October 24, 2022
Thyroid cancer is a relatively common condition diagnosed in both men and women, presenting many patients with a disruptive health challenge that may require medical treatment.
The thyroid is a butterfly-shaped gland at the base of the neck that's responsible for creating hormones that regulate metabolism. Both cancerous and benign growths can appear on the thyroid in patients as young as 20 years old, often without any visible lump or obvious symptoms.
Usually, a growth on the thyroid is detected as an incidental finding during another medical imaging procedure.
Dr. Susan Mandel
Getting diagnosed with any type of cancer is frightening. At the Abramson Cancer Center in Philadelphia, one of the key goals of thyroid cancer treatment is reassuring patients that the disease is rarely fatal. About 97% of thyroid cancer patients are considered stage one or stage two, meaning they have low-risk cancer.
"Those patients have incredibly high survival rates," Dr. Mandel said. "For patients classified as Stage one, the survival is over 97% for 10 years. Stage two survival rates are a little more variable, but when disease is limited to the neck, the 10-year survival rate is still over 95%."
The Penn Medicine Thyroid Cancer treatment team ensures that patients receive the knowledge, support and medical care that will get them through treatment with a minimal impact on quality of life.
The most common type of thyroid cancer is papillary thyroid carcinoma. It accounts for 85-90% of cases. Less commonly, about 5% of patients will have follicular thyroid cancer. Both are slow-growing cancers that derive from cells that produce thyroid hormone, but generally do not change the patient's thyroid function.
The more aggressive and rarer diseases include medullary and anaplastic thyroid cancer. These conditions are more likely to spread to other organs, yet they occur in a much smaller patient population.
The overall incidence of thyroid cancer has gone down significantly in recent years. Many patients were formerly diagnosed with small thyroid cancers that would never impact their life expectancies. Therefore, newer guidelines now recommend nodule biopsy at higher size thresholds. The overdiagnosis of thyroid cancer has been addressed nationally by establishing better standards for care, many of which were developed with input from Penn Medicine specialists.
When a nodule is detected on a patient's thyroid, it's typically recommended to get an ultrasound specifically for the thyroid.
Based on the characteristics of the nodule seen on the ultrasound, the medical team will determine whether it's necessary to take a biopsy of the tissue for further analysis.
When the biopsy results come back as benign, the patient is not considered at risk. Although some biopsies can clearly be identified as cancer, others are less obvious.
"About a third of our biopsies come back as inconclusive or indeterminate, meaning that the thyroid cells on the biopsy slide do not fit the criteria to label them as either cancer or benign," Dr. Mandel said.
In those cases, additional tests are performed that will examine the genes of nodules’ cells to better understand the risk of cancer. Based on those results, doctors determine whether the patient needs intervention or if they can be simply monitored moving forward.
If surgery is indicated, for many patients the best course of action is undergoing a day surgery. This could include removing one or both sides of the thyroid, in addition to lymph nodes that may be affected by the disease.
When appropriate, some patients may be given a one-time dose of radioactive iodine in order to reduce the risk of the cancer returning.
Patients who have advanced metastatic disease will see an oncologist, but most thyroid cancer patients will be treated primarily by an endocrinologist. The multidisciplinary care team also will include a radiologist, surgeon, and nuclear medicine specialist to administer radioactive iodine, when necessary. More targeted therapies and external beam radiation have been utilized in recent years to treat the most aggressive thyroid cancers.
Emily Haase-Overstreet was in her early twenties when she was diagnosed with papillary thyroid cancer at Penn Medicine in 2010. The disease had spread to her lymph nodes and she had a visible lump on the front of her neck.
Emily was treated by Dr. Mandel and her colleague, Dr. Rachel Kelz, an Endocrine Surgeon who serves as co-director of Penn Medicine's thyroid disease team.
Dr. Rachel Kelz
Haase-Overstreet underwent surgery to remove her thyroid and 29 lymph nodes.
"Recovery for me took about a week or two," Haas said.
During her recovery, Haas said her doctors checked in with her regularly, asking questions and offering her reassurance. These days, Emily takes a thyroid hormone replacement pill every morning. She feels her life has largely returned to normal.
More than a decade later, Emily still remains in touch with her doctors.
"I never felt I was dealing with white coats or that I was a number while at Penn," Haase-Overstreet said. "Dr. Mandel, Dr. Kelz and all other doctors, nurses and staff were truly genuine and I felt exceptionally cared for."
The team at Penn Medicine makes a concerted effort to ensure that patients are as comfortable as they can be under the circumstances. That includes directing patients to the Abramson Cancer Center's supportive care services like counselors, dietitians and family therapists.
"Like any other medical condition, you just have to do your treatment and live your life," Dr. Kelz said. "The whole point of doing the operation is to allow patients to get back to living their lives, because we expect it to be long and healthy."
Penn Medicine is recognized throughout the world for its industry-leading research in systemic treatments for advanced thyroid cancer. If you or a loved one are facing thyroid cancer, the health system’s multidisciplinary team of endocrinologists, surgeons and other specialists will be with you at every step, providing precise diagnosis and personalized treatment.
