Treating Thyroid Cancer - A Quick

Contents                                      lymph nodes with cancer cells in ...
On CancerHelp UK, we have quite detailed        Radiotherapy and chemotherapy
information about the likely outcome for    ...
your thyroid. This is because they are likely   •   What are the risks and benefits of
to contain cancer cells.           ...
one of these types of thyroid cancer, this        if the cancer cannot be completely
treatment may not be suitable for you...
Chemotherapy for thyroid cancer                 •   Are there any long term side effects?
Chemotherapy uses anticancer or ...
become less frequent until they are once a         Questions for your doctor about
year. You will have check ups for at le...

   More information
   For more information about thyroid cancer, visit our website
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Treating Thyroid Cancer - A Quick Guide


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Treating Thyroid Cancer - A Quick Guide

  1. 1. Treating Thyroid Cancer - A Quick Guide Contents lymph nodes with cancer cells in them (N) This is a brief summary of the information and if the cancer has spread to a different on ‘Treating thyroid cancer’ from body parts (M). CancerHelp UK. You will find more detailed information on the website. • T stages - There are 4 main T stages for thyroid cancer. T1 is the smallest In this information there are sections on size and T4 is the largest. – The stages of thyroid cancer – Statistics and outlook • N stages - There are 2 main N – Which treatment for thyroid cancer? groups. Either the cancer has not – Surgery spread to the lymph nodes (N0) or it – Radioactive iodine treatment has (N1). – Radiotherapy – Chemotherapy • M stages - There are 2 possible M – Follow up for thyroid cancer stages. Either the cancer has not – Thyroid cancer research spread to other body parts (M0) or it – Questions for your doctor has (M1). The stages of thyroid cancer The number stages of thyroid The stage of a cancer tells the doctor how cancer far it has spread. It is important because This depends on the type of thyroid cancer treatment is often decided according to the you have. CancerHelp UK has details of stage of a cancer. There are different ways the number stages for different types of of staging cancers. In thyroid cancer, thyroid cancer. doctors use the TNM system and the number system. Thyroid cancer statistics and outlook TNM stages of thyroid cancer Outlook means your chances of getting TNM stands for ‘tumour, node, metastasis’. better. Your doctor may call this your This system can describe the size of a prognosis. With thyroid cancer, the likely primary tumour (T), whether there are outcome depends on how advanced the cancer is when it is diagnosed. Treating Thyroid Cancer 01
  2. 2. On CancerHelp UK, we have quite detailed Radiotherapy and chemotherapy information about the likely outcome for You may have radiotherapy to treat thyroid different types of thyroid cancer. The cancer. A form of targeted radiotherapy statistics we use are taken from a variety of that uses a radioactive form of iodine called sources, including the opinions and 'Iodine 131' or I-131 may be used for experience of the experts who check every papillary or follicular thyroid cancer. section of CancerHelp UK. They are intended as a general guide only. For the Chemotherapy is sometimes used to treat more complete picture in your case, you’d advanced thyroid cancers or cancer that has have to speak to your own specialist. come back after it was first treated. How reliable are cancer statistics? Which surgery for thyroid No statistics can tell you what will happen cancer? to you. Your cancer is unique. The same Surgery is the treatment most often used type of cancer can grow at different rates in for thyroid cancer. You may have part of different people. The statistics cannot tell your thyroid removed (lobectomy or partial you about the different treatments people thyroidectomy), or an operation to remove may have had, or how that treatment may all of your thyroid gland (total have affected their prognosis. There are thyroidectomy). These are both major many individual factors that will affect your operations, carried out under general treatment and your outlook. anaesthetic. Which treatment for thyroid If you carry an abnormal gene for medullary cancer? thyroid cancer, your specialist will offer you The main treatments used for thyroid a total thyroidectomy to prevent a cancer cancer are surgery, radiotherapy and from developing. The whole gland has to chemotherapy. Thyroid hormones are be removed because cancer could develop sometimes used. Your treatment will be in any thyroid tissue left behind. planned taking into account the type of thyroid cancer you have, how far the cancer Most people diagnosed with thyroid cancer has grown or spread (the stage), your age, will have a total thyroidectomy. If there is a general health and level of fitness. risk that some cancer has been left behind, or that some cancer cells might have spread Surgery to treat thyroid cancer elsewhere in your body, you may also have You may have surgery to remove the radiotherapy after your surgery. whole thyroid or part of the thyroid. During the operation, your surgeon may Removing lymph nodes also remove any lymph nodes in the neck During your operation, your surgeon may that are enlarged or contain cancer cells. remove some lymph nodes. If you have Even if your cancer cannot be totally papillary or follicular thyroid cancer, you will removed, surgery will help to control your only have lymph nodes removed that are symptoms and can control the cancer when known to contain cancer cells. If you have combined with radiotherapy treatment. anaplastic thyroid cancer, your surgeon will remove most of the lymph nodes around Treating Thyroid Cancer 02
  3. 3. your thyroid. This is because they are likely • What are the risks and benefits of to contain cancer cells. having this operation? • What are the long-term effects of this Having your operation for thyroid operation? cancer • Will I have pain after this operation? When you go in to hospital for your • How long will I have a drip after operation, your surgeon, anaesthetist, nurse surgery? and physiotherapist will all come and talk to • When will I be able to start eating you. The surgeon will explain the again? operation. Ask as many questions as you • Will I be able to eat and drink normally need to. It may help to make a list after this operation? beforehand. Before surgery, you will need • Will I get help with my diet after the to have some tests such as an ECG. operation? • What are the possible complications of When you wake up, you are likely to have this type of operation? several tubes in place to give you fluids and • Will I need any other treatment as well drain the wound. You will probably have as surgery? some pain and stiffness in your neck. But • Is there any treatment I can have this is usually manageable. Tell your doctor instead of surgery? or nurse who will work to find the right • What will happen if I don’t have the painkiller for you. operation? • How long will it take me to get better? Over the next few days, your nurses will • How can I help myself get over the help you to get up and about. Most people operation? go home about 1 - 2 days after this surgery. • Will my voice be affected by the It will probably be uncomfortable to operation? swallow for a few days after your operation, so it may help to have a soft diet for a Radioactive iodine treatment for while. Talk to a dietician about this, or ask thyroid cancer for a diet sheet to take home. This type of radiotherapy for thyroid cancer is called internal radiotherapy. It uses a If you have had your whole thyroid radioactive form of iodine called iodine 131 removed, you will have to take tablets to or I-131. The radioactive iodine circulates replace the thyroid hormones that would throughout your body in your bloodstream. normally be made by the thyroid gland. Thyroid cancer cells will pick up the iodine wherever they are in your body. The Questions for your doctor about radiation in the iodine will then kill the surgery for thyroid cancer cancer cells. • Why do I need an operation? This is a targeted treatment. It will not • Which type of operation should I have affect other body cells as it is only thyroid and why? cells that pick up iodine. The treatment is • Will the operation cure my cancer? only suitable for follicular thyroid cancer and papillary thyroid cancer. Even if you have Treating Thyroid Cancer 03
  4. 4. one of these types of thyroid cancer, this if the cancer cannot be completely treatment may not be suitable for you. removed, or has spread. Your doctor will carry out a test to see if your cancer cells pick up iodine or not. You have external radiotherapy treatment in the hospital radiotherapy department, Having the treatment once a day, from Monday to Friday, with a To have the treatment, you go into hospital break at the weekends. The length of your for a few days. You have the iodine in a course of treatment depends on the type drink or capsule, or it can be injected it into and size of your cancer. a vein in your arm. You won’t be able to eat or drink for a couple of hours so your There is more information about body can absorb the iodine. After that, you radiotherapy and the possible side effects in can eat normally. The treatment will make the ‘radiotherapy’ section of CancerHelp you slightly radioactive and you will stay in a UK. single room for a few days. Then you will have a scan to see if the radiation has Questions for your doctor about dropped to a safer level. Once it has, you radiotherapy for thyroid cancer will be able to go home. • Why are you recommending There is more about radioactive iodine radiotherapy for me? treatment and its safety precautions in the • Are there any other types of treatment ‘radiotherapy’ section of CancerHelp UK. I could have? • How will the treatment help me? External radiotherapy for thyroid • What are the likely side effects? cancer • How long will they last? Radiotherapy uses high energy X-rays to • Is there anything I can do to help with attack cancer. You may have external side effects? radiotherapy • Are there any long term or permanent effects? • As a first treatment for anaplastic • Are there any special instructions after thyroid cancer that cannot be removed my treatment? with surgery • Is it safe to be around my family after • To shrink thyroid cancer that has come treatment? back after it was first treated • How often will I have to come to the • As well as iodine-131 for papillary or hospital for treatment? follicular thyroid cancer that cannot be • Can I get help with fares to and from completely removed with surgery the hospital? • To treat thyroid cancer that has spread • Is there any transport available? to another part of the body (secondary • Will I have to stay in hospital and if so, thyroid cancer) for how long? • Is there a number I can ring if I am Radiotherapy is not used routinely to treat worried about anything when at home? medullary thyroid cancer. But it may be used for some people to control symptoms Treating Thyroid Cancer 04
  5. 5. Chemotherapy for thyroid cancer • Are there any long term side effects? Chemotherapy uses anticancer or • Do I have any choice of treatment? 'cytotoxic' drugs to destroy cancer cells. • Is there a treatment that won't make They work by disrupting the growth of my hair fall out? cancer cells. As they circulate in the blood, • Is there a treatment that won't make they can reach cancer cells wherever they me infertile? are in your body. • Which drugs will I have? • What effect will the drugs have on the Chemotherapy is not used as a first cancer? treatment for thyroid cancer. This is • How will chemotherapy affect my because surgery and radiotherapy tend to immune system? work better for thyroid cancer. It is • Can I take anything to help boost my sometimes used to treat thyroid cancer that immune system? is advanced or has come back after • How long will my course of treatment treatment and is causing symptoms. be? • What side effects can I expect? The chemotherapy drugs most often used • How can I reduce the side effects? to treat thyroid cancer are doxorubicin and • What can I do to help myself feel well cisplatin. You have these drugs through a during chemotherapy? drip into your arm, every 3 or 4 weeks. • What other support is available? You usually have a course of about 6 • How will I know if I get an infection? treatments. • Who should I call if I get an infection while I am having chemotherapy? Chemotherapy drugs all have different side effects. Both these drugs can cause sickness Follow up for thyroid cancer and an increased risk of infection. After your treatment has finished, your doctor will want you to have regular check Doxorubicin can also cause hair loss and ups. During check-ups, your doctor will mouth ulcers. Cisplatin can cause kidney examine you. He or she will ask how you problems and difficulty hearing high pitched are feeling and whether you have had any sounds. symptoms or concerns. At some visits, you may have blood tests, X-rays and scans. There is more detailed in information in the You will not have all these tests at every ‘chemotherapy’ section of CancerHelp UK. visit to your specialist. What for your doctor about Scans are only usually done if you or your chemotherapy for thyroid cancer doctor have any concerns. But if you have had radioactive iodine treatment you may • Why do I need chemotherapy? have a scan about 4 - 6 months after your • How will I feel during chemotherapy? treatment. This is to make sure that the • Is there another treatment I can have treatment killed all the thyroid cancer cells. instead? • What do you hope the chemotherapy At first, your check ups will be every 4 - 6 will do for me? months. If all is well, they will gradually Treating Thyroid Cancer 05
  6. 6. become less frequent until they are once a Questions for your doctor about year. You will have check ups for at least treatment for thyroid cancer 10 years, and often for life. If you have anaplastic thyroid cancer, you will probably • What stage is my thyroid cancer? be seen more often. If you are worried or • What treatment do you recommend notice any new symptoms between for me? appointments, let your doctor know as • Do I have any choice of treatments? soon as possible. You don’t have to wait • What do you expect the treatment to until your next appointment. achieve? • What is the chance of the cancer Many people find their check ups quite coming back after I have been treated? worrying. You may find it helpful to tell • Can I have a second opinion? someone close to you how you are feeling. • Is there any experimental treatment I It is quite common nowadays to have could try? counselling after cancer treatment. For • Is there a clinical trial that is suitable for more information on this, look in the me? ‘coping with cancer’ section of CancerHelp • Will I need to take thyroid tablets after UK. my treatment? • Will I always have to take these? Thyroid cancer research • What follow up will I receive after my All treatments must be fully researched treatment? before they can be adopted as standard • What should I do if I am worried treatment for everyone. This is so that we between appointments? can be sure they work better than the treatments we already use. And so we know they are safe. First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials. There is too much information on research into thyroid cancer to include it all here. CancerHelp UK has information on • Genetics and gene therapy • Chemotherapy and other new drugs • New ways of giving radiotherapy • Blood supply and thyroid cancer • Chemoembolisation for thyroid cancer that has spread • Monoclonal antibodies • Cancer growth blockers Treating Thyroid Cancer 06
  7. 7. Notes More information For more information about thyroid cancer, visit our website You will find a wide range of detailed, up to date information for people affected by cancer, including a clinical trials database that you can search for cancer trials in the UK. You can view or print the information in a larger size if you need to. For answers to your questions about cancer call our Cancer Information Nurses on 0808 800 4040 9am till 5pm Monday to Friday Adapted from Cancer Research UK’s Patient Information Website CancerHelp UK in August 2009. CancerHelp UK is not designed to provide medical advice or professional services and is intended to be for educational use only. The information provided through CancerHelp UK and our nurse team is not a substitute for professional care and should not be used for diagnosing or treating a health problem or disease. If you have, or suspect you may have, a health problem you should consult your doctor. © Cancer Research UK 2009 Cancer Research UK Charity Number 1089464 Treating Thyroid Cancer 07