see if they will grow, but patients and surgeons are often reluctant to wait and see. That means many cancer nodules are overtreated with surgery.
THYROID CANCER MORE COMMON
The thyroid, a small, butterfly- shaped gland located at the front of the lower neck, makes hormones needed to regulate body functions and energy use. Thyroid cancer is the fifth-most
common cancer in women. More than 50,000 people get diagnosed with thyroid cancer every year, but only about 2,000 die from the disease.
Although thyroid cancer
is generally very treatable, the prognosis depends mainly on the cell type that is seen under a microscope after surgery or a biopsy. “Eighty percent are papillary
type,” says Datta. “This type is slow growing, so minimal surgery is the usual treatment. “Ten to 15% are follicular type.
A bit more likely to grow, but still very treatable with surgery. Three percent are medullary type, which are more dangerous and may require surgery along with other treatment. “The final type, anaplastic
carcinoma, is rare, and usually fatal, but makes up only 2% of thyroid cancers.”
WHO IS AT RISK? “Women are at higher risk than men by about three to one. The common age range is 20 to 55. Other risk factors include having neck exposure to radiation, a family history of thyroid cancer, or a history of Hashimoto’s thyroiditis,” says Datta. Radiation treatments to the front
of the neck may occur during other cancer treatments. Hashimoto’s disease is the most common cause of low thyroid function, called hypothyroidism.
WARNING SIGNS A thyroid cancer forms as a lump (nodule) in the thyroid gland. It is estimated that 20% to 50% of adults will eventually have a thyroid nodule. The vast majority of these nodules cause no symptoms and are too small to notice without a scan. If a thyroid nodule starts to grow, it
can be felt as a lump in the neck and can cause hoarseness if the nodule pushes against the nerve that supplies the voice box. Other symptoms may include
An ultrasound scan may be done or repeated to evaluate the risk for the nodule being cancer, which includes a larger size, a solid core, and irregular shape.
cough, trouble swallowing, neck pain, or pressure. A lump in the neck that grows quickly and is hard and fixed, as opposed to soft and movable, is more likely to be a cancer nodule.
DIAGNOSIS “Today, 95% of the patients I see were diagnosed by an ultrasound before any signs or symptoms,” says Datta. Finding these early cancers is a
benefit because they can be treated before they grow or spread. But it has also been a burden for surgeons, who must decide which ones to biopsy. The usual procedure is to
start with a blood test for thyroid hormones. If they are low or normal, the nodule is more likely to be cancer. An ultrasound scan may be done or repeated to evaluate the risk for the nodule being cancer, which includes a larger size, a solid core, and irregular shape. If a biopsy is suggested by these
findings, the surgeon will place a long, thin needle into the nodule, guided by the ultrasound. “Another option for small papillary
cancers, less than 1 centimeter in size, is watchful waiting, called active surveillance. Studies show the five-year survival rate is the same for surveillance as for early surgery. When radiofrequency ablation is approved for thyroid cancers and covered by insurance, it will add another good option for these patients with small, slow-growing nodules,” says Datta.
PREVENTION “If you have a family history, ask your doctor about genetic testing. Some genetic mutations found on a blood test can increase your risk of more dangerous thyroid cancer,” advises Datta. “Make sure your neck is covered
when you have X-rays. A healthy lifestyle, including not smoking, staying active, a healthy diet, and a healthy weight, may all lower your cancer risk,” he adds.
OCTOBER 2024 | NEWSMAX MAXLIFE 91
ULTRASOUND/PONYWANG©ISTOCK
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