done using a calcium infusion test. Although the calcitonin level of healthy people rises slightly after an injection of calcium, it's much higher in people with medullary thyroid cancer.

The calcium infusion test usually takes between 15 and 20 minutes and is done on an outpatient basis. You'll have a small amount of blood drawn before the injection of calcium and again at two, five, 10 and 15 minutes after the injection.

Complications

Thyroid tumors can lead to a number of complications, including:

  • Difficulty swallowing and breathing. Some thyroid cancers, particularly fast-growing anaplastic tumors and thyroid lymphomas, can cause hoarseness and difficulty breathing or swallowing when they spread to or press on your windpipe or esophagus.

  • Hoarseness. The nerves that control your vocal cords lie next to your thyroid gland. Aggressive thyroid cancers can irritate or damage these nerves, leading to a hoarse voice.

  • Diarrhea. Medullary thyroid cancer can cause severe diarrhea, which may be related to calcitonin production. It's usually controlled with drugs that reduce the activity of the intestine such as Lomotil or Imodium.

  • Spread of cancer (metastasis). The most serious complication of thyroid cancer is the spread of the cancer to other tissues and organs. This is especially likely in anaplastic cancer, which has often spread to the trachea or lungs by the time it's diagnosed. Follicular and papillary cancers also may spread to distant organs such as the lung, bone and liver.

 

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/15/08 02:26 AM