What is papillary carcinoma of the thyroid?
The thyroid gland is the shape of a butterfly and sits above your collarbone at the center of your neck. Its function is to secrete hormones that regulate your metabolism and growth.
Unusual lumps on your neck can be a symptom of a thyroid problem. Most of the time, the lump will be benign and harmless. It could be a simple buildup of excess thyroid cells that have formed a mass of tissue. Sometimes the lump is a papillary carcinoma of the thyroid.
There are five types of thyroid cancer. Papillary carcinoma of the thyroid is the most common type. This cancer is most common in adults over the age of 45.
Papillary carcinoma of the thyroid is a slow-growing cancer that typically develops in only one lobe of the thyroid gland. When caught in its early stages this cancer has a high survival rate.
Papillary carcinoma of the thyroid is generally asymptomatic, which means it doesn’t have any symptoms. You might feel a lump on your thyroid but most nodules on the thyroid aren’t cancerous. But if you do feel a lump, you should still see your doctor. They’ll be able to give you an exam and order diagnostic tests if necessary.
The exact cause of papillary carcinoma of the thyroid is unknown. There may be a genetic mutation involved but more research is need to confirm this hypothesis.
One risk factor for the disease is exposure of the head, neck, or chest to radiation. This happened more often before the 1960s when radiation was a common treatment for conditions like acne and inflamed tonsils. Radiation is still sometimes used to treat certain cancers.
People exposed to nuclear disasters or have lived within 200 miles of a nuclear disaster are at high risk. They may need to take potassium iodide to reduce their risk of developing cancer.
Your doctor can diagnose papillary carcinoma of the thyroid using a variety of tests. A clinical exam will uncover any swelling of the thyroid gland and nearby tissues. Your doctor may then order a fine needle aspiration of the thyroid. This is a biopsy in which your doctor collects tissue from the lump on your thyroid. This tissue is then examined under a microscope for cancer cells.
Your doctor may order blood tests to check levels of thyroid-stimulating hormone (TSH). TSH is the hormone that the pituitary gland produces, which stimulates the release of thyroid hormone. Too much or too little TSH is a cause for concern. It may show a variety of thyroid diseases, but it is not specific to any one condition, including cancer.
A technician will perform an ultrasound of your thyroid gland. This imaging test will allow your doctor to see the size and shape of your thyroid. They’ll also be able to detect any nodules and determine if they’re solid masses or filled with liquid. Liquid-filled nodules typically aren’t cancer, while solid ones have a greater chance of being malignant.
Your doctor may also want to do a thyroid scan. For this procedure, you’ll swallow a small amount of radioactive dye that your thyroid cells will take up. Looking at the nodule area on the scan, your doctor will see whether it’s “hot” or “cold.” Hot nodules take up more of the dye than the surrounding thyroid tissue and usually aren’t cancerous. Cold nodules don’t take up as much dye as the surrounding tissues and are more likely to be malignant.
Your doctor performs a biopsy to get a small piece of tissue from your thyroid. A definitive diagnosis is possible after the tissue is examined under a microscope. This will also allow for a diagnosis of which type of thyroid cancer is present.
Your doctor will perform the biopsy doing a procedure called fine needle aspiration. Or they may do surgery if they need a larger sample. During surgery, your doctor will often remove a large part of the thyroid and may even remove the entire gland if necessary.
Talk to your doctor before a biopsy or other testing if you have any concerns or questions. Your doctor should explain to you what, if any, medications you might need after surgery.
After your diagnosis, your doctor will stage the cancer. Staging is the term used for how doctors categorize the severity of a disease and the treatment needed.
Staging for thyroid cancer is different than for other cancers. There are stages 1 through 4, in order of ascending severity. Staging also takes into consideration a person’s age and the subtype of their thyroid cancer. Staging for papillary thyroid cancer is as follows:
People under age 45
- stage 1: The tumor is any size, may be in the thyroid, and may have spread to nearby tissue and lymph nodes. The cancer hasn’t spread to other parts of the body.
- stage 2: The tumor is any size and the cancer has spread to other parts of the body like the lungs or bone. It may have spread to the lymph nodes.
There is no stage 3 or stage 4 for people under 45 with papillary thyroid cancer.
People over age 45
- stage 1: The tumor is under 2 centimeters (cm) and the cancer is only found in the thyroid.
- stage 2: The tumor is larger than 2 cm but smaller than 4 cm and is still only found in the thyroid.
- stage 3: The tumor is over 4 cm and has grown slightly outside the thyroid, but has not spread to nearby lymph nodes or other organs. Or, the tumor is any size and may have grown slightly outside the thyroid and spread to lymph nodes around the thyroid in the neck. It has not spread to other lymph nodes or other organs.
- stage 4: The tumor is any size and has spread to other parts of the body like the lungs and bones. It may have spread to lymph nodes.
According to the Mayo Clinic, the typical treatment for papillary thyroid cancer includes:
- radiation therapy, including radioactive iodine therapy (NCI)
- thyroid hormone therapy
- targeted therapy
If the papillary thyroid cancer hasn’t metastasized or spread, surgery and radioactive iodine are the most effective treatments.
If you have thyroid cancer surgery, you may have part or all of your thyroid gland removed. Your doctor will do this by making an incision in your neck when you are under sedation. If your doctor removes your entire thyroid, you will have to take supplemental thyroid hormones for the rest of your life to manage hypothyroidism.
There are two different types of radiation therapy: external and internal. External radiation involves a machine outside the body sending radiation toward the body. Internal radiation, radioactive iodine (radioiodine) therapy, comes in liquid or pill form.
External beam radiation is a treatment that directs X-ray beams to the area of the cancer. This treatment is more common for other, more aggressive forms of thyroid cancer. It’s most often used if papillary thyroid cancer spreads from the thyroid or when the risk of surgery is too high.
External beam radiation can also provide palliative treatment when a cure is not possible. Palliative treatments help manage symptoms, but won’t affect the cancer.
To make thyroid hormone, thyroid cells take iodine from the bloodstream and use it to manufacture the hormone. There is no other part of your body that concentrates iodine this way. When cancerous thyroid cells absorb radioactive iodine, it kills off the cells.
Radioactive iodine therapy involves the consumption of the radioactive material I-131. You can receive this therapy in an outpatient setting because the I-131 medication comes in a liquid or capsule. Most of the radioactive part of the drug will be gone from your body within a week.
Chemotherapy drugs stop cancer cells from dividing. You’ll receive this treatment through injection.
There are different types of chemotherapy drugs that target specific types of cancer cells. Your doctor will help you decide which drug is right for you.
Thyroid hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Your doctor can prescribe drugs that stop your body from producing thyroid-stimulating hormones. These are the hormones that cause cancer to develop in the thyroid.
Some people with a partially removed thyroid will take hormone replacement pills because their thyroid is not able to produce enough thyroid hormones.
Targeted therapy drugs seek out a specific characteristic in cancer cells, like a gene mutation or protein, and attach themselves to those cells. Once attached, these drugs may kill the cells or may help other therapies, such as chemotherapy, work better.
Approved targeted therapy drugs for thyroid cancer include vandetanib (Caprelsa), cabozantinib (COMETRIQ), and sorafenib (Nexavar).
The outlook for papillary thyroid cancer is excellent if you’re diagnosed early. Early detection is key to treating the disease. See your doctor immediately if you notice any lumps around the region of your thyroid.