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Thyroid Cancer

What Exactly is Thyroid Cancer?

The thyroid gland is located in the front portion of the neck, below the larynx (the voice box) and in front of the trachea and esophagus. A normal-sized thyroid is butterfly-shaped and consists of two lobes that are joined together by the thyroid isthmus. The parathyroid glands are found on the back side of the thyroid.

Most thyroid tumors originate in the thyroid cells, which are responsible for the production of the thyroid hormone.

A distinction can be made among different types of thyroid cancers, depending on which tissue cells the cancer originates from:
  • Papillary
  • Follicular
  • Hurthle
  • Anaplastic
  • Medullary Carcinoma

About Thyroid Cancer and Thyroid Nodules

Thyroid nodules are common in the general population. Malignant thyroid tumours are less common. It is estimated that about 5% of thyroid nodules that are detected on exam are malignant in females and >5% of thyroid nodules are malignant in males. Thyroid nodules are discovered through a variety of ways, including: by your doctor during a routine visit, by feeling a bump in your neck and by chance after an ultrasound, CT, MRI or PET scan of the neck. If a thyroid nodule that is detected is concerning, you will often be referred to a physician who specializes in thyroid nodules and cancer. Multiple tests will be done to determine if the nodule is worrisome for cancer, including: blood tests, thyroid ultrasound, and ultrasound-guided fine-needle aspiration biopsy, if necessary. If worrisome for cancer, the mass is often surgically removed by a thyroid cancer specialist.

Types of Thyroid Cancers

The different types of thyroid cancers arise from different cells in the thyroid gland.

Well-differentiated thyroid cancer: This includes the subtypes of papillary thyroid cancer and follicular thyroid cancers. The tumor originates from the cells in the thyroid that produce thyroid hormones. These cancers often have a good prognosis.

  • Papillary thyroid cancer: This is the most common of all thyroid cancers.
  • Follicular thyroid cancer: This is the next most common thyroid cancer.

Medullary thyroid cancer: This is a rare form of thyroid cancer. Unlike papillary thyroid cancer and follicular thyroid cancer, these tumors arise from different cells in the thyroid, which produce a hormone called calcitonin. An increased serum calcitonin level may be suspicious for medullary thyroid cancer.

Anaplastic thyroid cancer: This is a very aggressive form of thyroid cancer that occurs far less often.

Symptoms of Thyroid Cancer

A bump that can be felt in the middle of the neck (where a bow tie is worn) is often a sign of a thyroid tumor and should be examined by your doctor. Symptoms of thyroid cancer are sometimes not experienced until the tumor has progressed to a later stage.

The following symptoms can be experienced in patients with thyroid cancer:

  • Shortness of breath and difficulty swallowing. when thyroid cancer progresses, it can press on the windpipe (trachea) or esophagus and cause these symptoms.
  • Enlarged lymph nodes in the neck
  • Coughing
  • Voice hoarseness

It is important to keep in mind that these symptoms are more commonly associated with less serious medical conditions, for example, the common cold. Nevertheless, consulting your health care provider is important when these symptoms develop, especially if they persist.

Thyroid Cancer Treatment at ENT Specialty Group

At ENT Specialty Group, our team of experienced thyroid surgeons and endocrinologists have expertise in the investigation and management of thyroid nodules. We understand the anxiety associated with discovering a thyroid tumour and the importance of proper treatment.

This may involve a thyroid morphology ultrasound examinationan ultrasound guided thyroid biopsy (USFNA), and when indicated, molecular testing of thyroid nodules (Afirma, ThyroseqV3, ThyGenx/Thyramir). When thyroid surgery is required it is performed at one of the McGill University hospitals (Jewish General Hospital, MUHC / Glen site Royal Victoria Hospital, MUHC / Montreal General Hosptial), McGill University affiliated hospitals, or University of Montreal affiliated hospitals. Our team also has extensive experience with the management and surgery of the parathyroid glands for elevated calcium levels (hypercalcemia).

Our aim is to provide patients with compassion, attention, and timely care from the moment that a thyroid nodule is discovered until treatment is no longer required.

Chances of Recovery from Thyroid Cancer

When thyroid cancer is identified and treated at an early stage, the prognosis is excellent. This is especially true for people diagnosed with papillary and follicular thyroid cancer. This is also correct  for patients diagnosed with medullary thyroid cancer at an early stage. Anaplastic thyroid cancer is quite rare and has a poor prognosis.

Surgery is the most common treatment for thyroid cancer. This is sometimes followed by treatment with radioactive iodine. External beam radiation therapy and chemotherapy are rarely used to treat thyroid cancer.

Our Thyroid Cancer Specialists

Dr. Veronique-Isabelle Forest Thyroid and Parathyroid Surgery, Head and Neck Surgery Specialist

Dr. Veronique-Isabelle Forest

Dr. Michael P. Hier Head & Neck Surgeon

Dr. Michael P. Hier

Dr. Karen M. Kost Voice Specialist, Head and Neck Surgeon

Dr. Karen M. Kost

Dr. Jasmine Kouz Endocrinologist

Dr. Jasmine Kouz

Dr. Richard Payne Thyroid and Parathyroid Surgeon

Dr. Richard Payne

Dr. Michael Tamilia Endocrinologist

Dr. Michael Tamilia

Dr. Ji Wei Yang Endocrinologist

Dr. Ji Wei Yang

FAQ's for Thyroid Cancer

1. What is thyroid cancer?

Thyroid nodules (or tumours) are either benign or malignant. The difference between benign and malignant tumours lies in the potential for cancers to spread outside of the thyroid gland to local structures (such as lymph nodes) and distant sites (such as the lungs). Fortunately the spread of thyroid cancer to distant sites is rare.

Common types of thyroid cancer include:

-Papillary thyroid carcinoma

-Follicular thyroid carcinoma

-Hurthle cell thyroid carcinoma

-Medullary thyroid carcinoma

-Anaplastic thyroid carcinoma

2. Whom does thyroid cancer affect?

Thyroid cancer occurs in men and women of all ages. Nonetheless, it typically affects young adults and middle-aged women. Women are affected more often than men. While some forms of thyroid cancer are inherited, the majority are not.

3. What are symptoms of thyroid cancer?

Many individuals with thyroid cancer do not have symptoms. Others complain of a “bump” in their neck. Sometimes people complain of voice change or difficulty swallowing, but these symptoms are not specific for thyroid cancer and are caused by many other medical conditions.

4. When should you see a doctor about thyroid cancer?

When you have a concern that you may have thyroid cancer, you should consult your doctor.

5. Which doctor do you see for thyroid cancer?

Your doctor will typically send you to an endocrinologist, an ENT specialist, or an endocrine surgeon when there is a concern about thyroid cancer.

6. How is thyroid cancer diagnosed?

When an individual feels a “bump” in their neck at the level of the thyroid gland (where a bow tie is worn) or when a thyroid nodule is detected incidentally during a scan, a workup is often warranted. There are several tests that are commonly performed when thyroid cancer is suspected. Blood tests are usually performed along with an ultrasound to visualize the thyroid tumour. An ultrasound guided fine needle biopsy is then required to get a tissue sample. Sometimes molecular testing is used when the diagnosis is uncertain or when more information is required prior to making management decisions.

7. What caused me to have thyroid cancer?

The cause of most forms of thyroid cancer is unknown. The most important identifiable risk factor is radiation exposure. A family history of thyroid cancer is also a risk factor for some forms. Certain ethnic groups may be more likely than others to develop thyroid cancer.

8. What therapeutic options are available to me now that thyroid cancer is suspected?

Thyroid cancer is usually treated with surgery, since removal of part or all of the thyroid gland (thyroidectomy) with or without excision of lymph nodes typically offers the best chance of cure.
Radioactive iodine therapy, external beam radiation therapy, chemotherapy and levothyroxine therapy (often prescribed as Synthroid ®) are forms of treatment that are sometimes used following surgery. These forms of treatment, when applied in the appropriate clinical setting, have been shown to reduce the risk of tumor recurrence and improve survival.

9. After thyroid cancer is treated, will I be followed for this disease and for how long?

Yes, clinical follow-up for life is strongly recommended. Although most recurrences are detected within 10 years, sometimes tumors are detected later.

10. What test(s) might I expect to undergo during this prolonged follow-up period?

Typically patients are seen twice yearly by their specialist for a physical examination and blood tests. In addition to verifying the adequacy of the levothyroxine dosage, the blood is usually tested for tumor markers such as thyroglobulin or calcitonin. If thyroglobulin or calcitonin is detected and is rising it will lead to a search of possible tumor recurrence. General surveillance for tumor recurrence also involves an ultrasound of the thyroid bed and neck. In select cases other tests are necessary such as a whole body scan, a CT scan, or a PET scan.

11. What are my chances of cure?

The majority of patients treated for thyroid cancer do not have a recurrence. Nevertheless, the prognosis depends on certain specific factors, such as how advanced the cancer was when it was detected, the exact type of malignancy, and the treatment that was given.

12. What is an Ultrasound Guided Fine Needle Aspiration Biopsy of a Thyroid nodule?

At times a biopsy of a thyroid nodule or thyroid lump is indicated to assess for thyroid cancer. The biopsy of the thyroid nodule or thyroid lump is usually performed under ultrasound guidance. An ultrasound guided fine needle aspiration biopsy of a thyroid nodule allows the doctor to see the area that is being sampled. This allows for a more precise biopsy.