- Posted by jdavis on August 31, 2011
The main treatments used for thyroid cancer are surgery, radiotherapy and chemotherapy. Hormone therapy is sometimes used. Your treatment will be planned taking into account:
- The type of thyroid cancer
- How far your cancer has grown or spread (the ‘stage’)
- Your general health
- Your age and level of fitness
Surgery is often used to treat thyroid cancer. You can have your whole thyroid removed a total thyroidectomy or part of your thyroid removed a lobectomy or partial thyroidectomy. Generally speaking, doctors prefer total thyroidectomy. There is a risk that the cancer could come back if only part of the thyroid is removed. Partial thyroidectomy is only done for papillary or follicular thyroid cancers that are less than a centimeter across (T1 stage). For larger papillary or follicular tumors and for medullar or Ana plastic thyroid cancers, the whole thyroid is usually removed.
If your specialist can feel enlarged lymph nodes in your neck, or if lymph nodes are found to contain cancer cells during your operation, they will be removed. In some situations, your surgeon may remove all the lymph nodes on one side of your neck if there is a risk that they may contain cancer cells. This is called ‘radical neck dissection’. It is done to help stop the cancer from coming back in the future. It is not usually necessary to remove all the nodes. If some nodes are removed, your surgeon may call this a ‘modified radical neck dissection’.
Thyroid cancer that has spread
If your cancer has already spread to another part of your body, your doctor may not recommend surgery. This is because surgery alone will not cure the cancer. But surgery is often still carried out because removing the thyroid will help control symptoms and can help to control the disease when combined with radiotherapy.
Surgery to prevent thyroid cancer
If medullary thyroid cancer is known to run in your family, you can be tested to see if you carry an abnormal RET gene. This is the gene that is known to cause the MEN syndrome that medullary thyroid cancer is related to. MEN stands for multiple endocrine neoplasia. Children in such families are usually tested early on. If they carry the gene, specialists advise removing the whole of the thyroid gland to stop the cancer from starting in the first place. They prefer to do this before the child is about 5 years old, sometimes as young as 6 months. But this decision is made individually, depending on the needs of the child.
Once you have had your thyroid removed, you will have to take thyroid hormone tablets for the rest of your life to replace those your thyroid would have made.
For thyroid cancer, a form of targeted radiotherapy is often used. This uses a radioactive form of iodine called ‘Iodine 131’ or I-131. Most papillary and follicular thyroid cancers pick up iodine very readily. When you are given radioactive iodine, it gets into the bloodstream and circulates throughout the body. The 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 reaches the whole body. This type of treatment can be given after surgery to reduce the risk of the cancer coming back or to treat cancer that has spread or has come back.
Your thyroid cancer can be tested to see if it picks up iodine well enough to have radioactive iodine treatment. If not, you may be given traditional external radiotherapy. Occasionally, both I-131 and external radiotherapy are used.
Medullary and anaplastic thyroid cancers do not pick up iodine well. They tend to be treated with traditional external beam radiotherapy. Radiotherapy is used to treat these cancers if they come back after they were first treated. It can also be used to treat an aplastic thyroid cancer if you cannot have it removed with surgery.
Chemotherapy is sometimes used to treat advanced thyroid cancers or cancer that has come back after it was first treated. It is still experimental, but there have been reports that this treatment has kept thyroid cancer under control for long periods in some cases. It can be used to treat all types of thyroid cancer.
Papillary and follicular thyroid cancer is treated with the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Taking these hormones by mouth stops your body from making another hormone called “thyroid stimulating hormone” (TSH). TSH may encourage the cancer to grow. So stopping it from being made can help to reduce the risk of the cancer coming back, or slow it down if it has already spread.
In other types of thyroid cancer, you will also be given thyroid hormones after you have had your thyroid removed. But this isn’t to treat the cancer. It is to replace the hormones that your thyroid made. This hormone replacement won’t make any difference to the chance of the cancer coming back. But it will make you feel much better than you would if you weren’t taking it.