g Thyroid Cancer: Diagnosis & Treatment | Apollo Proton

"Thyroid cancer can occur at any age, but the risk peaks earlier for women than for men."



Diagnosis

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Imaging tests:


  • Ultrasound - CT Scan / MRI / Nuclear Medicine Scan / PET Scan
  • Lab tests

Advanced genomic testing: Laryngoscopy


  • Biopsy

Fine needle aspiration (FNA)

Treatment

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Once diagnosed, the patient is counselled regarding the various treatment options depending upon the stage and grade of the disease. Some patients will require combinations of treatment to achieve optimal control of cancer.

Surgery

Types of surgeries may be used to treat thyroid cancer:


HEMITHYROIDECTOMY:


For small, well-differentiated tumours that have not spread beyond the thyroid gland, a lobectomy may sometimes be performed. In this type of thyroid cancer surgery, the lobe containing the cancer is removed, leaving the other healthy lobe behind. This may reduce the need to take thyroid hormone treatment after surgery since a functioning part of the thyroid remains.


TOTAL Thyroidectomy:


In this procedure, most or all of the thyroid gland is removed by surgery (total, near-total or subtotal thyroidectomy). This type of surgery for thyroid cancer is used for most patients. However, because very little or no functioning thyroid tissue is left behind, patients will need to take daily thyroid hormone replacement pills afterward.


Lymph node removal:


When the surgeon suspects that the thyroid cancer cells have spread to nearby lymph nodes, they will remove the enlarged or suspicious nodes in order to remove as much of cancer as possible. This thyroid cancer surgical procedure is usually performed at the same time as the surgery on the primary tumour.


Radioactive iodine treatment/nuclear medicine treatment.

Radiation Therapy

External beam radiation therapy (EBRT):


It directs the radiation from outside the body at cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumours. Examples of EBRT include 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy® and stereotactic radiosurgery.


Intensity-modulated radiation therapy (IMRT):


Uses advanced software to plan a precise dose of radiation, based on tumour size, shape and location. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3D geometrical shape of the tumor, including concave and complex shapes. If you have previously had radiation therapy for thyroid cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you.Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy tissue from harmful doses of radiation.


TomoTherapy:


Combines a form of intensity-modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. With this technology, we deliver more precise radiation to match complex tumor shapes while avoiding sensitive structures. Using built-in CT scanning to confirm the shape and position of the tumor before each treatment, TomoTherapy may reduce radiation exposure to healthy tissues and organs.

Systematic Treatment

Chemotherapy:


Chemotherapy is sometimes used to sensitize anaplastic thyroid cancers to external beam radiation therapy (EBRT).


The potential side effects of chemotherapy may include nausea, vomiting, hair loss and mouth sores. Your care team will use multiple measures to help reduce or moderate chemotherapy-related symptoms. Prior to receiving chemotherapy for thyroid cancer, you may receive pre-medications to help make symptoms more tolerable.


Hormone therapy:


Patients with thyroid cancer who have had most or all of their thyroid gland removed by surgery need to take daily hormone supplements in order to maintain their bodies’ normal metabolism.


Maintaining normal or above-normal levels of thyroid hormone in the blood may help reduce the amount of thyroid-stimulating hormone (TSH) made by the pituitary gland. TSH is a regulatory hormone that stimulates the growth of the thyroid gland, and may also stimulate thyroid cancer cells. Normally, the pituitary gland makes more TSH when levels of thyroid hormone are low, so increasing these levels can send a signal to reduce the production of thyroid-stimulating hormone, and potentially help to keep some thyroid cancers from recurring.

Targeted therapy

Targeted therapy drugs are designed to seek out a specific characteristic in cancer cells, such as a gene mutation or a protein, and attach themselves to those cells. Once attached, these drugs may kill the cells or may help other therapies, such as chemotherapy, work better. Among the drugs used in targeted therapy are so-called kinase inhibitors, which target specific enzymes called protein kinases that help regulate cell growth. Other targeted drugs, called angiogenesis inhibitors, are designed to prevent tumors from establishing new blood supplies.

Nuclear therapy

Radioactive iodine therapy:


Thyroid cancer may be used alone or in combination with other treatments, such as surgery. Treatment with radioactive iodine is used most frequently for thyroid cancers that have spread to the lymph nodes and other parts of the body, though its potential benefit in patients with small tumors that can be completely removed by surgery is not clear.


Because almost all iodine in your bloodstream gets taken up by the thyroid gland, radioactive iodine (I-131) may be used to destroy the thyroid gland and thyroid cancer cells in lymph nodes or other parts of the body. For this procedure, the radioactive iodine is taken into the body either in liquid or capsule form.


Radioactive iodine therapy is only recommended for differentiated cancer, such as papillary or follicular thyroid cancers. It is not used to treat medullary or anaplastic thyroid cancers, because these types of cancer cells do not take up iodine.

Radiotherapy

The treatment of well-differentiated cancers is surgical removal followed by radioactive iodine.


The role of radiotherapy is to treat thyroid cancer that is not responding to radioactive iodine treatment; it may be used to treat unresectable disease/ locally invasive disease in patients older than 45 yrs. Occasionally radiotherapy may be used to treat thyroid cancer in the neck, even in the presence of cancerous lesions elsewhere in the body.


In addition to this, radiotherapy is used to treat bone metastases arising from thyroid cancer. Bone metastases from thyroid cancer can often become large and pulsatile and radiotherapy serves to reduce the size of the metastasis, reduce pain and fracture risk. This treatment may be combined with surgical stabilization and bone-strengthening agents like Injdenosumab or bisphosphonates. Depending on several factors, doctors may choose to treat the bone lesions using a 1-5 fraction high dose SBRT treatment or a longer course of palliative radiotherapy.


At Apollo Proton Cancer Centre, radiotherapy treatments for differentiated thyroid cancer include Tomotherapy and Proton therapy, the latter in certain select situations. These select situations factor in the overall prognosis as well as benefits to be gained from proton therapy in reducing the risk of second cancers and early side-effects like dryness of mouth, swallowing difficulty.


Medullary thyroid cancer is rare cancer constituting 2-3% of all thyroid cancers. This cancer is treated surgically. While radiotherapy does not impact survival, it does reduce the risk of the disease recurring in the local site and glands of the neck. This benefit may be seen in patients in whom cancer has spread to neck tissues outside the thyroid, or involves lymph nodes or cannot be removed entirely.


Anaplastic cancer thyroid is aggressive cancer treated with a combination of surgery, radiotherapy, chemotherapy and targeted therapy. Various radiotherapy schedules are used in the treatment of anaplastic cancer, varying from short 18 fractions, 3.5-week schedules to longer schedules delivering radiotherapy twice daily.

Life after treatment
  • A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor.
  • A schedule for other tests you might need, such as early detection (screening) tests for other types of cancer, or test to look for long-term health effects from your cancer or its treatment.
  • Diet and physical activity suggestions that might improve your health, including possibly lowering your chances of cancer coming back.
  • Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care.

Winning Over Cancer

Dr. Naveen Hedne, Senior Consultant & Lead - Surgical Oncology talks about managing head & neck cancers during COVID-19. He said head & neck cancers can be easily identified & one should not ignore its symptoms, He further added that APCC is well equipped and ready to treat patients during the pandemic situation.

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Mr. Param Gandhi from Surat, Gujarat talks about the Proton Therapy for his father at Apollo Proton Cancer Centre. He also talks about the standard of care and treatment journey while conveying his heartfelt gratitude to Dr. Ghosh, Dr.Sapna, Dr Naveen, Dr.Vidyadharan, Dr.Pradeep and the entire team of Head & Neck Cancer Management for their excellent guidance & support. Wishing Param & his family good health always.

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Mr. Kishore Jain from Mumbai talks to us about his brother-in-law who was diagnosed with oral cancer and the treatment he underwent at Apollo Proton Cancer Centre. He thanks Dr.Sapna Nangia, Dr.T.Raja, Dr.Naveen, Dr. S. Vidyadharan and the entire team for their extensive help and making him feel optimistic during the treatment period. He is happy to see his brother-in-law who has recovered and is looking fit & healthy today.

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Ms.Pooja from Delhi speaks to us about her family member who was diagnosed with head & neck cancer in February, this was when COVID - 19 was picking up in India. She describes how Dr. Sapna Nangia (Director - Head Neck & Breast, Department of Radiation Oncology) gave her hope by explaining about Proton Therapy at Apollo Proton Cancer Centre.

While the treatment is still going on, she wants to thank the entire team at APCC for taking care of her travel formalities during this challenging time.

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