The word "cancer" naturally causes anxiety. But of all types of cancer, thyroid cancer by and large is one of the most curable cancers there are. There are four main varieties of thyroid cancer: papillary, follicular, medullary, and anaplastic. The first two types, papillary and follicular, share certain characteristics and account for more than 90% of all cases of thyroid cancer.
Papillary and follicular thyroid cancer are derived from the cells in the thyroid that make thyroid hormone. The cause of most of these cancers is not known, but it is known that radiation exposure is associated with this disease in a few patients. This type of cancer may occur in any age group and is more common in women than men. The overall long-term survival of papillary and follicular cancer is greater than 90%.
The primary treatment of thyroid cancer is surgical removal. In a few cases it may be necessary to remove only a part of the thyroid gland, but in most cases complete removal of the thyroid (total thyroidectomy) is preferred. Many patients will also need treatment with radioactive iodine. Papillary and follicular cancer arise from cells that normally extract iodine from the blood stream in order to make thyroid hormone. This property is very useful because even most abnormal cancer cells will take up iodine. Radioactive iodine is taken up by the abnormal cells and concentrated, causing death to these cells. Total thyroidectomy is necessary before treatment with radioactive iodine, because normal thyroid tissue is much more efficient in taking up iodine than abnormal cancer cells.
Medullary thyroid cancer accounts for 5-10% of thyroid cancers. It is derived from cells within the thyroid that make a hormone called calcitonin. Medullary thyroid cancer is treated primarily by surgical removal. This type of thyroid cancer is not effectively treated with radioactive iodine. Medullary thyroid cancer may run in families either by itself or as part of Multiple Endocrine Neoplasia type II. There is a good genetic test for most hereditary cases of this disease. If this disease runs in your family it is important for all children at risk to have this test. If a child tests positive for the gene defect, removal of the thyroid will prevent the development of the cancer.
Anaplastic thyroid cancer is very rare. It is an aggressive tumor that must be treated as quickly as possible after diagnosis.
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If you have questions you may contact us at Endocrine_Surgery@med.unc.edu