thyroid cancer

[tiredpoet]

I hope you can help here.  I have just heard an anecdote about a "friend of a friend" who had thyroid cancer for several years before she was diagnosed.  Long story short she said she she had a small thyroid nodule for about 3 or 4 years that was never biopsied (because it was so small when found) and was then never that closely followed up on, and it turned out to be malignant.  The woman in question is currently in treatment though and seems to be doing very well.

The reason I ask is the person who told me the story is now very worried that she too could have thyroid cancer that is being "missed."  I tried putting her mind at ease by saying it's probably not a cancer that could fester for years without being caught, but she seems convinced it's possible.

I'm finding it difficult to understand how this could be so that a person could have thyroid cancer for four years without knowing it.  Theoretically how long would it take thyroid cancer to advance to a state where it would be impossible to miss (or misdiagnose).  I thought a malignant nodule would grow fairly quickly, or are there malignant nodules that do not change in size?  
And if by some odd chance a malignant nodule were not caught for several years, wouldn't the cancer be in a fairly advanced stage by then?

[Reese120]

I had a 3.5 cm nodule removed last November.  I had a benign FNA done and when they performed the surgery to remove the nodule and 1/2 my thyroid, the frozen section came out benign.  4 days after my 1st surgery I was told the final patholofy was papillary thyroid cancer.  I know I had this nodule for at least 6 years because my OB felt it after the birth of my daughter.  My primary doctor dropped the ball and never had any tests done and told me I was fine just by a neck examination.  My suregeon at a top teaching hospital told me I probably had the cancer for 10 years or more!  I had no symptoms and whenever I had a thyroid blood test perfomed, my numbers always came out good!  My tumor was encapsulated (good thing) and did not spread the other side of my thyroid or lymph nodes.  I feel very lucky.  Good luck to your friend!

[Mark Lupo, M.D.]

Small thyroid cancers are quite common and often do not grow much during even a 5 year observation period.  So this story is not unusual.  FNA biopsy of a nodule is done depending on the nodule size/appearance on ultrasound - biopsy is very accurate and helps avoid surgery in the majority of cases.  So if one is worried about a thyroid nodule/cancer, ultrasound performed by a thyroid specialist is the best way to determine if FNA is needed.