how is papillary thyroid cancer best treated?

 

Thyroid cancer is now one of the most rapidly increasing  cancers in Australia especially in women – the good news is that most of this increase is due to the early detection of very small papillary cancers and that the cure rate for these is close to 99%.  Papillary thyroid cancer, like any other cancer,  may spread to other tissues in the body. There are three ways in which this happens:

 

LOCAL SPREAD into the tissues and organs near the thyroid including the windpipe (trachea), swallowing tube (oesophagus),  or the voice box and its nerves (larynx).

 

LYMPH NODE SPREAD along the lymph channels into the local (cervical) lymph glands.

 

BLOOD SPREAD into any organ in the body but commonly the bones, lungs and brain. It is this type of spread that can cause death if no treatment is undertaken.

 

Local and lymph node spread is treated by surgery. Very small cancers, generally less than 1 cm, can be safely treated by removing only half the thyroid gland (hemithyroidectomy) which means that lifelong medication is not required. Larger cancers, multiple cancers,  or cancers that have already spread to the lymph glands or into the surrounding organs are best treated by removing the whole thyroid (total thyroidectomy). This means that  lifelong medication with thyroxine will then be required. Some patients prefer to have  a total thyroidectomy even for small cancers as it makes follow-up easier even though the cure rate is the same. If the cancer has already spread, then it is treated by radioiodine therapy, where a capsule of radioactive iodine is swallowed and spreads throughout the whole body, destroying any small metastatic cells. There are minimal side effects from this form of treatment, although patients need to be kept isolated for 2 days because they are radioactive.

 

There are other types of thyroid cancer  which are much less common including follicular thyroid cancer, poorly differentiated insular thyroid cancer, anaplastic thyroid cancer, medullary thyroid cancer and thyroid lymphoma. These are more aggressive than papillary thyroid cancer and require more extensive treatment, which may include radiotherapy, chemotherapy and treatment with TKI inhibitors.