Cancer Education Slides

Thyroid Cancer2010

What is Cancer?

• A group of 100 different diseases

• The uncontrolled, abnormal growth of cells

• Cancer may spread to other parts of the body

What is Thyroid Cancer?

• An estimated 44,670 people diagnosed in the United States in 2010

• A disease of the thyroid gland in which cells grow uncontrollably and form a tumor or nodule

• Four main types of thyroid cancer: papillary, follicular, medullary, and anaplastic

• Papillary and follicular make up 80% to 90% of all thyroid cancer

• Five-year survival rate: 97% (all stages and types combined)

The Thyroid: Anatomy

• Located in the front of the neck just below the larynx (voicebox)

• Gland with two lobes, one on each side of the windpipe, joined by a narrow strip of tissue called the isthmus

The Thyroid: Function

• Important part of the endocrine system

• Absorbs iodine from the bloodstream to produce thyroid hormone, which regulates a person’s metabolism

What are the Risk Factors for Thyroid Cancer?

• Radiation exposure• Gender• Age• Race• Diet low in iodine• Genetics

Hereditary Thyroid Cancer: Multiple Endocrine Neoplasia (MEN)

2A• Causes 20% to 25% of all medullary thyroid cancer (MTC) cases

• A 95% to 100% lifetime risk of developing MTC• An increased risk of developing adrenal gland tumors and increased activity in the parathyroid gland

• Diagnosed when a person or close family members have at least two of the characteristic features

• Caused by a mutation in the RET gene; genetic testing is available

Hereditary Thyroid Cancer: Multiple Endocrine Neoplasia (MEN)

2B• Causes less than 2% of all medullary thyroid cancer cases

• Causes adrenal gland tumors, a long face, long arms and legs, and thick, lumpy lips caused by mucosal neuromas (noncancerous tumors)

• May cause bowel problems• Approximately 50% of people with MEN 2B have no family history of the condition

• Caused by a mutation in the RET gene; genetic testing is available

Other Hereditary Causes of Thyroid Cancer

• Familial medullary thyroid cancer• Familial papillary thyroid cancer• Familial adenomatous polyposis (FAP)• Cowden syndrome

What are the Symptoms of Thyroid Cancer?

• A lump in the front of the neck, near the Adam’s apple

• Hoarseness• Swollen glands in the neck• Difficulty swallowing• Difficulty breathing• Pain in the throat or neck• A cough that persists and is not caused by a cold

How is Thyroid Cancer Diagnosed?

• Physical examination

• Blood tests

• Ultrasound of neck

• Radionuclide scanning

• Diagnosis is confirmed with a biopsy

Thyroid Cancer Staging• Staging is a way of describing a cancer, such as the size of a tumor and if or where it has spread

• Staging is the most important tool doctors have to determine a patient’s prognosis

• Staging is described by the TNM system: the size and location of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to other areas of the body)

• Thyroid cancer staging differs by tumor type and the age of the patient

• Recurrent cancer is cancer that comes back after treatment

Stage I Papillary or Follicular Thyroid Cancer, patients younger than 45

• No spread to lymph nodes and no distant metastasis

• Treatment includes surgery, hormone therapy, and possible I-131 therapy after surgery

Stage I Papillary or Follicular Thyroid Cancer, patients 45 or

older

• A small tumor with no spread to the lymph nodes and no metastasis

• Treatment includes surgery, hormone therapy, and possible I-131 therapy after surgery

Stage II Papillary or Follicular Thyroid Cancer, patients younger

than 45• A tumor with any

metastasis regardless of spread to lymph nodes

• Treatment includes surgery, hormone therapy, and possible I-131 therapy after surgery

Stage II Papillary or Follicular Thyroid Cancer, patients 45 or

older

• A larger, non-invasive tumor but no spread to lymph nodes and no metastasis

• Treatment includes surgery, hormone therapy, possible I-131 therapy after surgery

Stage III Papillary or Follicular Thyroid Cancer, patients 45 or

older• Any tumor that has

spread to lymph nodes, but has not metastasized

• Treatment includes surgery, hormone therapy, possible I-131 therapy or external-beam radiation therapy after surgery

Stage IV Papillary or Follicular Thyroid Cancer, patients 45 or

older

• All tumors when there is evidence of metastasis

• Treatment may include a combination of surgery, hormone therapy, I-131 therapy, external-beam radiation therapy, and chemotherapy

• Clinical trials

Stage I Medullary Thyroid Cancer

• A small tumor with no spread to lymph nodes and no metastasis

• Treatment includes surgery, hormone therapy, and possible I-131 therapy after surgery

Stage II Medullary Thyroid Cancer

• Any tumor with no spread to the lymph nodes and no metastasis

• Treatment includes surgery, hormone therapy, possible I-131 therapy after surgery

Stage III Medullary Thyroid Cancer

• Any tumor that has spread to the lymph nodes, but has not metastasized

• Treatment includes surgery, hormone therapy, possible I-131 therapy or external-beam radiation therapy after surgery

Stage IV Medullary Thyroid Cancer

• Any evidence of metastasis

• Treatment may include a combination of surgery, hormone therapy, I-131 therapy, external-beam radiation therapy, and chemotherapy

• Clinical trials

Stage IV Anaplastic Thyroid Cancer

• All anaplastic/undifferentiated tumors, regardless of tumor size, location, or metastasis

• Treatment may include a combination of surgery, hormone therapy, I-131 therapy, external-beam radiation therapy, and chemotherapy

• Clinical trials

How is Thyroid Cancer Treated?

• More than one treatment may be used• Surgery• Hormone therapy• Radioactive iodine therapy (I-131)• External-beam radiation therapy• Chemotherapy

Cancer Treatment: Surgery

• Main treatment for thyroid cancer; type of surgery depends on the tumor size

• Total thyroidectomy: removal of the entire thyroid

• Near-total thyroidectomy: removal of the thyroid, except for a small part

• Lobectomy: removal of the lobe with the cancerous nodule; performed on some patients with papillary or follicular types

Cancer Treatment: Surgery, continued

• Neck dissection: removal of the lymph nodes in the neck

• Complications may include damage to the parathyroid gland, bleeding, infections, and hoarseness if the nerves to the larynx are damaged

Cancer Treatment: Hormone Therapy

• Required for patients treated with surgery• Replaces the hormone that is needed by the body and slows down the growth of any remaining cancer cells

• Levothyroxine (Levothroid, Levoxyl, Synthroid)

• Amount is different for every patient and tumor type; the doctor will monitor thyroid hormone levels with regular blood tests

Cancer Treatment: Hormone Therapy, continued

• Hyperthyroidism (too much hormone) may cause weight loss, chest pain, rapid heart rate, cramps, and diarrhea; patients may also feel hot

• Hypothyroidism (too little hormone) may cause fatigue, weight gain, and dry skin and hair; patients may also feel cold

• Side effects are rare; may include skin rash or hair loss during the first few months of treatment

Cancer Treatment: Radioactive Iodine Therapy (I-131)

• The thyroid absorbs nearly all iodine that enters the body

• Radioactive iodine is absorbed and destroys thyroid cancer cells not removed by surgery

• Treatment for papillary and follicular types typically

• Patients may be hospitalized for two to three days during treatment

Cancer Treatment: Radioactive Iodine Therapy (I-131), continued

• Low-iodine diet for several weeks beforehand• Stopping hormone therapy temporarily or receiving injections of recombinant TSH (Thyrogen)

• Short-term side effects may include nausea/vomiting and xerostomia (dry mouth)

• Long-term side effects may include infertility, especially in men, and repeated high doses can cause secondary cancers

Cancer Treatment: External-Beam Radiation Therapy

• The use of high-energy x-rays to destroy cancer cells

• External beam: outside the body• Usually given for advanced cancer if cancer cells remain after surgery and I-131 therapy

• Side effects may include skin redness, painful swallowing, cough, hoarseness, nausea, and fatigue

Cancer Treatment: Chemotherapy

• Use of drugs to kill cancer cells• Used occasionally for thyroid cancer• Given as part of a clinical trial in most cases

• Side effects may include fatigue, infection, nausea and vomiting, loss of appetite, and diarrhea

Current Research

• Minimally invasive video-assisted thyroid surgery• Experimental combinations of chemotherapy and other treatments

• Vascular endothelial growth factor (VEGF) inhibitors which may block the formation of new blood vessels necessary for tumor growth

• Targeted therapies that affect only the cancer cells and not healthy cells

• Use of molecular biology to fine-tune diagnosis and predict treatment outcomes

• Genetic testing of RET oncogenes

The Role of Clinical Trials for the Treatment of Thyroid

Cancer• Clinical trials are research studies involving people

• They test new treatment and prevention methods to determine whether they are safe, effective, and better than the standard treatment

• The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process

• Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

Clinical Trials: Patient Safety

• Informed consent: participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks; informed consent is an ongoing process

• Participation is always voluntary, and patients can leave the trial at any time

• Other safeguards exist to ensure ongoing patient safety

Clinical Trials: Phases

• Phase I trials determine the safety and dose of a new treatment in a small group of people

• Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a specific type of cancer

• Phase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the standard treatment for that disease; phase III trials involve a large number of patients

Clinical Trials Resources

• Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org)

• CenterWatch (www.centerwatch.com)

• National Cancer Institute (www.cancer.gov/clinical_trials)

• American Thyroid Association (www.thyroidtrials.org)

• EmergingMed (www.emergingmed.com)

Coping with Side Effects

• Side effects are treatable; talk with the doctor or nurse

• Medications can reduce the inflammation and pain that may cause difficulty swallowing; changes in diet can also reduce swallowing difficulties

• Fatigue is a common, treatable side effect• Pain is treatable; non-narcotic pain-relievers are available

• Antiemetic drugs can reduce or prevent nausea and vomiting

• For more information, visit www.cancer.net/sideeffects

After Treatment

• Follow-up with the doctor every six months to a year

• Follow-up visits usually include a physical examination and blood tests

• Other tests may include chest x-ray, an ultrasound of the neck, or radionuclide scanning

• The doctor will determine if other tests are needed

• Fear of recurrence is common; talk with your health-care team about ways to cope

Where to Find More InformationCancer.Net Guide to Thyroid Cancer

(www.cancer.net/thyroid)

• Overview• Medical

Illustrations• Risk Factors• Symptoms• Diagnosis• Staging With

Illustrations• Treatment

• Clinical Trials• Side Effects• After Treatment• Current Research• Questions to Ask the

Doctor• Patient Information

Resources

Cancer.Net (www.cancer.net)

• Comprehensive, oncologist-approved cancer information

• Guides to more than 120 types of cancer and cancer-related syndromes

• Coping resources• Survivorship information• Cancer information in Spanish• Weekly feature articles• The latest cancer news• For patient information resources, please call 888-651-3038