Papillary Cancer

Papillary tumors are the most common type of thyroid cancer.

Papillary carcinoma typically appears as an irregular, solid mass or cyst rising out of thyroid tissue. Papillary cancer has a high cure rate. This form of thyroid cancer has a ten-year survival rate for all patients; it’s estimated at 80-90%. In about 50% of smaller tumors and in over 75% of larger thyroid tumors, there will be spread to lymph nodes in the neck area. Cancer that has spread to lymph nodes in the neck lead to a high recurrence rate but the mortality rate is constant. Spread of the disease to distant area is not as common but can occur in the lungs and bones.

Characteristics of Papillary Thyroid Cancer

Management of Papillary Thyroid Cancer

There is much controversy regarding the management and treatment of papillary cancer. Some medical experts state that if the tumors are small enough and not invading other tissues simply removing the diseased lobe and the small center area called the isthmus is sufficient. This alone should allow a chance for a cure comparative to removing the entire thyroid. The more conservative state a low rate of tumor even though small amounts of tumor cells can still be found in nearly 88% of the opposite lobe of the thyroid tissue. Other studies showed an increased risk of hypoparathyroidism and recurring laryngeal nerve injury in patients that underwent total thyroidectomy or removal of the entire thyroid. Total removal is a far more aggressive form of thyroidectomy and studies have shown that in highly skilled hands there are fewer chances of recurring nerve injury and permanent hypoparathyroidism, a 2% chance of recurrence to be exact. These studies have also shown that patients with complete removal of the thyroid followed by thyroid suppression and radioiodine therapy have a much lower recurrence rate of the cancer. They also experience a lower mortality when tumors measure larger than a 1/2 inch. Keep in mind that it is always preferable to decrease the amount of normal thyroid tissue absorbing the radioiodine.

Based on the above-mentioned studies and epidemiology of papillary cancer, the following is a typical plan:

Papillary carcinomas that are isolated and are less than 1cm in younger patients between the ages 20-40 with no history of exposure to radiation can be treated with hemithyroidectomy and isthmusthectomy. All other patients should most likely be treated with total thyroidectomy as well as removal of any large lymph nodes in the center sides of the neck. Other traits or characteristics of tumors and legions can be seen under the microscope and will be a determining factor on whether a surgeon should take the entire thyroid gland out.

Radioactive Iodine (After Surgery)

Thyroid cells have the unique ability to absorb iodine. No other cell in the body can absorb or concentrate iodine other than thyroid cells. Iodine is absorbed by the thyroid to create thyroid hormones. Physicians take advantage of this unique function of the thyroid gland and give radioactive iodine to patients who suffer from thyroid cancer. There is a form of radioactive iodine that is toxic to cells. Papillary cancer cells can absorb this type of iodine (since they absorb iodine in general). The toxicity can be used to target for death cancer cells. This toxic iodine isotope is also referred to as I-131. Not everyone with papillary thyroid cancer needs to undergo this type of therapy. However, for those bearing large tumors, evidence of cancer spread to lymph nodes or distant areas and older patients could benefit from this therapy. Treatments do vary from person to person, case by case. No recommendations can be made here so always consult your physician. But, this has been proven to be quite an effective form of chemotherapy with very little downside.

Patients need to be off the thyroid replacement and on some type of low iodine diet for at least one to two weeks before therapy. The treatment is usually administered 6 weeks after surgery, but this can vary from patient to patient. It can be done every 6 months if needed.

Thyroid Hormone Pills After Thyroid Cancer Surgery

Regardless of how much of the thyroid gland was removed, most experts agree that patients should be placed on thyroid hormone supplementation for the rest of their lives. This is necessary to replace the hormone in patients who have no thyroid left at all. It is also necessary to prevent further growth of the gland in those patients who still possess some thyroid tissue after there surgery, since in their case the removal of the gland was only partial. There is reliable evidence that follicular carcinoma responds well to thyroid stimulating hormone or TSH that is secreted by the pituitary gland, So, exogenous thyroid hormone is administered which causes a decrease in thyroid stimulating hormone levels and a lowers the momentum of growth for any remaining cancer cells. It has also been shown that recurrences and mortality rates are lower in patients receiving thyroid supplementation for the purpose of suppression.

Long-Term Follow Up

It is advisable for patient to get annual chest x-rays and thyroglobulin levels. Thyroglobulin is not effective for diagnosing thyroid cancer. It is however, quite useful in the follow up stages for indications of differentiated or distinct carcinoma assuming that a complete removal of the thyroid gland has been performed. A high thyroglobulin level may be indicative of a recurrence but your doctor will be able to provide you with an accurate finding.