Last Updated on Wednesday, 21 October 2009 15:49

Thyroid cancer represents 1% of new cancer diagnoses annually. Thyroid cancer is about 3 times more common in women than men and is usually diagnosed between the age of 25 to 65, peaking in the 3rd and 4th decades.

Thyroid Cancer and Treatment Options

By Dr. Alen N. Cohen. M.D., F.A.C.S:

The thyroid gland and what is it’s function?

The thyroid gland is shaped like a butterfly and sits just below the voice box and in front of the trachea (wind-pipe). It resides under thin muscle layers in the midline central neck just above the sternum and moves with swallowing as it is attached to the trachea. The thyroid gland is a central organ in the body that secretes thyroid hormones and as such regulates our body’s metabolism, energy level and various other functions. Various disorders within the thyroid gland can arise such as hypo- or hyperthyroidism, various autoimmune disorders (i.e. Hashimoto’s thyroiditis, Grave’s disease), an enlarged multinodular gland called a goiter and even thyroid cancer.

How common is thyroid cancer and who does it affect?

Thyroid cancer represents 1% of new cancer diagnoses annually. In the U.S. approximately 35,000 people are diagnosed with thyroid cancer yearly. Thyroid cancer is about 3 times more common in women than men and is usually diagnosed between the age of 25 to 65, peaking in the 3rd and 4th decades. With recent advances in the treatment of thyroid cancer, it remains to have an extremely favorable prognosis with an over 90% cure rate in most patients.

What are the different types of thyroid cancer?

Thyroid cancers are divided into four types, namely papillary, follicular, medullary and anaplastic thyroid carcinoma. Rare thyroid cancers include lymphoma, sarcoma and squamous cell carcinoma. Papillary and follicular thyroid carcinomas are referred to as well-differentiated types of thyroid cancer and represent 80-90% of all thyroid cancers with papillary being the most common. Medullary thyroid carcinomas accounts for 5-10% of all thyroid cancers and anaplastic carcinoma accounts for only 1-2%. The other types combined account for less than 1% of all thyroid cancers.

How do patients with thyroid cancer usually present?

Thyroid cancer most commonly presents as a painless, palpable, solitary thyroid nodule which is usually picked up during examination either by the patient or physician or more commonly these days incidentally with the advent of detailed imaging modalities such as CT, MRI, PET or ultrasound. Nodules and cysts are not uncommon findings among the general population as they occur in up to 7% of all adults in the United States. Although the majority of these nodules, over 80%, are benign in nature, all masses within the thyroid gland warrant further attention as 5-10% will turn out to be cancerous.

Which patients are at higher risk for thyroid cancer?

Patients are risk-stratified usually by their thyroid specialist, whether this is a surgeon or endocrinologist. Risk factors include age at presentation. The patient's age at presentation is important because solitary nodules are more likely to be malignant in patients older than 60 years and in patients younger than 30 years. In addition, thyroid nodules are associated with an increased rate of malignancy in male individuals.

Rapid growth of a nodule may suggest malignancy. Sudden onset of pain is more strongly associated with benign disease, such as hemorrhage into a benign cyst or subacute inflammatory thyroiditis, than with malignancy. Hoarseness suggests involvement of the recurrent laryngeal nerve and vocal fold paralysis and may be a sign of malignancy. Difficulty swallowing may be a sign of impingement of the lower throat or esophagus.

Other risk factors include whether or not the tumor is limited to the thyroid gland, whether it’s size is less than 4 centimeters, and whether there are distant metastases. Relative risk factors include whether there is a history of radiation exposure or a family history of thyroid cancer.