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Thyroid Cancer - Causes and treatment

An explosion in Thyroid cancer diagnosis

Thyroid cancer levels have significantly increased in the Western world over the last 15 years. In 2016 there will be about 63,000 cases in the USA, with two thirds in women.

In the UK in the year 2000 there were only about 1,300 people diagnosed with thyroid cancer. Now it is about 3,500 a year. Similarly, two thirds are women.

Open quotesThyroid cancer diagnosis levels have tripled in 20 yearsClose quotes

But the explosion in diagnosis, may not reflect the real incidence according to experts.The UN´s Cancer Agency and IARC believe that the epidemic of thyroid cancer is due to over-diagnosis. They believe much of the explosion in the Western world is because of CAT scans picking up more problems which do not need treating. Yet victims usually have surgery, which can leave them in pain, and requiring hormone treatment for the rest of their lives. 

The four main types of Thyroid Cancer:

Papillary is the most common, affecting six out of ten of those diagnosed with thyroid cancer. This type is more common in women, and usually affects younger people. It is usually slow growing, but can sometimes spread to lymph nodes in the neck or near by.

Follicular thyroid cancer is most found in young or middle aged people - making up three out of every 20 diagnosed. It can spread to other parts of the body, most often to the lungs or bones.

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Medullary is a rare type, affecting between one in 10 and one in 20 of all those diagnosed. About a quarter of these run in families. They are caused by an inherited faulty gene. Medullary Thyroid cancer can spread to the lungs or bones.

Anaplastic is usually diagnosed in older people, and most commonly in women. About three quarters of those affected are over 60. Some three out of every 20 thyroid cancers diagnosed are this type, which tends to grow more quickly than the others.

Survival Rates for Thyroid cancer

5 year survival for Papilliary and follicular is 100% for those diagnosed at stage 1 or 2. It declines to just over 50% for those diagnosed at stage 4. Medullary is near 100% for stages 1 and 2. All anapaestic is deemed stage 4.

Causes and risks of Thyroid cancer

Who is most at risk?

  • Those who have had radiotherpay to the neck area at some earlier point in their lives. The cancer may develop between 10 to 30 years after treatment.
  • People who have been exposed to radiation - It is more common in survivors of atomic explosions or accidents. For example, there was an increase in cases in the Ukraine, particularly in children, after the Chernobyl nuclear reactor accident in 1986. a massive cloud of pollution extended across Western Europe - for example, the cloud of caesium-137 moved up into Sweden and extensively though Switzerland, Southern German, the whole of France and up through England and Wales to Scotland. The worst of the cloud by-passed the UK and went up the North Sea.
  • It is possible to inherit abnormal genes that increase your risk. These genes cause syndromes called MEN2a and MEN2b. Both of these cause medullary thyroid cancer. If MEN2 runs in your family, you and your relatives may be referred for screening for thyroid cancer. Medullary thyroid cancer can run in families where there is no sign of MEN2 gene changes.
  • Gardners syndrome and Cowdens disease are two other conditions that can run in families, and are linked to an increase risk of this cancer.

The symptoms of Thyroid cancer

These can include:

  • A lump at the base of the neck
  • A hoarse voice that does not get better
  • Soreness or difficulty swallowing that does not get any better
  • A lump elsewhere in the neck

All these are more likely to be caused by other illnesses, but if the hoarse voice or sore throat stays for more than a few weeks you should ask your doctor about it.

Most thyroid lumps are not cancer. As many as nine out of 10 women, over 70, will have small lumps (nodules) in their thyroid glands. Only about one in 20 thyroid lumps are cancer.

Treatments for Thyroid cancer

Surgery

Surgery is often used. Either a total or near total thyroidectomy - your whole thyroid removed - or a lobectomy - partial thyroidectomy.

The type of surgery depends on the patient and their type of cancer.

Radioactive iodine may be given after surgery. Iodine will be taken up by any remaining thyroid cells.

Radiotherapy. A form of targeted radiotherapy is often used for thyroid cancer. This uses a radioactive form of iodine called I131. It gets into the bloodstream and circulates throughout the body. Cancer cells pick it up and the radiation kills them. This is a very good treatment, because it only affects the cancer cells. There are very few side effects and the radiotherapy treats the whole body. It can be used after surgery to reduce the risk of the cancer coming back, and to treat cancer that has spread or come back. Medullary and Anaplastic thyroid cancers do not pick up iodine well, so they tend to be treated with traditional external beam radiotherapy.

Proton therapy is ialso sometimes used.

Chemotherapy is sometimes used to treat advanced thyroid cancers, or those that have come back after a first treatment. It is still experimental, but there have been reports that is has kept thyroid cancer under control for long periods in some cases. In America the FDA has approved sorafenib, lenvatinib, vandentanib and carbozantinib depending on the type of thyroid cancer. These may not be available at your UK hospital. All cause side-effects and you should check them out in detail.

For information on your Cancer Drugs and chemotherapy click here.

Hormone Therapy. Thyroid hormone replacement usually involves Levothyroxine, a pill you take daily. The size of pill should be determined by your weight and size. Calcium and iron supplements may interfere with this.


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