Papillary Thyroid cancer is cancer of the thyroid, which is a formation of lumps or nodules in the butterfly-shaped gland at the base of the neck just above the collarbone. It is also called Papillary Thyroid Carcinoma.
Papillary Thyroid cancer can be treated through surgery where a part of the complete thyroid gland is removed. It can also be treated by means of radiation therapy, chemotherapy, thyroid hormone therapy, or targeted therapy.
Sometimes, symptoms may be found because of tests for another problem. It could also be found during physical examination where your doctor found a lump or nodules on your thyroid. As the nodule gets bigger you may find symptoms like:
- Difficulty to swallow
- A lump in your neck that could be seen and felt
- Sore throat or hoarseness in the voice that is consistent
- Swollen lymph nodes in the neck
- The difficulty with breathing especially while lying down.
- Peak onset ages are from 30 – 50 years old
- It is more common in women than men by a 3:1 ratio
- The prognosis depends on age, tumor size and, gender.
The exact cause of Papillary Thyroid cancer is not known but certain factors listed below can be attributed to the cause:
- Genetic condition: Certain genetic conditions such as Cowden disease, Familial Adenomatous Polyposis (FAP), and Gardner syndrome may affect it.
- Radiation therapy: Exposing the neck, head and, chest to radiation may raise a chance.
- Family history: This cancer also runs in the family for some cases.
- Gender: For some unknown reasons, it is more common in women.
Diagnosis and Tests
Physical exam to check for nodules and symptoms
- Blood tests to check levels of thyroid stimulating hormones (TSH)
- Thyroid scan
- CT Scan
- PET/CT Scan
- Vocal-chord exam (Laryngoscopy)
Stages of cancer
The stage indicates how far cancer has progressed.
• Tumour (T): Ranges from 1 – 4 depending on the size
• Node (N): Either 0 or 1 depending on whether cancer has spread on to nearby lymph glands
• Metastases (M): Either 0 or 1, depends on whether cancer has spread to other parts of the body.
Types of treatment
- Surgery: The first line of treatment for most thyroid cancer involving one of the followings:
- Thyroid lobectomy: Removal of half of the thyroid gland
- Total thyroidectomy: Removal of all the thyroid gland
- Subtotal thyroidectomy: Almost all the thyroid gland is removed.
- Radiation Iodine Ablation (RIA): If the thyroid is more than 4 centimeters in size and grows beyond the thyroid, a one-time treatment of taking radioactive iodine may be done in liquid or pill form. This kills any leftover cancer cells after surgery.
- External radiation: X-Ray beams are exposed to the affected area. When the risk of surgery is too high, cancer is aggressive and, papillary thyroid cancer spreads beyond the thyroid, such treatment is decided.
- Chemotherapy: To stop the cancer cells from dividing through injection, drugs are administered. Your doctor will choose the right type of chemotherapy drug.
- Thyroid hormone therapy: Your doctor can prescribe drugs that will remove cancer producing hormones or blocks their action to stop the cancer cells from growing.
- Targeted therapy: These drugs take specific characters in cancer cells like protein or gene mutation and sticks to them to kill the cells or help other therapies like chemo to work better.
- Physical examination of the body
- Diagnostic tests and scans
- Your complete medical history and review of tests is done by your doctor
- Your cancer stage will be identified, and type of treatment will be discussed
- You will be asked to stop some medications by your doctor
- If you are suffering from hyperthyroidism, you may be asked to take some medicine to control your hormone levels before surgery
- You will be asked to fast 8 – 12 hours before surgery
- An uncomplicated surgery should take less than 2 hours to perform otherwise, a total thyroidectomy could take around 3 – 4 hours
- A general anesthesia will be administered to you
- A small incision, about an inch, is made in the lower part of the neck. The incision also depends on the size of the nodule
- All the vital structures inside the neck are identified, separated, or divided to avoid any damage
- Once the lobectomy is identified, the isthmus is divided
- The gland or the infected area is totally or partially or sub-totally removed
- The lymph nodes nearby are also examined if they are cancerous or not
- The incision is then closed with stitches.
- You will be in a special recovery area where you will be monitored closely
- Temporary fluids be inserted through tubes until you can drink again, and other tubes be inserted to remove any excess fluid from the incision area
- Your stitches will dissolve in a few days or be removed manually
- You will experience soreness of throat and neck for a few days
- Your voice may also change for a few days
- Some pain relief medications will be given to you
- You may need to eat soft foods and drinks until you recover fully
- You will be hospitalised for about a day or two depending on your recovery
- You will be taught how to exercise your stiff neck and leg along with breathing exercises to ensure a proper functioning of your lungs and body to avoid blood clots or infections.
- If Total thyroidectomy is done, you will need to take thyroid hormone replacement therapy to compensate for the loss
- Strenuous activities may be avoided for some days
- You will need to take some blood tests every few months to check your thyroid hormone levels and get the right dose of medicine
- Follow-up will be scheduled.
Factors affecting the cost of Papillary Thyroid cancer
Many factors such as below affect the cost price.
- Choice of hospital
- Location of the hospital
- Surgeon’s fee
- Cost for blood and diagnostic tests
- Type of treatment and surgery
- Medicinal costs
- Duration of stay
- Cost of post-surgery care
Potential risks and complications
The minimally invasive surgery for Papillary Thyroid cancer is usually safe and effective but complications can occur although rare.
- If the vocal nerve is damaged during the operation, you will sound permanently hoarse
- Due to the trauma of a tube placed in the air pipe during surgery, the voice box gets affected and your voice may change which will take 3 – 6 months to recover. If it takes longer than 6 months, rehabilitation and procedures will be done by ENT doctors and speech therapists
- If parathyroid glands are affected, it results in hypocalcemia– a numbness or tingling of lips and fingertips. This can be treated with calcium and Vitamin D supplements.