Rates of thyroid cancer have tripled in the past 30 years. So, if you find or have a test that shows you have a lump on your neck, it’s normal to be a little worried. But, what’s also normal are benign neck lumps.
“Most of the time a lump on the neck that is a thyroid nodule is benign,” explains endocrine surgeon Masha Livhits, MD, Ronald Reagan UCLA Medical Center. “We don’t really know what causes it. But if we were to ultrasound everyone as they got older, more than half of those over age 70 would have a thyroid lump.”
Incidental Discoveries Lead to Over-Diagnosis
Papillary thyroid cancer is the most common type of thyroid cancer, and it is the one that has been skyrocketing in the United States and elsewhere. Thankfully, this is the least aggressive type of thyroid cancer. Canada, Australia, Western Europe, Korea, and Japan all show similar patterns of increase. Research studies show that the rise is very likely due to over-diagnosis.
“It’s common to find thyroid nodules on imaging,” says Dr. Livhits. “In cases where a patient feels a lump on the neck, most of those are benign, too. But what’s really increased is thyroid nodules being discovered incidentally because someone gets a scan for neck pain or an ultrasound of the carotid arteries.”
Over-diagnosis in medical terms refers to finding a disease, including cancer cells, which if left alone would not cause symptoms or fatality. A study published a few years ago in the journal Thyroid found that while reported incidences of thyroid cancer have indeed jumped sharply during the past 30 years, mortality due to the disease has not.
WHAT YOU SHOULD KNOW
Thyroid cancer can cause any of the following signs or symptoms:
- A lump in the neck, sometimes growing quickly
- Swelling in the neck
- Pain in the front of the neck, sometimes going up to the ears
- Hoarseness or other voice changes that do not go away
- Trouble swallowing or trouble breathing
- A constant cough that is not due to a cold
If you have any of these signs or symptoms, talk to your doctor right away. Many of these symptoms can also be caused by non-cancerous conditions or even other cancers of the neck area.
Source: American Cancer Society
Proposed Name Change
In 2016, researchers at the University of Pittsburgh School of Medicine along with an international panel of pathologists and clinicians gathered together to reclassify a common type of papillary thyroid cancer, which was formerly called encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). The rationale behind the name change is to reflect that it is noninvasive and has a low risk of recurrence. The change, described in JAMA Oncology, is expected to reduce the psychological and medical consequences of a cancer diagnosis, potentially affecting thousands of people worldwide.
The new name “noninvasive follicular thyroid neoplasm with papillary-like nuclear features,” or NIFTP, is meant to guide pathologists in diagnosis, but omits the word “cancer,” indicating that it need not be treated with radioiodine or other aggressive approaches. NIFTP cannot be determined from a biopsy alone. The entire nodule needs to be removed surgically and analyzed by a pathologist to figure out whether it is NIFTP or an invasive cancer. It will take some time for this term and treatment approach to be universally adopted.
Dr. Livhits agrees that this type of thyroid tumor is typically very slow growing and has an excellent prognosis. “Over time, we’ve become less aggressive with our treatment,” she explains. “If you have a small thyroid cancer that is less than a centimeter in size, one option may be to just watch it with serial ultrasounds. Like with prostate cancer, there is now an option for an active surveillance approach in certain cases.”
Diagnosis and Surgical Interventions
All of this does not mean that all lumps should be ignored. Larger nodules and those that grow over time need further examination. Usually that means an ultrasound followed by fine needle biopsy, if warranted. It’s best to consult with an experienced endocrinologist who lists thyroid as their clinical interest and specializes in thyroid diseases (some may focus mostly on diabetes, for example). Likewise, a radiologist who does a lot of thyroid ultrasounds is more likely to be skilled in identifying nodules that need further investigation. A fine needle biopsy is quick, outpatient, and should be guided by ultrasound. The radiologist removes cells from the nodule with a small-gauge needle, which are then assessed for cancer.
Most thyroid cancers are removed surgically, and removal of the entire thyroid gland has been the standard. But that may not always be necessary. “We used to remove the whole thyroid with any thyroid cancer,” says Dr. Livhits. “Now we just remove half of it in a lot of cases, so potentially most people can avoid being on thyroid medication afterwards. Half a thyroid usually has an 80 percent chance of working on its own.”
Risk Factors and Prevention
According to the American Cancer Society, thyroid cancer can occur at any age, but the risk peaks earlier for women (who are usually in their 40s or 50s when diagnosed) than for men (who are typically in their 60s or 70s). Women are also three times more likely to have a thyroid cancer and other thyroid diseases as compared to men.
Most people who have thyroid cancer don’t have any risk factors, so it’s not a preventable disease. Childhood exposure to radiation does raise risk, but the scant amounts of radiation from imaging tests are, according to research, unlikely to raise risk. Similarly, lack of iodine, which can lead to thyroid nodules, is usually not a problem in the Western world.
Some thyroid cancers are associated with gene mutations. If you have a family history of thyroid cancer a blood test can reveal a genetic mutation for familial medullary thyroid cancer. This type of cancer is usually treated and prevented by removing the entire gland.
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