Thyroid Cancer Awareness

03 Jan 2018
By Elizabeth Shaughnessy, MD, PhD, FACS

In my training as a surgical oncologist, I certainly performed my share of thyroidectomies and node excisions for thyroid cancer. My practice quickly focused on breast cancer once in academic practice, given the demand in the community. Yet, my patients will report thyroid cancer frequently enough that I felt I should revisit this topic, to fill in the details of our growing knowledge.

We should all be aware of this cancer. Not only is it the fifth most common cancer, it affects three times as many women as men! Only 2% of the cases will occur in children or adolescents. In adulthood, women present usually in their 40’s or 50’s, whereas men will present later, in their 60’s or 70’s.

There can be a hereditary component; RET gene mutations are associated with the development of medullary cancer of the thyroid, which may be part of familial medullary thyroid cancer (FMTC) and multiple endocrine neoplasia type 2 (MEN2). Thyroid cancer is present in the spectrum of malignancies of several different cancer syndromes. These include familial adenomatous polyposis (FAP) where the APC gene is mutated; Gardner’s syndrome; Cowden’s Syndrome, where the PTEN gene is mutated; and Carney complex type 1. Even if a cancer syndrome has not been identified, a family history is still significant in raising the risk of cancer in a patient being evaluated for thyroid nodules.

The histologic subtypes include papillary, follicular, medullary and anaplastic. Staging for papillary and follicular tends to be predominant Stage I and stage II; they are more frequent and slow-growing. In contrast, medullary and anaplastic are far more aggressive, and may require more resection. Statistically, disease that is limited to the thyroid has a five-year survival of 99%. Local disease that extends beyond the thyroid has a five-year survival of 98%. Metastatic disease has a 5-year survival of 55%.

Lifestyle issues, such as radiation exposure or low iodine diet, still play a role in risk and outcome in addition to family history and histologic type. No excuses for those of us who need to don a thyroid shield during fluoroscopy!

In a month known for its garnet birthstone, carnation flower, and traditionally bed linen & towel sales, sharing this exercise has sharpened our awareness for the coming year!

Dr. Elizabeth Shaughnessy is in an academic practice at the University of Cincinnati, with an emphasis on breast cancer and breast disease. She serves as Surgical Director of the multidisciplinary breast cancer program. In her free time, Dr. Shaughnessy likes to garden, hike, and do yoga.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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