Small Papillary Thyroid Cancer Is More Common and Not Without Risk than Previously Believed

(Oct. 5, 2007) — Patients with micropapillary thyroid cancer—small tumors equal to or less than 1 centimeter—and tumors even smaller, less than 1 millimeter (mm)—are more common and not without a risk as previously thought, according to a new study presented on Fri., Oct. 5, at the 78th Annual Meeting of the American Thyroid Association (ATA) in New York.

This is contrary to the widely perceived belief that small papillary thyroid cancers are clinically insignificant and don't require active treatment. Papillary is the most common type of thyroid cancer, accounting for about 80% of all thyroid cancers.

The findings suggest that the size of the tumor itself may not be the sole determinant for the degree of the cancer's aggressiveness.

Small papillary cancer can indeed metastasize or spread to other parts of the body. Ten percent of patients in the study with micropapillary cancer and six percent of those with less than 1 mm cancers had tumors that spread to nearby lymph nodes in the neck.

The study also shows that small papillary thyroid cancer can come back after the initial treatment. In the study, 12 percent of patients with micropapillary cancer who received radioactive iodine treatment after surgery required a second treatment of radioactive iodine, 11-60 months later because the cancer had come back. For those patients with less than 1 mm thyroid cancer, 19 percent of those who received the post-operative radioactive iodine treatment also required a second radioactive iodine treatment.

The standard treatment for papillary thyroid cancer is surgery to remove the thyroid gland (thyroidectomy). If the cancer is large, or has spread to lymph nodes, or if the patient is at a higher risk for cancer to come back, then radioactive iodine ablation therapy is often used to destroy any remaining thyroid cancer cells after surgery. Very frequently, radioactive iodine treatment is not given for small cancers, unless there are some clinical indications or suspicions for more aggressive disease, despite its small size.

Researchers also found that a substantial proportion of patients in their study had micropapillary and less than 1 mm thyroid cancers, suggesting that small papillary cancers are quite common. Close to half (45 percent) of papillary thyroid cancer patients in the study had micropapillary cancer, while over a quarter (26 percent) of these patients had less than 1 mm cancer.

"I hope our study will enhance the understanding of small papillary thyroid cancer, which seems to be increasing in number, yet the natural course or optimum treatment is not well known," said Haruko Akatsu Kuffner, M.D., author of the study and Assistant Professor of medicine, Division of Endocrinology and Metabolism at the University of Pittsburgh in Pittsburgh, Pa.

"We would like to be appropriately aggressive in treating small aggressive cancers. However, it is also important not to be aggressive in managing the majority of these patients with clinically insignificant small cancers. A better understanding of this disease will help us to better risk stratify these patients," added Dr. Kuffner.

This large, retrospective study involved reviewing the records from 1992 to 2004 of 888 papillary thyroid cancer patients with original pathology records including the cancer size available through the use of the University of Pittsburgh Thyroid Cancer Database.

Source: http://www.thyroid.org/professionals/publications/news/07_10_05_kuffner.html

Comments

[Care1]

Should you always chose RAI for hyperthyroidism

[Janette DeRouin]

I had cancer in 2005,and it was surgically removed and iodine radioactive pills taken I was told Iwould always need to stay on the low-side of thyroid meds.I have fibromyagia,chronic fatigue,post menipousal,and still feel sluggish alot.Do you think natural tyroid meds at a higher level would help??

[cancer syndrome]

Breast cancer: A lump or thickening of the breast; discharge from the nipple; change in the skin of the breast; a feeling of heat; or enlarged lymph nodes under the arm

Colorectal cancer: Rectal bleeding (red blood in stools or black stools); abdominal cramps; constipation alternating with diarrhea; weight loss; loss of appetite; weakness; pallid complexion

Kidney cancer: Blood in urine; dull ache or pain in the back or side; lump in kidney area, sometimes accompanied by high blood pressure or abnormality in red blood cell count

Leukemia: Weakness, paleness; fever and flu-like symptoms; bruising and prolonged bleeding; enlarged lymph nodes, spleen, liver; pain in bones and joints; frequent infections; weight loss; night sweats

Lung cancer: Wheezing, persistent cough for months; blood-streaked sputum; persistent ache in chest; congestion in lungs; enlarged lymph nodes in the neck

Melanoma: Change in mole or other bump on the skin, including bleeding or change in size, shape, color, or texture

[cervical cancer]

Cervical cancer symptoms often go unnoticed because they mimic so many other ailments. Many women pass these symptoms off as PMS or ovulation pains. Many times, however, cervical cancer has no symptoms.

When symptoms are present, they usually do not appear until the cancer is more advanced. This does vary from woman to woman.

[Papillary thyroid cancer]

Cancer name itself is dangerous. Thyroid cancer is very rare. It starts from thyroid gland and is kind of neck cancer. According to a new study, it has been found that those who stay in volcanic regions, are at higher risk of thyroid cancer. Papillary thyroid cancer is a type of thyroid cancer which mostly found in women. If anyone observes symptoms of it, should consult doctor immediately.

[marcy]

are blood counts significant in patients with thyroid cancer?

[john]

This blog is really a great source of information which is very useful for me. Thank you very much for such important information.

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