Thyroid Cancer: Symptoms, Diagnosis and Treatment (video/podcast)

Finding a lump or bump in your neck can be unsettling. Most neck lumps, along with symptoms such as hoarseness or difficulty swallowing, are caused by conditions that are not serious, but they also can be a symptom of thyroid cancer.

While no one wants a cancer diagnosis, thyroid cancer is one of the most treatable cancer types, and most people diagnosed with it have very good outcomes. In this video, San Diego Health host Susan Taylor discusses thyroid cancer symptoms, diagnosis and treatment with Jacob New, MD, PhD, a medical oncologist at Scripps Cancer Center and Scripps Clinic Torrey Pines.

The thyroid is a small, butterfly-shaped gland located at the base of the neck, in front of the windpipe. It produces hormones that help regulate the body’s metabolism and affect many functions, including heart rate, energy levels, brain function and muscle function.

“The thyroid is a small but mighty organ,” says Dr. New. “For a small gland, it plays a big role.”

Thyroid cancer affects tens of thousands of people in the United States each year, and the rate has been increasing. According to Dr. New, this does not necessarily mean more people are developing the disease; instead, thyroid cancer is increasingly being detected at earlier stages, including during imaging for another condition or even a routine examination.

In most cases, the cause of thyroid cancer is not known, and there are few established risk factors. Certain types can be associated with inherited conditions, but this is not common.

Most people with thyroid cancer do not have symptoms when they are diagnosed. A thyroid nodule may be discovered during a routine physical examination or incidentally on an ultrasound, CT scan or other imaging test performed for another reason.

When thyroid cancer does cause symptoms, they are generally related to the neck. Possible symptoms include:

• A lump or bump in the neck
• Hoarseness or a change in your voice
• Difficulty swallowing

However, these symptoms can have many causes that have nothing to do with cancer, including tonsillitis, strep throat and respiratory infections.

If you have a suspicious lump or bump on your neck (known as a nodule), the first step may be an ultrasound exam to evaluate it. If the nodule has certain characteristics, your doctor may recommend a fine-needle biopsy. During this procedure, a small needle is inserted into the nodule to collect a sample of cells. A pathologist examines the sample under a microscope to determine whether cancer is present.

Sometimes a biopsy does not provide a clear answer. In those situations, genetic testing may provide additional information to help guide the next steps.

If thyroid cancer is diagnosed, it’s important to know that not every thyroid cancer case needs to be treated immediately. The appropriate treatment depends on the specific type of thyroid cancer and the individual patient. Your care team will consider your circumstances and recommend a personalized treatment plan.

Chemotherapy and radiation are not commonly used to treat thyroid cancer. For many patients, treatment involves surgery. Depending on the circumstances, the surgeon may remove part of the thyroid or the entire thyroid. If the entire thyroid is removed, your body will no longer produce thyroid hormones. You’ll need thyroid hormone medication, usually taken as an oral pill once a day.

Recovery after thyroid surgery is generally quite good. Most patients can return to normal activities within days or weeks.

Most thyroid cancers remain localized in the neck, although nearby lymph nodes can sometimes be involved. It is less common for thyroid cancer to spread, or metastasize, to organs such as the lungs. If it does, targeted therapies may be an option. Unlike traditional chemotherapy, targeted therapies are designed to act on specific characteristics of cancer cells.

“There’s something unique about the cancer cells that separates them from the rest of the body,” says Dr. New. “The therapies for thyroid cancer target these particular vulnerabilities.”

In some circumstances, immunotherapy may be considered. Immunotherapy uses the body’s own immune system to target and fight advanced or aggressive cancer cells.

Overall, the outlook for people with thyroid cancer is very good.

“Thyroid cancer is a very treatable condition,” says Dr. New. “From the diagnosis, the initial management, the considerations of surgery and any medicines or other therapies that might be needed, it’s highly personalized.”

If you notice a new or persistent neck lump, hoarseness or difficulty swallowing, talk with your doctor.

“There are lots of reasons to have a lump or a bump or hoarseness, and it is rare that those are thyroid cancer,” says Dr. New. “If you do have these symptoms, please see your primary care physician. They can determine what may be causing your symptoms and whether you need additional evaluation.”