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Thyroid cancer - papillary carcinoma

Papillary carcinoma of the thyroid

Papillary carcinoma of the thyroid is the most common cancer of the thyroid gland. The thyroid gland is located inside the front of the lower neck.

Causes

About 85% of all thyroid cancers diagnosed in the United States are the papillary carcinoma type. It is more common in women than in men. It may occur in childhood, but is most often seen in adults between ages 20 and 60.

The cause of this cancer is unknown. A genetic defect or family history of the disease may also be a risk factor.

Radiation increases the risk of developing thyroid cancer. Exposure may occur from:

  • High-dose external radiation treatments to the neck, especially during childhood, used to treat childhood cancer or some noncancerous childhood conditions
  • Radiation exposure from nuclear plant disasters

Radiation given through a vein (through an IV) during medical tests and treatments does not increase the risk of developing thyroid cancer.

Symptoms

Thyroid cancer often begins as a small lump (nodule) in the thyroid gland.

While some small lumps may be cancer, most (90%) thyroid nodules are harmless and are not cancerous.

Most of the time, there are no other symptoms.

Exams and Tests

If you have a lump on your thyroid, your health care provider will order blood tests and possibly an ultrasound of the thyroid gland.

If the ultrasound shows that the lump is less than 1 centimeter, a special procedure called a fine needle aspiration biopsy (FNAB) may be performed. This test helps determine if the lump is cancerous.

CT scan of the neck may also be done to determine the size of the tumor.

Thyroid function tests are often normal in people with thyroid cancer.

Treatment

There are three types of thyroid cancer treatment:

  • Surgery
  • Radioactive iodine
  • Medicine

Surgery is done to remove as much of the cancer as possible. The bigger the lump, the more of the thyroid gland must be removed. Often, the entire gland is taken out.

After the surgery, you may receive radioiodine therapy, which is often taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images clearer, so doctors can see if there is any cancer left behind or if it comes back later.

If surgery is not an option, external radiation therapy can be useful.

After surgery or radioiodine therapy, you will need to take medicine called levothyroxine for the rest of your life. This replaces the hormone the thyroid would normally make.

Your provider will likely have you take a blood test every several months to check thyroid hormone levels. Other follow-up tests that may be done after treatment for thyroid cancer include:

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

The survival rate for papillary thyroid cancer is excellent. More than 90% of adults with this cancer survive at least 10 to 20 years. The prognosis is better for people who are younger than 40 and for those with smaller tumors.

The following factors may decrease the survival rate:

  • Older than 55
  • Cancer that has spread to distant parts of the body
  • Cancer that has spread to soft tissue
  • Large tumor

Possible Complications

Complications include:

  • Accidental removal of the parathyroid gland, which helps regulate blood calcium levels
  • Damage to a nerve that controls the vocal cords
  • Spreading of cancer to lymph nodes (rare)
  • Spreading of cancer to other sites (metastasis)

When to Contact a Medical Professional

Call your provider if you have a lump in your neck.

References

Kwon D, Lee S. Invasive thyroid cancer. In: Myers EN, Snyderman CH, eds. Operative Otolaryngology-Head and Neck Surgery. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 82.

National Cancer Institute website. Thyroid cancer treatment (adult) (PDQ) – health provisional version. www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional. Updated February 1, 2018. Accessed March 22, 2018.

Thompson LDR. Malignant neoplasms of the thyroid gland. In: Thompson LDR, Bishop JA, eds. Head and Neck Pathology. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 25.

  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Thyroid cancer - CT scan

    Thyroid cancer - CT scan - illustration

    This CT scan of the upper chest (thorax) shows a malignant thyroid tumor (cancer). The dark area around the trachea (marked by the white U-shaped tip of the respiratory tube) is an area where normal tissue has been eroded and died (necrosis) as a result of tumor growth.

    Thyroid cancer - CT scan

    illustration

  • Thyroid cancer - CT scan

    Thyroid cancer - CT scan - illustration

    This CT scan shows a thyroid cancer tumor in the throat, encircling, narrowing, and displacing the windpipe (trachea).

    Thyroid cancer - CT scan

    illustration

  • Thyroid enlargement - scintiscan

    Thyroid enlargement - scintiscan - illustration

    This image shows the enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.

    Thyroid enlargement - scintiscan

    illustration

  • Thyroid gland

    Thyroid gland - illustration

    The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.

    Thyroid gland

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Thyroid cancer - CT scan

      Thyroid cancer - CT scan - illustration

      This CT scan of the upper chest (thorax) shows a malignant thyroid tumor (cancer). The dark area around the trachea (marked by the white U-shaped tip of the respiratory tube) is an area where normal tissue has been eroded and died (necrosis) as a result of tumor growth.

      Thyroid cancer - CT scan

      illustration

    • Thyroid cancer - CT scan

      Thyroid cancer - CT scan - illustration

      This CT scan shows a thyroid cancer tumor in the throat, encircling, narrowing, and displacing the windpipe (trachea).

      Thyroid cancer - CT scan

      illustration

    • Thyroid enlargement - scintiscan

      Thyroid enlargement - scintiscan - illustration

      This image shows the enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.

      Thyroid enlargement - scintiscan

      illustration

    • Thyroid gland

      Thyroid gland - illustration

      The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.

      Thyroid gland

      illustration

     

    Review Date: 1/19/2018

    Reviewed By: Richard LoCicero, MD, private practice specializing in hematology and medical oncology, Longstreet Cancer Center, Gainesville, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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