Thyroid cancer - papillary carcinoma

Papillary carcinoma of the thyroid

About 75-85% of all thyroid cancers diagnosed in the United States are papillary carcinoma. It is more common in women than in men. It may occur in childhood, but is typically seen in people between ages 20 and 40.

The cause of this cancer is unknown. A genetic defect may be involved.

High-dose external radiation to the neck increases the risk of developing thyroid cancer. Papillary thyroid cancer in children has also been linked to atomic bomb testing in the Marshall Islands and the 1986 Chernobyl nuclear disaster in the Ukraine.

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

Thyroid cancer usually begins as a small bump (nodule) in the thyroid gland, which is located at the front of the neck. However, it should be emphasized that most thyroid bumps are harmless and noncancerous (benign).

If you have a lump on your thyroid, your doctor will order blood tests and an ultrasound of the thyroid gland.

If the ultrasound shows that the lump is bigger than 1.0 centimeter, a special biopsy called a fine needle aspiration (FNA) will be performed. This test determines if the lump is cancerous or benign (not cancerous).

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

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. Frequently, the entire gland is taken out.

After the surgery, most (but not all) patients receive radioactive iodine, which is usually taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images more clear, so doctors can see if there is any additional cancer.

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

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

The patient will need a blood test every 3 to 6 months to check thyroid levels, and an imaging test called a radioactive iodine (I-131) uptake scan once a year.

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

The following factors may decrease the survival rate:

• Age over 40
• Cancer has spread to distant parts of the body
• Cancer has spread to soft tissue
• Large tumor

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)

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

Larsen PR, Kronberg HM, Schlomo M, et al. Williams Textbook of Endocrinology. 10th ed. St. Louis, MO: WB Saunders; 2003:469-473.

Hemminki K. Familial risks for nonmedullary thyroid cancer. J Clin Endocrinol Metab. 2005; 90(10): 5747-5753.

Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. St. Louis, MO: WB Saunders; 2005:1177-1180.