The risk factors and treatment plans for thyroid cancer

The number of thyroid cancer cases in the United States is on the rise, but Farzad Masroor, MD, head and neck surgeon at GBMC’s Milton J. Dance, Jr. Head and Neck Center, says that statistic doesn’t tell the whole truth. The American Cancer Society’s 2022 estimates for thyroid cancer cases in the U.S. show 11,860 new cases in men and 31,940 in women. 

“A lot of these cancers are being caught incidentally, meaning a small cancer in the thyroid gland is found on imaging tests done for other reasons, say for neck or chest pain. Most of these incidental cancers are small, slow growing, and may take many years to cause problems for the patient, if ever. The term for these cancers is microcarcinomas,” Dr. Masroor notes. 

Dr. Masroor explains that when this is the case, the cancer is at a very early stage and has an excellent prognosis. For patients with microcarcinomas under 55 years of age, their chance of dying from the cancer is less than 2% over 10 years. This is a welcome statistic, especially since thyroid cancer isn’t easily attributed to lifestyle or demographic risk factors. 

“Well-known risk factors for thyroid cancer are a family history of thyroid cancer or a history of receiving radiation to the neck. These are not common, and so for most patients there is nothing the patient has done that increased their chance of getting it. It’s just an unfortunate event for most patients,” Dr. Masroor says. “It does occur more commonly in women than in men, usually in the middle part of their lives.” 

The thyroid is a butterfly-shaped gland located in front of the windpipe or trachea. Treatment for thyroid cancer varies depending on the individual patient as well as the size and spread of the cancer. Treatment often consists of removal of the entire thyroid gland or the side of the gland housing the tumor. 

“The first line of treatment is surgery for the most common types of thyroid cancer called differentiated thyroid cancer. It gives you the best chance of controlling and curing the cancer. Afterward, we sometimes use a special type of medicine called radioactive iodine (RAI). Chemotherapy and radiation are not routinely used but instead reserved for advanced cases after surgery,” Dr. Masroor says. 

The American Cancer Society also states recent studies have suggested people with very small tumors may choose to participate in “active surveillance” of the cancer, with routine ultrasounds, rather than have immediate surgery. 

While many thyroid cancers are discovered incidentally, Dr. Masroor explains there are some symptoms to note. He says if you have any of these symptoms, you should contact your doctor right away. 

“There are three major areas affected by thyroid cancer: the windpipe, the swallowing tube (esophagus), and the nerve to the voice box,” he says. 

When a thyroid cancer pushes on any of those structures, it’s going to produce pressure, which can lead to trouble swallowing, a hoarse voice, or difficulty breathing. Dr. Masroor says sometimes patients just feel off. “They feel like something isn’t quite right. They have night sweats and an achy fullness in the neck,” he adds. 

Regardless of the severity of a cancer diagnosis, Dr. Masroor says getting treatment from a well-qualified team, like the one at GBMC, is incredibly important. 

Many patients are able to return home on the same day as their surgery and have a relatively easy recovery, which is not particularly painful and only requires over-the-counter medication for relief. 

“With a skilled and experienced surgeon and treatment team, most patients with this type of thyroid cancer can expect to be cured,” Dr. Masroor says.