Papillary carcinoma surgery

[azusername]

I had FNA of a single nodule measuring slightly larger than 1 cm in the largest dimension.

Here's my pathology results:
The smears are cellular and composed of neoplastic follicular epithelium arranged in papillary architectural patterns as well as cohesive complex two dimensional sheets. Neoplastic epithelium have elongated irregular nuclear contours with evenly distributed nuclear chromatin, inconspicuous nucleoli and dense to wispy cytoplasm. Occasional intranuclear pseudoinclusions can be seen in some of the neoplastic follicular epithelium. Also present are occasional foamy and hemosiderin laden macrophages.

I'm not sure what the pathology results mean, but the pathologist told me I have papillary carcinoma and need to get a total thyroidectomy within one month. Is there something about the pathology results that indicate I need the surgery within the month or is that the general suggested timeframe for surgery for those with papillary carcinoma? I am trying to figure out how long I have before I need surgery (so that I have time to research surgeons, etc.), but do not want to put my health at risk by delaying the surgery to do so. Any other info you think would help is appreciated. Thanks!

[Mark Lupo, M.D.]

The description sounds like papillary cancer -- and that seems to be the conclusion of the pathologist as well.  You could have the slides sent to another pathologist for a second opinion.  The customary treatment is total thyroidectomy.  There is no set time-frame, but I usually tell patients with biopsy proven cancer that surgery should be done w/in 6 weeks.  During the wait, you consult with a surgeon (interview more than one if needed) and have a skilled endocrinologist do a neck ultrasound to make sure there are no suspicious lymph nodes that need to be removed at the time of surgery -- if not available, then a neck CT scan may help -- ask the surgeon.  Thyroid hormone replacement is started after surgery and there is no need to come off it for RAI (I-131) if that is indicated as we can now use thyrogen injections to prepare patients for I-131 treatment.  The hypothyroidism is slightly over-treated with levothyroxine tablets in patients with cancer and most do very well in terms of symptoms.

[azusername]

Does anyone have any idea how soon I need surgery if I have papillary carcinoma?  Sorry for the repost, but I'm freaking out since the pathologist told me to get it within the month.  I'm not sure I can even get a surgery consult here in that amount of time!  Am I stressing over nothing?  Thanks!!

[4lynnie]

I have papillary carcinoma (4 months now), and my understanding is that is very slow-growing.   You can have have it for years and never know.   Before thyroidectomy I had more than 12 nodules, but not one was cancer.   Pathology found two small spots on the back of the gland.   The word "carcinoma' is very upsetting.  And there is so much conflicting information on the internet and even in books.    Listen and read, read, read.  Ask questions of everyone.   For 5+ years all my labs were normal even tho I had a cold nodule, and I had to push all this time to get someone to look at me and listen to me.     In 5 years it must not have gotten worse because the two spots were really minute.  You can do this.   You can get through this.   Don't panic but be persistent.