You might be diligent with your smear tests and head to your GP as soon as you see a mole that's changed shape. But there’s one cancer on the rise in women that we might not be paying quite as much attention to: thyroid.
'Thyroid cancer is an abnormal growth of thyroid cells that has the potential to spread to other parts of the body,' says Dr. Kyle Zanocco, an endocrine surgeon and assistant professor of surgery at UCLA Health. Thyroid cancer occurs when thyroid cells—which make up the butterfly-shaped gland that sits below your voice box—acquire genetic mutations that lead to an uncontrolled growth, says Dr. Zanocco.
The condition is especially common in women, who are three times more likely to develop thyroid cancer than men. While the disease can be found in any gender at any age, it’s most frequently found in women in their 40s and 50s, says Dr. Zanocco.
Experts don’t know why thyroid cancer strikes more women, but there are theories. 'Before puberty, thyroid cancer is seen evenly distributed in boys and girls, and we only see the proportion of women increasing after puberty,' says Dr. R. Michael Tuttle, an endocrinologist at Memorial Sloan Kettering Cancer Center who specialises in thyroid cancer. 'So it likely has something to do with the female hormones, but no one is really sure.'
What are the types of thyroid cancer?
1. Differentiated thyroid cancer
Differentiated thyroid cancer (which is further broken down into subtypes of papillary, follicular, or Hurthle cell carcinoma) accounts for well over 90 percent of thyroid cancers. It develops in the cells of the thyroid that are responsible for the usual functions of the thyroid gland, like producing and releasing hormones. Most differentiated thyroid cancers, and papillary thyroid cancer in particular, don’t typically act in an aggressive way and aren’t unusual tumours, which means the prognosis is very good, says Dr. Tufano.
2. Medullary thyroid cancer
This form doesn’t originate in the usual thyroid cells but in what are called 'C cells.' These cells produce a hormone called calcitonin, which for other animals is used to decrease calcium in the bloodstream, says Dr. Tufano. (Humans don’t have that need, so they don’t serve a purpose for us.) About 1/4 of patients with medullary cancer have inherited the condition, says Dr. Steven I. Sherman, chair of the Endocrine Neoplasia and Hormonal Disorders department at MD Anderson Cancer Center.
3. Anaplastic thyroid cancer
This form is the rarest and most aggressive form of thyroid cancer. 'It develops when multiple additional genetic changes occur that turn differentiated cancer—which is a disease where most people live long enough to die from something else and is very slow growing—into one of the most highly aggressive forms of cancer that we have today, period,' says Dr. Sherman. Anaplastic thyroid cancer only occurs in about 1,000 people in the U.S. per year, he adds.
What are the symptoms of thyroid cancer?
Here’s the really tricky part: Most people with thyroid cancer are completely asymptomatic, says Dr. Tuttle, which is why a good portion of thyroid cancers are detected during other screenings. For the more aggressive and advanced thyroid cancers, however, there are some signs to watch for. These symptoms are very rare, so if you’re experiencing them, head to your doctor right away.
1.A change in your voice
One of the ways aggressive thyroid cancers can become symptomatic is by the local invasion of surrounding structures, including the nerve that controls your vocal chord, says Dr. Tufano. If that nerve is invaded by the cancer, it can cause hoarseness or changes in your voice.
2. Coughing up blood
Similarly, because the thyroid is intimately associated with the trachea and oesophagus, in very rare cases it can cause you to cough up blood, says Dr. Tufano.
3. Difficulty swallowing or breathing
Advanced thyroid cancer can make swallowing or breathing difficult if the tumour is exerting pressure on the structures within the neck, says Dr. Zanocco, including the windpipe or food pipe.
4. Extreme diarrhoea
This symptom is specific to medullary thyroid cancer because of the proteins this specific type of cancer makes. 'Sometimes, patients will come in presenting with chronic diarrhoea and may get evaluated by gastroenterologists—sometimes for months or years—trying to figure out what the cause of the diarrhoea is, and it turns out to be related to medullary carcinoma,' says Dr. Sherman. For those with medullary cancer, they could have bowel movements between 10 and 20 times per day, he adds.
5. A large lump at the base of your neck
This symptom is what some physicians will notice incidentally during a physical exam by feeling a lump in your thyroid gland, which is typically painless, says Dr. Tuttle. If you’ve received radiation to your neck, especially, keep in mind that you’re more at risk for developing thyroid cancer, says Dr. Sherman, so talk with your physician about examining your neck to make sure you’re not developing one of these cancerous lumps.
6. Swollen lymph nodes
As the thyroid cancer tumour gets bigger, it can also cause swelling of the lymph nodes on the side of the neck, says Dr. Sherman. (Note that your lymph nodes swell with any illness—even a cold—so this symptom alone is unlikely because of cancer.)
How is thyroid cancer treated?
Because there’s such a wide range of thyroid cancers with varying degrees of aggression, how the cancer is treated is also pretty specific to the individual.
For differentiated and medullary thyroid cancers, the primary treatment is surgical removal of half or all of the thyroid gland and, if needed, the lymph nodes in the region, says Dr. Sherman. Then, some patients will be treated with a follow-up of radioactive iodine, which is delivered in a pill that gets concentrated specifically in the thyroid cells—including those that are cancerous—and eventually kills them off.
The next step for patients who have undergone surgical removal of their thyroid is to receive thyroid hormone medication to make up for what their body used to produce, says Dr. Sherman. 'For differentiated cancer, the traditional triad was surgery, radioactive iodine, and thyroid hormone therapy,' he explains. 'We now are being more selective in who gets radioactive iodine, and who gets and how much surgery is performed.
In fact, for some patients with differentiated thyroid cancer that’s very small and limited to the thyroid, they might not have to undergo any treatment at all. Rather, they’d go under active surveillance, which would mean monitoring the cancer via ultrasound every 4 to 6 months for the first year or two after diagnosis, and then every 6 to 12 months after that, says Dr. Sherman.
'The majority of our data shows that even if we delay intervening until the nodule grows by 3 millimetres, for example, most of those patients still do very well,' says Dr. Tufano.
Treating anaplastic thyroid cancer, however, looks a little different because of its aggression. Although there used to be no treatment for this type of cancer, there are now chemotherapy options that can allow patients with this condition to live for up to one to two years with a good quality of life, says Dr. Sherman.
The most important thing is seeing a doctor who specialises in the treatment of thyroid cancer should you get diagnosed, especially for less aggressive types.
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