Thyroid Cancer Treatment in Delhi, India

There are various types of Thyroid Cancers:

• Papillary Thyroid Cancer - Papillary thyroid cancer is the commonest type of thyroid cancer. It is common in children and women. Previous exposure to radiation can be a cause. Papillary thyroid cancer is usually due to environmental causes and is not inherited. It is called as a well-differentiated thyroid cancer and has excellent cure rates.
• Follicular Thyroid Cancer - Follicular thyroid cancer is the second commonest type of cancer from the thyroid. It is also a type of well-behaved thyroid cancer but with a slightly higher risk of spread than papillary cancer of thyroid.
• Anaplastic Thyroid Cancer - Anaplastic thyroid cancer is one of the more aggressive types of thyroid cancers. It is often seen in patients who have had a thyroid swelling for a long period of time. It tends to spread fast both locally and to distant organs.
• Medullary Thyroid Cancer - Medullary thyroid cancer is a specialised type of thyroid cancer that is hereditary in many patients. Some of the cases occur in young children. It can be treated well with adequate surgery.
• Hurthle cell cancer - Also known as Hurthle cell carcinoma or oxyphilic cell carcinoma, hurthle cell cancer is a type of thyroid cancer that arises from the Hurthle cells, which are large cells with abundant eosinophilic (pink-staining) cytoplasm. These cells are a type of follicular cell found in the thyroid gland. Hurthle cell cancer accounts for a small percentage of all thyroid cancers, and it is considered a subtype of differentiated thyroid cancer.

While the exact cause of most cases of thyroid cancer remains unknown, here are some factors that may contribute to the risk of thyroid cancer.

• Genetic Factors: Inherited genetic mutations, such as in the RET or BRAF genes, can increase the susceptibility to thyroid cancer.
• Radiation Exposure: Exposure to ionising radiation, particularly during childhood, is a known risk factor for thyroid cancer.
• Gender: Thyroid cancer is more prevalent in women than men, suggesting a hormonal influence.
• Age: The risk of thyroid cancer increases with age, with most cases diagnosed between the ages of 25 and 65.
• Thyroid Conditions: Certain pre-existing thyroid conditions, such as goitre or thyroid nodules, may elevate the risk of developing thyroid cancer.
• Family History: A family history of thyroid cancer or other related endocrine cancers can contribute to an increased risk.
• Iodine Deficiency or Excess: Imbalances in iodine levels can impact thyroid function and potentially contribute to the development of thyroid cancer.
• Environmental Factors: Exposure to certain environmental pollutants and toxins may be linked to an increased risk of thyroid cancer.
• Hormonal Factors: Hormonal changes, such as those occurring during pregnancy or the use of certain hormonal therapies, may play a role in thyroid cancer development.

It's important to note that regular screenings and awareness of risk factors can aid in early detection and management of the condition.

Diagnosing thyroid cancer typically involves a comprehensive assessment that includes various medical tests and procedures. The following are key elements in the diagnostic process:

Physical Examination

A healthcare professional may conduct a thorough examination of the neck to check for any abnormalities, such as nodules or swelling in the thyroid gland.

Medical History

Gathering information about the patient's medical history, including any family history of thyroid conditions or cancer, is crucial in the diagnostic process.

Blood Tests

Blood tests may be conducted to assess thyroid hormone levels and detect any abnormalities that could indicate thyroid dysfunction or cancer.

Imaging Studies

• Ultrasound: An ultrasound scan of the thyroid is commonly used to evaluate the size, shape, and texture of the thyroid gland and to identify any nodules.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): These imaging techniques may be employed to assess the extent of tumour growth and determine if cancer has spread to surrounding tissues or lymph nodes.
• PET scan: It is normally not indicated but may be required in a few cases.

Fine Needle Aspiration (FNA) Cytology

This minimally invasive procedure involves using a thin needle to extract a small tissue sample from a thyroid nodule. The sample is then examined under a microscope to determine if cancer cells are present.

Thyroid Scan

A thyroid scan involves using radioactive iodine to create images of the thyroid gland. This can help identify areas of the thyroid that may exhibit abnormal function. 

Genetic Testing

In some cases, genetic testing may be recommended to identify specific genetic mutations associated with thyroid cancer, particularly if there is a family history of the disease.

Laryngoscopy

This test examines the vocal cords and the function of the recurrent laryngeal nerve, which is important for vocal cord movement. It helps assess potential damage caused by thyroid tumours.

Once a diagnosis is confirmed, further staging tests may be conducted to determine the extent of cancer spread. The results of these diagnostic procedures guide the development of an appropriate treatment plan tailored to the individual's specific situation.

Thyroid cancer causes various symptoms that can be easily ignored by the patient as any other discomfort. Some of the thyroid cancer symptoms are:

• Most commonly, a lump or a bulge in the neck
• Difficulty in swallowing
• Breathing difficulty often with a wheezing sound while breathing
• Change in voice or hoarseness in voice
• Irritating cough without any symptom of cold or other reason

If thyroid cancer has advanced and spread to different parts of your body, one might show the following signs

• Fatigue
• Reduced appetite
• Nausea
• Vomiting
• Unanticipated weight loss
• Bone pain

Before treating thyroid cancer, there are a few things that are taken into consideration. Type of cancer, extent of disease (stage) along with the age of the patient are the major things that determine how the doctors would go about the treatment. Following are the thyroid cancer treatment options available in India:

Surgery

For most of the cases, surgery is the main treatment for thyroid cancer. In patients with early disease, removal of half of the thyroid (hemithyroidectomy) may be sufficient. In others or in those with metastases, removal of the whole thyroid or total thyroidectomy is the surgery of choice. Thyroid surgery is a specialised procedure in which some nerves (recurrent laryngeal nerves) and parathyroid glands have to be saved to ensure good long term quality of life. In expert hands, it is a very safe and effective surgery.

Robotic Thyoid Surgery

Surgery with the help of a robot may help in avoiding apparent scar in the neck. This may allow cancer control with cosmesis. There are different ways to perform these surgeries- from behind the ear, from axilla or from the mouth.

Radioactive Iodine Treatment

Radioactive Iodine scanning and treatment is an essential part of thyroid cancer treatment after surgery for well differentiated thyroid cancers. The process is started within one month of surgery and can be repeated at intervals depending upon the needs of the patient. While waiting for the scan, patients have to stop thyroid replacement medicine that leads to symptoms such as weakness, fatigue etc. There is an alternative approach using recombinant TSH and scanning that can avoid such symptoms.

Thyroid Hormone Therapy

Thyroid hormone therapy is a critical component of treatment in thyroid cancer. It is mandatory whenever thyroid gland has been removed. Further, the dose of drugs is adjusted to suppress the level of TSH in the body and this helps in cancer control and prevents regrowth of cancer cells.

Active Surveillance

As thyroid cancers have excellent prognosis, a few select cases may be observed. Intervention may be needed if any characteristics of disease change.

Chemotherapy

In Chemotherapy, anti-cancer drugs are made to enter the patient’s body by injecting them into a vein or muscle. With the help of this treatment, the drug flows throughout the body, destroying cancer cells. It is used mostly during the advanced stages of cancer, especially anaplastic cancer of thyroid.

Radiation Therapy

External radiation (using linear accelerator) is useful in select cases of thyroid cancer when radio-iodine uptake is not good or if there are bone metastases.

Thyroid cancer, like many other types of cancer, can lead to various complications, depending on factors such as the stage of the cancer, and its type. Common complications associated with thyroid cancer include:

• Metastasis: Thyroid cancer can spread (metastasize) to other organs or tissues, particularly to the lymph nodes, lungs, and bones. The extent of metastasis influences the overall prognosis and treatment approach.
• Recurrence: Despite successful initial treatment, thyroid cancer may recur. Regular follow-up appointments and monitoring are essential to detect and promptly address any signs of recurrence.
• Thyroid Hormone Imbalance: Treatment options for thyroid cancer often involve surgery, which may result in the removal of all or part of the thyroid gland. This can lead to an imbalance in thyroid hormone levels, necessitating lifelong thyroid hormone replacement therapy.
• Voice and Swallowing Issues: Surgical procedures on the thyroid gland can potentially affect the nearby structures, including the vocal cords and the recurrent laryngeal nerve. This may result in voice changes or difficulty swallowing.
• Calcium Imbalance: The parathyroid glands, which regulate calcium levels in the body, are often located near the thyroid. Surgery may inadvertently damage these glands, leading to a decrease in calcium levels and requiring supplementation.
• Emotional and Psychological Impact: A cancer diagnosis and its treatment can have a significant emotional and psychological toll. Anxiety, depression, and adjustment issues are common, and supportive care is essential for the well-being of individuals affected by thyroid cancer.
• Cardiovascular Risks: In some cases, thyroid cancer or its treatment may increase the risk of cardiovascular issues, such as heart disease. This emphasises the importance of comprehensive health management and regular monitoring.
• Secondary Cancers: While not common, some individuals treated for thyroid cancer may be at a slightly higher risk of developing secondary cancers, particularly in the long term.

It's important for individuals diagnosed with thyroid cancer to work closely with their healthcare team to address and manage potential complications. Regular follow-up appointments, adherence to recommended treatments, and a healthy lifestyle can contribute to better overall outcomes and quality of life.

Preventing thyroid cancer involves adopting certain lifestyle choices and minimising exposure to known risk factors. While it may not be possible to prevent all cases of thyroid cancer, the following measures can help reduce the risk:

• Optimal Iodine Intake: Ensure adequate but not excessive iodine intake. Iodine is essential for thyroid function, but both deficiency and excess can contribute to thyroid issues. Choose iodized salt and include iodine-rich foods in your diet, but avoid excessive supplementation without medical guidance.
• Reduced Radiation Exposure: Minimise exposure to ionising radiation, especially during childhood. This includes limiting unnecessary medical radiation and being cautious about occupational or environmental exposures.
• Regular Self-Examination: Be aware of your neck and thyroid area. Regularly perform self-examinations to check for any lumps, swelling, or changes in the thyroid region. Report any abnormalities to your healthcare provider promptly.
• Thyroid Protection During Radiation Therapy: If radiation therapy is necessary, particularly for head or neck cancer treatment, steps can be taken to shield the thyroid from radiation exposure.
• Genetic Counselling: If there is a family history of thyroid cancer or related conditions, consider genetic counselling to assess the potential genetic factors that may increase the risk. This can help in making informed decisions about monitoring and preventive measures.
• Regular Check-ups and Screenings: Attend routine medical check-ups and screenings, especially if you have risk factors such as a family history of thyroid cancer or a history of radiation exposure. Early detection can significantly improve outcomes.

Healthy Lifestyle Choices

• Balanced Diet: Maintain a healthy and balanced diet rich in fruits, vegetables, and whole grains. Antioxidant-rich foods may offer some protection against cancer.
• Physical Activity: Engage in regular physical activity, as exercise is associated with a lower risk of certain cancers, including thyroid cancer.
• Avoid Tobacco: If you smoke, consider quitting. Smoking is not a direct cause of thyroid cancer, but it is linked to an increased risk of other cancers and health issues.

It's important to note that while these are general measures, they do not guarantee prevention. Individuals with concerns about their risk or those with a family history of thyroid cancer should consult with healthcare professionals for personalised advice and monitoring.

Thyroid cancer patients have excellent quality of life after treatment. This is very important as most thyroid cancer patients survive very long and have very high cure rates.

Like all cancers, regular follow up care is important in thyroid cancer also. After completion of treatment, the patient should see the doctor every 6 months. Regular examination, testing to make sure that dose of thyroid hormone replacement is adequate and scanning with radioiodine (if indicated) are important parts of follow up. With proper treatment and regular follow up, survival rates for well differentiated thyroid cancer are among the highest in all cancers.

1. Is thyroid cancer curable?

Thyroid cancer is often highly treatable and has a good prognosis, especially when diagnosed early. The cure rate is generally high, and many individuals with thyroid cancer respond well to treatment.

2. How common is thyroid cancer?

Thyroid cancer is relatively uncommon compared to other types of cancer. However, its incidence has been increasing in recent years. It is more prevalent in women than men, and it is often diagnosed at a younger age.

3. What are the thyroid cancer stages?

Thyroid cancer is staged based on the extent of the disease. The stages typically range from I to IV, with higher stages indicating more advanced disease. Staging considers factors such as tumour size, involvement of lymph nodes, invasion of surrounding structures like nerves, windpipe or food pipe and the presence of distant metastasis.

4. What is metastatic thyroid cancer?

Metastatic thyroid cancer refers to cancer that has spread beyond the thyroid gland to other parts of the body. Common sites of metastasis include the lymph nodes, lungs, and bones. Advanced stages of thyroid cancer may involve metastatic disease.

5. How does thyroid cancer affect pregnancy?

Thyroid cancer itself does not necessarily impact fertility or pregnancy. However, the treatment, especially if it involves surgery and radioactive iodine therapy, may have implications for fertility. It's essential for individuals with thyroid cancer who plan to become pregnant to discuss fertility preservation options with their healthcare team. Thyroid hormone levels also need to be checked frequently during pregnancy.

6. How long does it take to recover from thyroid cancer treatment?

Recovery time can vary depending on the type and extent of treatment. After surgery, individuals may need a few weeks to regain strength. Radioactive iodine therapy may require isolation for a short period. Lifelong thyroid hormone replacement therapy is often necessary for those undergoing total thyroidectomy, but individuals can typically resume normal activities relatively soon after treatment.

7. What is the thyroid cancer survival rate?

The overall survival rate for thyroid cancer is generally high, with a five-year survival rate exceeding 90%. Survival rates can vary based on factors such as the cancer subtype, stage at diagnosis, and the effectiveness of treatment.

8. Can hyperthyroidism be a thyroid cancer symptom?

Hyperthyroidism, characterised by an overactive thyroid, is not a typical symptom of thyroid cancer. However, some thyroid cancer may be linked to changes in thyroid hormone levels, potentially causing hyperthyroidism or hypothyroidism.

9. How do I manage the side effects of thyroid cancer treatment?

The management of side effects depends on the specific treatment received. Common side effects, such as fatigue, changes in voice, or hormone imbalances, can be addressed through supportive care, medications, and adjustments to thyroid hormone replacement therapy.

10. Can Thyroid Cancer Recur after Surgery and Treatment?

Yes, thyroid cancer can recur, even after surgery and initial treatment. Regular follow-up appointments, monitoring, and adherence to recommended treatments are crucial to detect and manage any recurrence promptly.

11. What is the prognosis/outlook for thyroid cancer?

The prognosis for thyroid cancer is generally favourable, especially when diagnosed early. The outlook depends on factors like the cancer type, stage, and how well it responds to treatment. With appropriate care, many individuals with thyroid cancer lead healthy and fulfilling lives. Regular follow-ups are essential for long-term monitoring.

Reviewed By Dr. Akshat Malik - Senior Consultant- Cancer Care / Oncology, Surgical Oncology, Head & Neck Oncology, Robotic Surgery on 7 Nov 2024.

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