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    Thyroid cancer - papillary carcinoma

    Papillary carcinoma of the thyroid

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

    Causes

    About 80% of all thyroid cancers diagnosed in the United States are thepapillary carcinoma type. This type of cancer is more common in women than in men. It may occur in childhood, but is most often seen in adultsbetweenages 30 and 50.

    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 somenon-cancerous childhood conditions
    • Radiation exposure from nuclear plant disasters

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

    Symptoms

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

    While some small lumps may be cancer, most (90%) thyroid nodules are harmless and are not cancerous.

    Most of the time, there are no other symptoms.

    Exams and Tests

    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 specialprocedure called a fine needle aspiration biopsy (FNAB) will be performed. This test helps determine if the lump is cancerous.

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

    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. Often, the entire gland is taken out.

    After the surgery, most patients receive radioactive iodine, which is usually taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images clearer, so doctors can see if there is any cancer left behind or if it comes back later.

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

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

    Most patients who had thyroid cancer need to have 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
    • An imaging test called a radioactive iodine (I-131) uptake scan

    Outlook (Prognosis)

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

    The following factors may decrease the survival rate:

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

    Possible 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)

    When to Contact a Medical Professional

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

    References

    Ladenson P, Kim M. Thyroid. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 244.

    National Comprehensive Cancer Network. NCCN Guidelines in Oncology 2010: Thyroid Cancer. Version 1.2010.

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            Tests for Thyroid cancer - papillary carcinoma

            Review Date: 3/22/2012

            Reviewed By: Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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