Overview of Papillary Thyroid Cancer

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Papillary thyroid cancer is the most common type of thyroid cancer. This cancer type affects the thyroid gland, which is located in the front of the neck (right below your Adam’s apple). The thyroid is comprised of two main types of cells—follicular cells and c-cells. Follicular cells make and store thyroid hormones—papillary thyroid cancer starts within these cells.

This cancer progresses slowly and tends to affect only one lobe of the thyroid gland. Despite its slow growth, it often spreads to the lymph nodes. Papillary thyroid cancer accounts for eight out of 10 thyroid cancer cases.

Women are three times more likely to have papillary thyroid cancer than men are. Also, adults between the ages of 20 to 60 years are more likely to develop this cancer than other age groups.

Papillary thyroid cancer, even when it has spread, is usually treated successfully. There’s the usual form of papillary thyroid cancer and then, there are variants of it. Some of these variants are:

  • Follicular
  • Columnar
  • Tall cell
  • Insular
  • Diffuse sclerosing
  • Papillary microcarcinoma
  • Diffuse follicular
Papillary thyroid cancer
Verywell / JR Bee 

Symptoms

Most times, papillary thyroid cancer is asymptomatic. This means that if you have it, you’ll likely not experience any symptoms. When symptoms do show up, they are:

  • a small lump/mass in the neck.
  • difficulty swallowing and/or breathing
  • pain in the neck and/or throat area
  • horseness of the voice

Causes

It isn't yet known what causes papillary thyroid cancer; however, there are certain DNA mutations linked to it. For one, mutations in the RET gene are found in a significant percentage of cases of papillary thyroid cancer. Mutations in the BRAF gene are also commonly found in papillary thyroid cancer, and when this is the case, the cancer tends to grow and spread faster.

Some risk factors associated with papillary thyroid cancer are:

  • Exposure to high dose external radiation treatments on the neck: This is usually from having a childhood condition or cancer that was treated using radiation to the neck and head.
  • Exposure to radiation during disasters at nuclear plants
  • A family history of papillary thyroid cancer: The medical community believes that certain genes on chromosomes 1 and 19 are responsible for thyroid cancers like this running through families.
  • Having a genetic condition like Familial adenomatous polyposis (FAP), Cowden disease and canary complex, type 1

Diagnosis

Papillary thyroid cancer is usually found when one goes to the hospital complaining of its symptoms, most especially, a lump in the neck. You should know that most lumps found in the neck are benign (non-cancerous) and are simply referred to as thyroid nodules. Since it usually doesn't show any symptoms, this cancer is also discovered during routine screenings or health check-ups.

Your doctor will diagnose you with papillary thyroid cancer after conducting a combination of tests.

Your doctor will give you a physical exam, paying particular attention to the area where the thyroid is located in your neck and your lymph nodes.

During this process, your doctor will ask you about your medical history and whether you have a family history of thyroid cancer. Other tests that your doctor may conduct to reach a diagnosis include:

  • Ultrasound: This test involves using sound waves from a wand-like instrument to obtain images of your thyroid. If a thyroid nodule is discovered in your neck, your doctor will likely order this test to get a better idea of its exact location, size, texture and other features which may signify whether it is cancerous or not. This test is non-invasive and is usually not a definitive diagnosis method. If your doctor suspects that you may have thyroid cancer after an ultrasound then more tests will be ordered to confirm it.
  • CT-scan: Computed tomography (CT) scan is an imaging test that uses X-ray to get very clear and detailed pictures of your body. These pictures are used to determine the location and size of the cancer, if any, and whether it has spread to other areas of your body.
  • Magnetic resonance imaging (MRI): This is another type of imaging test used in the process of diagnosing papillary thyroid cancer. It is used to get clear pictures of the thyroid gland and the surrounding areas. This test is usually done to check if the cancer has spread to other parts of the body like the lymph nodes.
  • Blood tests: There are some blood tests that your doctor will order if he suspects you have papillary thyroid cancer. These blood tests by themselves can't diagnose if you have papillary thyroid cancer but they can show if your thyroid is functioning properly and help your doctor decide what other tests are necessary. These tests will check for the levels of thyroid stimulating hormone (TSH) and thyroid hormones (T3 and T4) in your blood. The levels of these hormones are usually normal even when a person has papillary thyroid cancer but in rare cases, they are affected.
  • Biopsy: This is the most conclusive test that can be done to find out whether a thyroid nodule is cancerous or not. Biopsies for papillary thyroid cancer is done using a technique called fine needle aspiration. Fine needle aspiration involves inserting a very tiny needle into the thyroid nodule and some of its cells being drawn out through the needle (which is hollow). The doctor performing this test may repeat this process a couple of times, taking cells from different parts of the nodule.

The cells will then be taken sent to a pathologist for testing. The pathologist will examine the cells under a microscope and decide whether they are benign or cancerous. 

Fine needle aspiration is relatively pain-free and is sometimes done with the assistance of ultrasound to assist the doctor’s vision and ensure that he’s getting the cells from the right places.

Fine needle aspiration test results can be one of the following:

  • the nodule is benign (non-cancerous)
  • the nodule is malignant (cancerous); during the same examination procedure with the microscope, the pathologist will also determine if the cancer is papillary thyroid cancer
  • it's indeterminate (in this case, it can’t be said with reasonable certainty whether the cells are benign or cancerous, so further tests are usually ordered by the doctor)
  • the cells collected during the procedure were not enough and as a result, a conclusive diagnosis cannot be made (your doctor will likely recommend that another fine needle aspiration test should be performed or a biopsy using a larger needle—or, he/she may decide to schedule surgery to remove the nodule)
  • a radioactive iodine scan is ordered (this involves you swallowing or being injected with a small quantity radioactive iodine, which is then absorbed by your thyroid gland after a while)

After a time (usually after six and then after 24 hours), a scan is made of your thyroid gland. This scan will tell your doctor whether the nodule in your thyroid gland is behaving like normal thyroid tissue or not.

You may be wondering why some of the tests mentioned (like the blood tests) are ordered if they cannot by themselves detect the presence or otherwise of papillary thyroid cancer. A diagnosis, especially when it comes to cancer, is not just about determining if there are cancerous cells present but also about determining the stage the cancer is in, how fast it’s growing, how much it has spread and what organs (and their functions) it has affected if any.

It is only with a detailed and accurate diagnosis that your doctor can then go on to create a very effective treatment plan for you.

Treatment

Surgery is the most common way that papillary thyroid cancer is treated. The surgery can take three forms.

  • Thyroidectomy: This involves surgically removing the entire thyroid gland.
  • Lobectomy: If the tumor is small and has not spread outside the thyroid gland, it may be treated by simply removing the lobe (side) of the thyroid gland that has the tumor.
  • Neck dissection: Even if the cancer hasn't spread to the lymph nodes yet, your doctor may recommend that the ones close to the thyroid gland be removed surgically. It has been medically suggested that this could help reduce the risk of cancer returning to the neck area.

Also, the removal of the lymph nodes allows them to be properly tested for signs of cancer, allowing your doctor to determine the stage of your cancer accurately. This surgery is commonly called central neck dissection and is usually done while the thyroidectomy is being performed.

In situations where the cancer has already spread to the lymph nodes, your doctor will likely recommend a more extensive removal of your lymph nodes and not just the ones near your thyroid gland.

This surgery is called a modified radical neck dissection (MRND) or lateral neck dissection. With this surgery, there’s a slight risk of injury to the nerves in the surrounding area.

Radioactive iodine treatment is sometimes done in addition to a thyroidectomy when the cancer is still in its early stages. However, when the cancer is in its late stages, radioactive iodine therapy is almost always given as it significantly increases the survival rates of such patients.

The thyroid gland absorbs most of the iodine in your body, and so this treatment involves taking radioactive iodine (also known as I-131), which will then destroy all the remaining thyroid cells or tissue left after your thyroidectomy. This procedure oftentimes requires you to be in the hospital for some days afterward, in a special isolated ward, to prevent others from being exposed to the radiation that may still be leaking from you.

Coping

Once you undergo a thyroidectomy, you will have to take a drug called levothyroxine every day for the rest of your life. The purpose of this drug is to replace the thyroid hormone that your removed thyroid gland would otherwise have been producing.

After all your treatments have been completed, your doctor will likely schedule follow up appointments with you to monitor your cancer. Even though the chances are relatively low, there’s still a chance that your papillary thyroid cancer may recur. During these follow-up appointments, your doctor may order the following tests.

  • Physical examination
  • Radioactive iodine scan
  • Thyroid ultrasound
  • Blood tests to check for your the levels of your thyroid hormones, thyroid stimulating hormone and thyroglobulin.

If you underwent a thyroidectomy, your thyroglobulin levels should be very very low. If its levels start to rise during your routine blood tests, it may be a sign that your cancer is coming back.

If your cancer does come back, it’s important to discuss your options extensively with your doctor. It is possible that you may need to undergo radioiodine therapy or surgery again. You may also need to undergo chemotherapy, targetted therapy, or external radiation therapy if the recurring cancer has spread to other parts of the body.

A Word From Verywell

Being diagnosed with papillary thyroid cancer can be a lot to take in at first. If you can afford it, you should see a therapist to help you process and work through your feelings about your diagnosis. Some hospitals offer counseling services for people who have cancer and you can also speak to your friends, family, or try joining a support group, as speaking about your feelings can be extremely helpful.

The outcomes for papillary thyroid cancer after treatment are usually very good, but it may be helpful to have realistic expectations based on discussions with your doctor about your own individual case.

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