Cancer of the adrenal cortex, a rare cancer, is a disease in which malignant cells are found in the adrenal cortex, which is the outside layer of the adrenal gland. Cancer of the adrenal cortex is also called adrenocortical carcinoma. There are two adrenal glands, one above each kidney in the back of the upper abdomen. The adrenal glands are also called the suprarenal glands. The inside layer of the adrenal gland is called the adrenal medulla. Cancer that starts in the adrenal medulla is called pheochromocytoma.

The four parathyroid glands

The parathyroid are a set of four small glands located at the base of the neck, close to the thyroid gland, either in its substance, or along its posterior surface, or very close to it.

The parathyroid are involved in maintaining calcium metabolism, and they do this with the help of a hormone they produce called parathyroid hormone (PTH).

The cells in the adrenal cortex make important hormones that help the body work properly. When cells in the adrenal cortex become cancerous, they may make too much of one or more hormones, which can cause symptoms such as high blood pressure, weakening of the bones, or diabetes. If male or female hormones are affected, the body may go through changes such as a deepening of the voice, growing hair on the face, swelling of the sex organs, or swelling of the breasts. Cancers that make hormones are called functioning tumours. Many cancers of the adrenal cortex do not make extra hormones and are called non-functioning tumours.

A doctor should be seen if the following symptoms appear and won’t go away:

• pain in the abdomen,
• loss of weight without dieting
• weakness.

If there is a functioning tumour, there may be symptoms or signs caused by too many hormones. If there are symptoms, a doctor will order blood and urine tests to see whether the amounts of hormones in the body are normal. A doctor may also order a computed tomography scan of your abdomen, a special x-ray that uses a computer to make a picture of the inside of the abdomen. Other special x-rays may also be done to tell what kind of tumour is present.

The chance of recovery (prognosis) depends on how far the cancer has spread (stage) and on whether a doctor was able to surgically remove all of the cancer.

BACK

Gastrointestinal carcinoid tumours are cancers in which malignant cells are found in certain hormone-making cells of the digestive, or gastrointestinal, system. The digestive system absorbs vitamins, minerals, carbohydrates, fats, proteins, and water from the food that is eaten and stores waste until the body eliminates it. The digestive system is made up of the stomach and the small and large intestines. The last 6 feet of intestine is called the colon. The last 10 inches of the colon is the rectum. The appendix is an organ attached to the large intestine.

Carcinoid syndrome is the pattern of symptoms that typically are exhibited by people with carcinoid tumours. The symptoms include bright red facial flushing, diarrhoea, and occasionally wheezing. A specific type of heart valve damage can occur, as well as other cardiac problems. Carcinoid tumours secrete excessive amounts of the hormone serotonin. Surgery with complete removal of the tumour tissue is the ideal treatment. It can result in a permanent cure if it is possible to remove the tumour entirely.

There are often no signs of a gastrointestinal carcinoid tumour in its early stages. Often the cancer will make too much of some of the hormones, which can cause symptoms. A doctor should be seen if the following symptoms persist:

• Pain in the abdomen.
• Flushing and swelling of the skin of the face and neck.
• Wheezing.
• Diarrhoea.
• Symptoms of heart failure, including breathlessness.

If there are symptoms, a doctor may order blood and urine tests to look for signs of cancer. Other tests may also be done. If there is a carcinoid tumour, the patient has a greater chance of getting other cancers in the digestive system, either at the same time or at a later time.

The chance of recovery (prognosis) and choice of treatment depend on whether the cancer is just in the gastrointestinal system or has spread to other places, and on the patient's general state of health. There are treatments for all patients with gastrointestinal carcinoid tumours. Four kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays to kill cancer cells).
• Biological therapy (using the body's natural immune system to fight cancer).
• Chemotherapy (using drugs to kill cancer cells).

Depending on where the cancer started, the doctor may take out the cancer using one of the following operations:

1. A simple appendectomy removes the appendix. If part of the colon is also taken out, the operation is called a hemicolectomy. The doctor may also remove lymph nodes and look at them under a microscope to see if they contain cancer.
2. Local excision uses a special instrument inserted into the colon or rectum through the anus to cut the tumour out. This operation can be used for very small tumours.
3. Fulguration uses a special tool inserted into the colon or rectum through the anus. An electric current is then used to burn the tumour away.
4. Bowel resection takes out the cancer and a small amount of healthy tissue on either side. The healthy parts of the bowel are then sewn together. The doctor will also remove lymph nodes and have them looked at under a microscope to see if they contain cancer.
5. Cryosurgery kills the cancer by freezing it.
6. Hepatic artery ligation cuts and ties off the main blood vessel that brings blood into the liver (the hepatic artery).
7. Hepatic artery embolization uses drugs or other agents to reduce or block the flow of blood to the liver in order to kill cancer cells growing in the liver.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the digestive system.

Biological therapy tries to get the patient's body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defences against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Treatment by type
Treatment of gastrointestinal carcinoid tumour depends on the type of tumour, the stage, and the patient's overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

Localized Gastrointestinal Carcinoid tumours
If the cancer started in the appendix, the treatment will probably be surgery to remove the appendix (appendectomy) with or without removal of part of the colon (hemicolectomy) and lymph nodes.

If the cancer started in the rectum, treatment will probably be simple surgery to remove the cancer, surgery using electric current to burn the cancer away, surgery to remove part of the rectum, or surgery to remove the anus and part of the rectum. An opening will be made for waste to pass out of the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag).

If the cancer started in the small intestine, the treatment will probably be surgery to remove part of the bowel (bowel resection). Lymph nodes may also be taken out and looked at under the microscope to see if they contain cancer.

If the cancer started in the stomach, pancreas, or colon, the treatment will probably be surgery to remove the organ affected by the cancer and possibly other nearby organs.

Regional Gastrointestinal Carcinoid tumours
The treatment will probably be surgery to remove the organ affected by the cancer and possibly other nearby organs.

Metastatic Gastrointestinal Carcinoid tumours
Treatment may be one of the following:

1. Surgery to relieve symptoms caused by the cancer. Surgery to freeze and kill the cancer may also be performed.
2. Chemotherapy to relieve symptoms caused by the cancer.
3. Chemotherapy injected directly into the hepatic artery to block the artery and kill cancer cells growing in the liver.
4. Radiation therapy to relieve symptoms caused by the cancer.
5. Radioactive substances injected into the cancer to relieve the symptoms caused by the cancer.
6. Biological or immunological therapy.

Carcinoid syndrome
Treatment options for metastatic carcinoid tumour may be one of the following:

1. Surgery to remove the cancer.
2. Surgery to cut and tie the main artery that goes to the liver (hepatic artery ligation) or injecting chemotherapy into the liver through the hepatic artery to block the artery and kill cancer cells growing in the liver.
3. Drugs designed to relieve symptoms caused by the cancer.
4. Biological therapy to relieve symptoms caused by the cancer.
5. A clinical trial of new combinations of chemotherapy drugs.

BACK

Islet cell cancer, a rare cancer, is a disease in which malignant cells are found in certain tissues of the pancreas. The pancreas is about 6 inches long and is shaped like a thin pear, wider at one end and narrower at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine. The broader right end of the pancreas is called the head, the middle section is called the body, and the narrow left end is the tail.

The pancreas has two basic jobs in the body. It produces digestive juices that help break down (digest) food, and hormones (such as insulin) that regulate how the body stores and uses food. The area of the pancreas that produces digestive juices is called the exocrine pancreas. About 95% of pancreatic cancers begin in the exocrine pancreas. The hormone-producing area of the pancreas has special cells called islet cells and is called the endocrine pancreas. Only about 5% of pancreatic cancers start here.

The islet cells in the pancreas make many hormones, including insulin, which help the body store and use sugars. When islet cells in the pancreas become cancerous, they may make too many hormones. Islet cell cancers that make too many hormones are called functioning tumours. Other islet cell cancers may not make extra hormones and are called non-functioning tumours. Tumours that do not spread to other parts of the body can also be found in the islet cells.  A doctor will need to determine whether the tumour is cancer or a benign tumour.

A doctor should be seen if there is pain in the abdomen, diarrhoea, stomach pain, a tired feeling all the time, fainting, or weight gain without eating too much.

If there are symptoms, the doctor will order blood and urine tests to see whether the amounts of hormones in the body are normal. Other tests, including x-rays and special scans, may also be done.

The chance of recovery (prognosis) depends on the type of islet cell cancer the patient has, how far the cancer has spread, and the patient’s overall health.

Stages of islet cell cancer
Once islet cell cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. The staging system for islet cell cancer is still being developed. These tumours are most often divided into one of three groups:

1. islet cell cancers occurring in one site within the pancreas,
2. islet cell cancers occurring in several sites within the pancreas, or
3. islet cell cancers that have spread to lymph nodes near the pancreas or to distant sites.

A doctor also needs to know the type of islet cell tumour to plan treatment. The following types of islet cell tumours are found:

Gastrinoma
The tumour makes large amounts of a hormone called gastrin, which causes too much acid to be made in the stomach. Ulcers may develop as a result of too much stomach acid.

Insulinoma
The tumour makes too much of the hormone insulin and causes the body to store sugar instead of burning the sugar for energy. This causes too little sugar in the blood, a condition called hypoglycaemia.

Glucagonoma
This tumour makes too much of the hormone glucagon and causes too much sugar in the blood, a condition called hyperglycaemia.

Miscellaneous
Other types of islet cell cancer can affect the pancreas and/or small intestine. Each type of tumour may affect different hormones in the body and cause different symptoms.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.

How islet cell cancer is treated
There are treatments for all patients with islet cell cancer. Three types of treatment are used:

• Surgery (taking out the cancer).
• Chemotherapy (using drugs to kill cancer cells).
• Hormone therapy (using hormones to stop cancer cells from growing).

Surgery is the most common treatment of islet cell cancer. The doctor may take out the cancer and most or part of the pancreas. Sometimes the stomach is taken out (gastrectomy) because of ulcers. Lymph nodes in the area may also be removed and looked at under a microscope to see if they contain cancer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Hormone therapy uses hormones to stop the cancer cells from growing or to relieve symptoms caused by the tumour.

Hepatic arterial occlusion or embolization uses drugs or other agents to reduce or block the flow of blood to the liver in order to kill cancer cells growing in the liver.

Gastrinoma
Treatment may be one of the following:

1. Surgery to remove the cancer.
2. Surgery to remove the stomach (gastrectomy).
3. Surgery to cut the nerve that stimulates the pancreas.
4. Chemotherapy.
5. Hormone therapy.
6. Hepatic arterial occlusion or embolization to kill cancer cells growing in the liver.

Insulinoma
Treatment may be one of the following:

1. Surgery to remove the cancer.
2. Chemotherapy.
3. Hormone therapy.
4. Drugs to relieve symptoms.
5. Hepatic arterial occlusion or embolization to kill cancer cells growing in the liver.

Glucagonoma
Treatment may be one of the following:

1. Surgery to remove the cancer.
2. Chemotherapy.
3. Hormone therapy.
4. Hepatic arterial occlusion or embolization to kill cancer cells growing in the liver.

Miscellaneous Islet Cell Cancer
Treatment may be one of the following:

1. Surgery to remove the cancer.
2. Chemotherapy.
3. Hormone therapy.
4. Hepatic arterial occlusion or embolization to kill cancer cells growing in the liver.

BACK

Parathyroid cancer, a very rare cancer, is a disease in which malignant cells are found in the tissues of the parathyroid gland. The parathyroid gland is at the base of the neck, near the thyroid gland. The parathyroid gland makes a hormone called parathyroid hormone (PTH), or parathormone, which helps the body store and use calcium.

Problems with the parathyroid gland are common and are usually not caused by cancer. If parathyroid cancer is found, the parathyroid gland may be making too much PTH. This causes too much calcium to be found in the blood. The extra PTH also takes calcium from the bones, which causes pain in the bones, kidney problems, and other types of problems. There are other conditions that can cause the parathyroid gland to make too much PTH. It is important for a doctor to determine what is causing the extra PTH. Hyperparathyroidism is a condition which can cause the body to make extra PTH. If hyperparathyroidism runs in the family, there is a greater chance of getting this type of cancer.

A doctor should be seen if there are the following symptoms: bone pain, a lump in the neck, pain in the upper part of the back, weak muscles, difficulty speaking, or vomiting.

If there are symptoms, the doctor will conduct a physical examination and feel for lumps in the throat. The doctor may also order blood tests and other tests to check for cancer or other types of tumours that may not be cancer (benign tumours).

The chance of recovery (prognosis) depends on whether the cancer is just in the parathyroid gland or has spread to other parts of the body (stage) and the patient’s general health.

How parathyroid cancer is treated
There are treatments for all patients with parathyroid cancer. Two kinds of treatment are used:

1. Surgery (taking out the cancer).
2. Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).

Surgery is the most common treatment of parathyroid cancer. A doctor may remove the parathyroid gland (parathyroidectomy) and the half of the thyroid on the same side as the cancer (ipsilateral thyroidectomy).

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy (using drugs to kill cancer cells) is being studied in clinical trials. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the parathyroid gland.

Localized Parathyroid Cancer
Treatment may be one of the following:

1. Surgery to remove the parathyroid gland (parathyroidectomy) and the half of the thyroid on the same side as the cancer (ipsilateral thyroidectomy).
2. A clinical trial of surgery followed by radiation therapy.
3. A clinical trial of radiation therapy.

Metastatic Parathyroid Cancer
Treatment may be one of the following:

1. Surgery to remove the parathyroid gland (parathyroidectomy) and other tissues around the thyroid if they contain cancer.
2. Surgery to remove as much of the parathyroid gland as possible in order to reduce production of PTH.
3. Medical treatment to reduce the amount of calcium in the blood.
4. A clinical trial of surgery followed by radiation therapy.
5. A clinical trial of radiation therapy.
6. A clinical trial of chemotherapy.

Recurrent Parathyroid Cancer
Recurrent disease can occur as late as 34 years after the first tumour.

Treatment may be one of the following:

1. Surgery to remove the parathyroid gland (parathyroidectomy) and other tissues around the thyroid if they contain cancer.
2. Surgery to remove as much of the parathyroid gland as possible in order to reduce production of PTH.
3. Medical treatment to reduce the amount of calcium in the blood.
4. A clinical trial of surgery followed by radiation therapy.
5. A clinical trial of radiation therapy.
6. A clinical trial of chemotherapy.

BACK

Pheochromocytoma, a rare cancer, is a disease in which malignant cells are found in special cells in the body called chromaffin cells. Most pheochromocytomas start inside the adrenal gland (the adrenal medulla) where most chromaffin cells are located. There are two adrenal glands, one above each kidney in the back of the upper abdomen. Cells in the adrenal glands make important hormones that help the body work properly. Usually pheochromocytoma affects only one adrenal gland. Pheochromocytoma may also start in other parts of the body, such as the area around the heart or bladder.

Most tumours that start in the chromaffin cells do not spread to other parts of the body and are not cancer. If a tumour is found, the doctor will need to determine whether it is cancer or benign.

Pheochromocytomas often cause the adrenal glands to make too many hormones called catecholamines. The extra catecholamines cause high blood pressure (hypertension), which can cause headaches, sweating, pounding of the heart, pain in the chest, and a feeling of anxiety. High blood pressure that goes on for a long time without treatment can lead to heart disease, stroke, and other major health problems.

If there are symptoms, a doctor may order blood and urine tests to see if there are extra hormones in the body. A patient may also have a special nuclear medicine scan. A CT scan, an x-ray that uses a computer to make a picture of the inside of a part of the body or an MRI scan, which uses magnetic waves to make a picture of the abdomen, may also be done.

Pheochromocytoma is sometimes part of a condition called multiple endocrine neoplasia syndrome (MEN). People with MEN often have other cancers (such as thyroid cancer) and other hormonal problems. The chance of recovery (prognosis) depends on how far the cancer has spread, and the patient’s age and general health.

Localized benign pheochromocytoma
Tumour is found in only one area and has not spread to other tissues. Most pheochromocytomas do not spread to other parts of the body and are not cancer.

Regional pheochromocytoma
Cancer has spread to lymph nodes in the area or to other tissues around the original cancer. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)

Metastatic pheochromocytoma
The cancer has spread to other parts of the body.

Recurrent pheochromocytoma
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the area where it started or in another part of the body.

How pheochromocytoma is treated
There are treatments for all patients with pheochromocytoma. Three kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
• Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of pheochromocytoma. A doctor may remove one or both adrenal glands in an operation called adrenalectomy. The doctor will look inside the abdomen to make sure all the cancer is removed. If the cancer has spread, lymph nodes or other tissues may also be taken out.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation comes from a machine outside the body (external radiation therapy).

Localized Benign Pheochromocytoma
Treatment will probably be surgery to remove one or both adrenal glands (adrenalectomy). After surgery the doctor will order blood and urine tests to make sure hormone levels return to normal.

Regional Pheochromocytoma
Treatment may be one of the following:

1. Surgery to remove one or both adrenal glands (adrenalectomy) and as much of the cancer as possible. If cancer remains after surgery, drugs will be given to control high blood pressure.
2. External radiation therapy to relieve symptoms (in rare cases).
3. Chemotherapy.

Metastatic Pheochromocytoma
Treatment may be one of the following:

1. Surgery to remove as much of the cancer as possible. If cancer remains after surgery, drugs will be given to control high blood pressure.
2. External radiation therapy to relieve symptoms.
3. Chemotherapy.

BACK

Types of pituitary tumours
Once a pituitary tumour is found, more tests will be done to find out how far the tumour has spread and whether or not it makes hormones. A doctor needs to know the type of tumour to plan treatment. The following types of pituitary tumours are found:

ACTH-producing tumours
These tumours make a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to make glucocorticoids. When the body makes too much ACTH, it causes Cushing’s disease.

Prolactin-producing tumours
These tumours make prolactin, a hormone that stimulates a woman’s breasts to make milk during and after pregnancy. Prolactin-secreting tumours can cause the breasts to make milk and menstrual periods to stop when a woman is not pregnant. In men, prolactin-producing tumours can cause impotence.

Growth hormone-producing tumours
These tumours make growth hormone, which can cause acromegaly or gigantism when too much is made.

Non-functioning pituitary tumours
Non-functioning tumours do not produce hormones.

How pituitary tumours are treated
There are treatments for all patients with pituitary tumours. Three kinds of treatment are used:

• Surgery
• Radiation therapy (using high-dose x-rays to kill tumour cells).
• Drug therapy.

Surgery is a common treatment of pituitary tumours. A doctor may remove the tumour using one of the following operations:

• A transsphenoidal hypophysectomy removes the tumour through a cut in the nasal passage.
• A craniotomy removes the tumour through a cut in the front of the skull.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation for pituitary tumours usually comes from a machine outside the body (external radiation therapy). Radiation therapy may be used alone or in addition to surgery or drug therapy.

Certain drugs can also block the pituitary gland from making too many hormones.

ACTH-Producing Pituitary Tumours
Treatment may be one of the following:

1. Surgery to remove the tumour (transsphenoidal hypophysectomy or craniotomy
2. Radiation therapy. Clinical trials may be testing new types of radiation therapy.
3. Surgery plus radiation therapy.
4. Radiation therapy plus drug therapy to stop the tumour from making ACTH.

Prolactin-Producing Pituitary Tumours
Treatment may be one of the following:

1. Surgery to remove the tumour (transsphenoidal hypophysectomy or craniotomy).
2. Radiation therapy.
3. Surgery, radiation therapy, and drug therapy.
4. Drug therapy to stop the tumour from making prolactin. Clinical trials are testing new drugs for this purpose.

Growth Hormone-Producing Pituitary Tumours
Treatment may be one of the following:

1. Surgery to remove the tumour (transsphenoidal hypophysectomy or craniotomy).
2. Radiation therapy.
3. Drug therapy to stop the tumour from making growth hormone.

Non-functioning Pituitary Tumours
Treatment may be one of the following:

1. Surgery to remove the tumour (transsphenoidal hypophysectomy or craniotomy).
2. Radiation therapy alone or in addition to surgery.

Recurrent Pituitary Tumours
Treatment of recurrent pituitary tumour depends on the type of tumour, the type of treatment the patient has already had, and other factors such as the patient’s general condition. Patients may want to take part in a clinical trial of new treatments.

BACK

Thyroid Cancer
Cancer of the thyroid is a disease in which cancer cells are found in the tissues of the thyroid gland. The thyroid gland is at the base of the throat. It has two lobes, one on the right side and one on the left. The thyroid gland makes important hormones that help the body function normally.

Cancer of the thyroid is more common in women than in men. Most patients are between 25 and 65 years old. People who have been exposed to large amounts of radiation, or who have had radiation treatment for medical problems in the head and neck have a higher chance of getting thyroid cancer. The cancer may not occur until 20 years or longer after radiation treatment.

A doctor should be seen if there is a lump or swelling in the front of the neck or in other parts of the neck.

If there are symptoms, a doctor will feel the patient’s thyroid and check for lumps in the neck. The doctor may order blood tests and special scans to see whether a lump in the thyroid is making too many hormones. The doctor may want to take a small amount of tissue from the thyroid. This is called a biopsy. To do this, a small needle is inserted into the thyroid at the base of the throat and some tissue is drawn out. The tissue is then looked at under a microscope to see whether it contains cancer.

There are four main types of cancer of the thyroid (based on how the cancer cells look under a microscope):

• papillary
• follicular
• medullary
• anaplastic

The chance of recovery (prognosis) depends on the type of thyroid cancer, whether it is just in the thyroid or has spread to other parts of the body (stage), and the patient’s age and overall health. Some types of thyroid cancer grow much faster than others.

The genes in our cells carry the hereditary information from our parents. An abnormal gene has been found in patients with some forms of thyroid cancer. If medullary thyroid cancer is found, the patient may have been born with a certain abnormal gene which may have led to the cancer. Family members may have also inherited this abnormal gene. Tests have been developed to determine who has the genetic defect long before any cancer appears. It is important that the patient and his or her family members (children, grandchildren, parents, brothers, sisters, nieces and nephews) see a doctor about tests that will show if the abnormal gene is present. These tests are confidential and can help the doctor help patients. Family members, including young children, who don’t have cancer, but do have this abnormal gene, may reduce the chance of developing medullary thyroid cancer by having surgery to safely remove the thyroid gland (thyroidectomy).

Stages of cancer of the thyroid
Once cancer of the thyroid is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for papillary cancers of the thyroid:

Stage I papillary
Cancer is only in the thyroid and may be found in one or both lobes.

Stage II papillary
In patients younger than 45 years of age: Cancer has spread beyond the thyroid.
In patients older than 45 years of age: Cancer is only in the thyroid and larger than 1 centimetre (about 1/2 inch).

Stage III papillary
Cancer is found in patients older than 45 years of age and has spread outside the thyroid (but not outside of the neck) or has spread to the lymph nodes.

Stage IV papillary
Cancer is found in patients older than 45 years of age and has spread to other parts of the body, such as the lungs and bones.

The following stages are used for follicular cancers of the thyroid:

Stage I follicular
Cancer is only in the thyroid and may be found in one or both lobes.

Stage II follicular
In patients younger than 45 years of age:
Cancer has spread beyond the thyroid.
In patients older than 45 years of age:
Cancer is only in the thyroid and larger than 1 centimetre (about 1/2 inch).

Stage III follicular
Cancer is found in patients older than 45 years of age and has spread outside the thyroid (but not outside of the neck) or to the lymph nodes.

Stage IV follicular
Cancer is found in patients older than 45 years of age and has spread to other parts of the body, such as the lungs and bones.
Other types or stages of thyroid cancer include the following:

Stage I medullary
Cancer is less than 1 centimetre (about 1/2 inch) in size.

Stage II medullary
Cancer is between 1 and 4 centimetres (about 1/2 to 1 1/2 inches) in size.

Stage III medullary
Cancer has spread to the lymph nodes.

Stage IV medullary
Cancer has spread to other parts of the body.

Anaplastic
There is no staging system for anaplastic cancer of the thyroid. This type of cancer of the thyroid grows faster than the other types.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the thyroid or in another part of the body.

How cancer of the thyroid is treated
There are treatments for all patients with cancer of the thyroid. Four types of treatment are used:

Surgery (taking out the cancer).
Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
Hormone therapy (using hormones to stop cancer cells from growing) .
Chemotherapy (using drugs to kill cancer cells).
Surgery is the most common treatment of cancer of the thyroid. A doctor may remove the cancer using one of the following operations:

• Lobectomy removes only the side of the thyroid where the cancer is found. Lymph nodes in the area may be taken out (biopsied) to see if they contain cancer

• Near-total thyroidectomy removes all of the thyroid except for a small part

• Total thyroidectomy removes the entire thyroid

• Lymph node dissection removes lymph nodes in the neck that contain cancer

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation for cancer of the thyroid may come from a machine outside the body (external radiation therapy) or from drinking a liquid that contains radioactive iodine. Because the thyroid takes up iodine, the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells.

Hormone therapy uses hormones to stop cancer cells from growing. In treating cancer of the thyroid, hormones can be used to stop the body from making other hormones that might make cancer cells grow. Hormones are usually given as pills.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the thyroid.

Stage I Papillary Thyroid Cancer
Treatment may be one of the following:
Surgery to remove one lobe of the thyroid (lobectomy), followed by hormone therapy. Radioactive iodine also may be given following surgery.
Surgery to remove the thyroid (total thyroidectomy).

Stage I Follicular Thyroid Cancer
Treatment may be one of the following:
Surgery to remove the thyroid (total thyroidectomy).
Surgery to remove one lobe of the thyroid (lobectomy), followed by hormone therapy. Radioactive iodine also may be given following surgery.

Stage II Papillary Thyroid Cancer
Treatment may be one of the following:
Surgery to remove one lobe of the thyroid (lobectomy) and lymph nodes that contain cancer, followed by hormone therapy. Radioactive iodine also may be given following surgery.
Surgery to remove the thyroid (total thyroidectomy).

Stage II Follicular Thyroid Cancer
Treatment may be one of the following:
Surgery to remove the thyroid (total thyroidectomy).
Surgery to remove one lobe of the thyroid (lobectomy) and lymph nodes that contain cancer, followed by hormone therapy. Radioactive iodine also may be given following surgery.

Stage III Papillary Thyroid Cancer
Treatment may be one of the following:
Surgery to remove the entire thyroid (total thyroidectomy) and lymph nodes where cancer has spread. Total thyroidectomy followed by radiation therapy with radioactive iodine or external beam radiation therapy.

Stage III Follicular Thyroid Cancer
Treatment may be one of the following:
Surgery to remove the entire thyroid (total thyroidectomy) and lymph nodes or other tissues around the thyroid where the cancer has spread.
Total thyroidectomy followed by radioactive iodine or external beam radiation therapy.

Stage IV Papillary Thyroid Cancer
Treatment may be one of the following:
Radioactive iodine.
External beam radiation therapy.
Hormone therapy.
A clinical trial of chemotherapy.

Stage IV Follicular Thyroid Cancer
Treatment may be one of the following:
Radioactive iodine.
External beam radiation therapy.
Hormone therapy.
A clinical trial of chemotherapy.

Medullary Thyroid Cancer
Treatment will probably be surgery to remove the entire thyroid (total thyroidectomy) unless the cancer has spread to other parts of the body. If lymph nodes in the neck contain cancer, the lymph nodes in the neck will be removed (lymph node dissection). If the cancer has spread to other parts of the body, chemotherapy may be given.

Anaplastic Thyroid Cancer
Treatment may be one of the following:
Surgery to remove the thyroid and the tissues around it. Because this cancer often spreads very quickly to other tissues, a doctor may have to take out part of the tube through which a person breathes. The doctor will then make an airway in the throat so the patient can breathe. This is called a tracheostomy.
Total thyroidectomy to reduce symptoms if the disease remains in the area of the thyroid.
External beam radiation therapy.
Chemotherapy.
Clinical trials studying new methods of treatment of thyroid cancer.

Recurrent Thyroid Cancer
The choice of treatment depends on the type of thyroid cancer the patient has, the kind of treatment the patient had before, and where the cancer comes back. Treatment may be one of the following:
Surgery with or without radioactive iodine.
External beam radiation therapy to relieve symptoms caused by the cancer.
Chemotherapy.
Radioactive iodine.
Radiation therapy given during surgery.
Clinical trials.

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