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Thyroid cancer - papillary carcinoma



Alternative Name

Papillary carcinoma of the thyroid

Overview

Papillary carcinoma of the thyroid is the most common cancer of the thyroid gland.

See also: Thyroid cancer


Review Date: 3/2/2010

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.



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Risk Factors

About 80% of all thyroid cancers diagnosed in the United States are papillary carcinoma type. It is more common in women than in men. It may occur in childhood, but is most often seen in adults around the age of 45.

The cause of this cancer is unknown. A genetic defect may be involved.

Radiation increases the risk of developing thyroid cancer. Exposure may occur from:

  • High-dose external radiation treatments to the neck, especially during childhood, used to treat childhood cancer or some benign childhood conditions.
  • Radiation due to atomic bomb testing in the Marshall Islands and the 1986 Chernobyl nuclear disaster in the Ukraine, mostly in children.

Radiation given through a vein (through an IV) during medical tests and treatments does not increase the risk of developing thyroid cancer.

Signs/Symptoms

Thyroid cancer usually begins as a small lump (nodule) in the thyroid gland, which is located at the center part of the front of the neck.

While some small lumps may be cancer, most thyroid nodules are harmless and are not cancerous.

Most of the time, there are no other symptoms.

Calling your health care provider

Call your health care provider if you have a lump in your neck. 

Treatment

There are three types of thyroid cancer treatment:

  • Surgery
  • Radioactive iodine
  • Medication

Surgery is done to remove as much of the cancer as possible. The bigger the lump, the more of the thyroid gland must be removed. Frequently, the entire gland is taken out.

After the surgery, most patients should receive radioactive iodine, which is usually taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images more clear, so doctors can see if there is any additional cancer.

If surgery is not an option, external radiation therapy can be useful.

After surgery or radioactive iodine, the patient will need to take medication called levothyroxine sodium for the rest of their life. This replaces the hormone that the thyroid would normally make.

Most patients who had thyroid cancer need to a blood test every 6 - 12 months to check thyroid levels. Other follow-up tests that may done after treatment for thyroid cancer include:

  • Ultrasound of the thyroid done in the first year
  • An imaging test called a radioactive iodine (I-131) uptake scan
Outlook

The survival rate for papillary thyroid cancer is excellent. More than 95% of adults with such cancer survive at least 10 years. The prognosis is better for patients younger than 40 and for those with smaller tumors.

The following factors may decrease the survival rate:

  • Age over 45
  • Cancer has spread to distant parts of the body
  • Cancer has spread to soft tissue
  • Large tumor

Complications

Complications include:

  • Accidental removal of the parathyroid gland, which helps regulate blood calcium levels
  • Damage to a nerve that controls the vocal cords
  • Spreading of cancer to lymph nodes (rare)
  • Spreading of cancer to other sites (metastasis)
Signs & Testing

If you have a lump on your thyroid, your doctor will order blood tests and possibly an ultrasound of the thyroid gland.

If the ultrasound shows that the lump is bigger than 1.0 centimeter, a special biopsy called a fine needle aspiration (FNA) will be performed. This test helps determines if the lump is cancerous.

Thyroid function tests are usually normal in patients with thyroid cancer.