Thyroid Cancer
The multidisciplinary management of thyroid cancer at Mount Sinai involves collaboration among surgical, medical/endocrinology, and nuclear medicine specialists. The thyroid surgical team at Mount Sinai’s Department of ENT/Head and Neck Surgery includes Eric Genden, MD, Raymond Chai, MD, Nazir Khan, MD, Brett Miles, MD, Edward Shin, MD, Catherine Sinclair, MD, Marita Teng, MD, Mark Urken, MD, and facial plastics and reconstruction surgeon Joshua Rosenberg, MD. Our team works closely with other experts and collaborates to craft the least invasive, personalized treatment plan for each patient to minimize scarring and hospital stays.
Minimal Thyroid Surgery Scarring
Our head and neck surgeons are recognized for their expertise in minimizing scarring for those who require thyroid surgery. Patients often remark during their postoperative visit that the size of the incision is “tiny,” and that friends have complimented them on the scar appearance. During surgery, the incision is camouflaged in a natural skin fold and our team employs plastic surgery techniques to ensure the least visible scar possible. Dissolvable stitches are strategically hidden under the skin, and then covered with a skin-colored surgical tape. It is common to see swelling and a ridge form around the scar area temporarily, but within a few months, the great majority of our patients are extremely happy with their barely noticeable scar.
Types of Thyroid Cancer
Thyroid cancer is a malignant growth in the thyroid, which is the butterfly-shaped gland at the base of the neck. The thyroid produces the hormone that controls a variety of metabolic functions in the body, such as heart rate, weight, and body temperature. When present, thyroid cancer usually manifests in the form of a palpable nodule or mass. The most common types of thyroid cancer include:
- Papillary thyroid cancer/carcinoma (PTC) is the most common type of thyroid cancer, comprising approximately 80 percent of all thyroid cancers. Papillary cancer tends to grow slowly and may spread to the lymph nodes in the neck, but still usually has an excellent prognosis. Most patients with papillary thyroid cancer can be successfully treated with a thorough initial operation, and some patients may require additional treatment with radioactive iodine. Most people are cured and have a normal life expectancy (over 95 percent).
- Follicular thyroid cancer (FTC) is the second most common type of thyroid cancer, accounting for 10-15 percent of all thyroid cancers. It may spread to the lymph nodes in the neck, and is also more likely than papillary thyroid cancer to spread through the blood stream to distant areas (such as the lungs). The prognosis for follicular thyroid cancer remains very good – over 90 percent of patients are cured.
- Hurthle cell cancer is a rare type of follicular thyroid cancer that has many pink-staining cells (so-called oncocytes or Hurthle cells). The pathologist will look for signs of cancer cells invading into surrounding blood vessels or breaking outside of the thyroid, which may predict the cancer will behave more aggressively.
- Poorly differentiated and anaplastic (also known as undifferentiated) thyroid cancer have cancer cells that do not look or behave like normal thyroid cells. Patients usually present with a rapidly growing neck mass. These are very rare types of thyroid cancer, and occur in less than 2 percent of cases. Unfortunately, they tend to be very aggressive and not responsive to treatment. Management of these cancers require the involvement of a multi-disciplinary team with surgeons, endocrinologists, and medical oncologists.
- Medullary thyroid cancer (MTC) makes up 5-10 percent of all thyroid cancer cases. It is often associated with hereditary conditions (multiple endocrine neoplasia, type 2 or MEN-2). All patients with medullary thyroid cancer should undergo genetic testing for a RET gene mutation. If a mutation is found, then the patient’s family members may be at risk for medullary thyroid cancer. In addition, new targeted therapies are available for RET-mutated MTC.
Causes and Risk Factors for Thyroid Cancer
Factors such as the following may increase your risk of developing thyroid cancer:
- History of radiation to the head, neck, or chest, especially in infancy or childhood
- Family history of thyroid cancer
- Female gender
- Age 30 and over
- Exposure to radiation from nuclear accidents or nuclear testing areas
Signs and Symptoms of Thyroid Cancer
Symptoms such as the following could indicate thyroid cancer:
- A lump in the neck
- Neck pain or tightness
- Hoarseness
- Difficulty swallowing
- Difficulty breathing
- Persistent cough
- Enlarged lymph nodes in the neck
Diagnosis of Thyroid Cancer
At Mount Sinai, our physicians have expertise in diagnosing and treating all stages of thyroid cancer. Diagnosing thyroid cancer involves a careful examination of your neck and throat to detect lumps or swelling, as well as a discussion about your medical history. One or more of the following tests may be ordered to determine if the cancer has spread and the optimal treatment plan:
- Ultrasound
- Fine needle aspiration biopsy
- Thyroid scan
- Blood tests for hormone levels
- CT, MRI, or PET scan
Treatments for Thyroid Cancer
Treatment depends on the stage of the cancer. Other than a few rare forms of thyroid cancer, the primary treatment modality is surgery. Examples of treatment options include:
- Minimally invasive surgery: Thyroidectomy is the surgical removal of a portion or all of the thyroid gland. If the nearby (central compartment) lymph nodes appear involved, they may be removed at the same time. In the event that additional lymph nodes are involved, they may also be removed through an extended incision in the same operative setting. These surgeries are usually performed under general anesthesia, and sometimes may require a one-night hospital stay. Our surgical approaches at Mount Sinai are minimally invasive, utilizing small incisions, often as tiny as two centimeters. Skin closure is accomplished with absorbable sutures and a small waterproof surgical tape. Because of these techniques, interference with normal lifestyle is generally negligible, and surgical recovery is typically quite rapid.
- Radioactive iodine therapy: Radioactive iodine is a medication administered orally to destroy any remaining thyroid tissue without affecting the rest of the body. This treatment is designed to eliminate microscopic bits of thyroid tissue and thyroid cancer. Its administration is overseen by an endocrinologist and a nuclear medicine doctor.
- External radiation therapy: Radiation beams can be directed at the tumor from a source outside the body. This treatment is uncommonly used for thyroid cancer, but remains an option for advanced, recurrent, or inoperable disease. A radiation oncologist designs and monitors this treatment.
Thyroid Cancer Prevention
Detecting thyroid cancer early and treating it is the best way to ensure the most successful outcome. Routine physical exam screening is generally performed by general practitioners, internists, and gynecologists. Patients between the ages of 20 and 39 should have a thyroid exam every three years and every year for those 40 and over. If you or your loved one has prior radiation exposure or a family history of thyroid cancer, screening should be more frequent.