Dr. Sunil Malla Buzor Barua
Endocrine Surgeon, GNRC Hospitals
Do we really need to know about thyroid cancer? Is it an exotic disease that happens to some unknown person, one amongst millions, who we are unlikely to ever come across? Cristina Fernandez de Kirchner, President of Argentina, had it. So did actress Catherine Bell, Pulitzer Prize winning film critic Roger Ebert and Saturday Night Live comedian Joe Piscopo. Almost one out of every 25 people reading this article will develop it by the time they are in their old age. Don’t panic; if you are one of those persons, it is most likely a tiny cancer (micropapillary) that you won’t notice and won’t affect you in any significant way. However, not all people are so fortunate.
The thyroid gland is a butterfly shaped organ situated in the front of the neck. It secretes hormones essential for normal metabolism, growth and development, and the maintainance of body temperature. Many people concerned about their weight gain despite desperate efforts to slim down are becoming aware of the term hypothyroidism, a situation where the thyroid doesn’t produce enough hormones for the body’s requirements. There are others in whom the opposite happens, where patients lose weight despite having a good appetite, a situation called hyperthyroidism.
But what happens in thyroid cancer? More often than not, there are no dramatic symptoms to start off with other than a swelling in the neck; the thyroid hormone levels are usually normal. This swelling may grow over many months to years, eventually compressing the wind pipe and causing difficulty in breathing and swallowing, hoarseness and pain; or spread to other organs such as the lungs and bones causing coughing, pain in the bones, and occasionally bone fractures.
Thyroid cancers consist of a diverse group of diseases ranging from what pathologists like to call well-differentiated thyroid cancer (the good thyroid cancer), which has one of the best prognoses of all cancers,to anaplastic thyroid cancer, having one of the worst. In between, there are a range of tumors which will challenge both the patient and physician and punish any neglect on the part of either. Women are affected three times as often as men, but men have a worse deal when it comes to the eventual outcome. It can occur at any age, with around two out of three cases occurring under the age of 55.
Fortunately, the majority of these tumors belong to the well-differentiated category which can be successfully treated if detected in time. In patients below the age of forty, the prognosis is so good that it is quite likely that the patient may outlive the surgeon.
Medullary thyroid cancer especially interests endocrine surgeons because in many cases it is associated with exotic syndromes with multiple hormone secreting tumors which often mislead physicians with their unusual presentations. The neck lump may go unnoticed while the patient is treated for varied problems such as chronic diarrhoea, panic attacks associated with headache and sweating, hypertension, abdominal pain, bone pains, a tendency towards bone fractures, recurrent kidney stones, depression and fatigue. Some medical historians suspect that American president Abraham Lincoln had a rare syndrome called Multiple Endocrine Neoplasia type 2b, consisting of medullary thyroid carcinoma, a tall thin gangly appearance, swellings of the nerves and a hormone secreting tumor of the adrenal glands (pheochromocytoma).
Anaplastic thyroid cancer is the cancer that all thyroid surgeons dread; Although rare, it is one of the deadliest and most aggressive cancers known to man, a relentless boa constrictor that suffocates its victim. I still find it difficult to tell a patient and his relatives the true significance of this diagnosis. It most often arises in an elderly person who has harboured an apparently harmless lump in the front of his or her neck for many years. In many cases, there is an underlying well differentiated cancer that has gradually gone bad under the influence of mutated genes. And all of a sudden, as if possessed by an awakened demonic force, it rapidly expands over a few weeks. Most patients succumb within a year of diagnosis, despite all efforts. Newer drugs are being developed and tested which may provide a ray of hope in the future.
The treatment of thyroid cancer involves an operation removing the thyroid gland and any enlarged neck lymph nodes as the first step. For well-differentiated cancers (the good cancers-papillary and follicuar), this may be followed by what is called a radioactive iodine uptake test to see if there are any remaining cancer containing areas in the neck and other organs. Such areas are then treated with a dose of radioactive iodine taken as a liquid or in capsule form. Radiation and chemotherapy is not required for the majority of cancers, being reserved for inoperable and aggressive tumors.
Thyroid cancers need not be feared but must not be neglected. If you develop a swelling in your neck, please do get it evaluated at an appropriate healthcare centre.
