THYROID CANCER: WHAT YOU SHOULD KNOW

Thyroid cancer is one of the few cancers increasing in the number of newly diagnosed cases each year in America today. It affects women three times as many times as men and it occurs in all age groups.

Signs and symptons to discuss with your doctor: a lump in your neck, a lymph node swelling (specially is it's recurring), fullness in the neck, voice changes, difficulty breathing, sleep apnea, recurrent sore throat or pain in the neck.

There are several types of thyroid cancer; papillary, follicular, medullary, anaplastic and several variants. Treatment depends on the type of thyroid cancer, tumor size, age of the patient, and other factors and may include one or more of the following; surgery, thyroid hormone replacement, radioactive iodine, external beam radiation and chemotherapy.

AfroAmerican and Latino Women ages 15 to 35 are more likely to be diagnosed at secondary or advanced stages of disease when clinical outcomes and quality of life issues are more difficult to manage and predict.

Thyroid cancer can spread or metastasize to other endocrine organs or glands, the lymphactic system, lungs, and bones. It can sometimes reappear decades after initial treatment. Because of this, patients should have follow-up tests throughout their lifetime, so that any recurrence can be treated properly.

You are not alone! Whether you are newly diagnosed, are still being tested for possible thyroid cancer, or have been living with it for many years, you may have fears, concerns or questions. Thyroid Cancer presents many unique challenges. These include the potential impact of diagnostic tests and treatment on your quality of life, as well as the emotional and financial stress over the need for long term follow up care and monitoring.

The Happy Angels Project Inc., our random acts of kindness volunteer group believes that no one should have to be alone as they cope with thyroid cancer; patient, caregiver, survivor or loved one. We have formed a unique support network in the community and online under Stevie JoEllie's Cancer Care Fund.

Our free services and outreach programs are available to everyone whose life has been touched by thyroid cancer. We hope our supportive services network can be of help to you and your family too as a patient and survivor. Visit our blog regularly for program development news, clinical updates.

Our Community Support Groups Meets the First Wednesday of the Month for the English Language Session and the Third Wednesday of the Month for the Spanish Language Session at Gilda's Club Northern NJ located at 575 Main Street Hackensack NJ from 6:00 PM to 7:30 PM

~~~ Please call to confirm and verify dates: (973) 830-7557 or Email: sjccfthynet@gmail.com

CANCER PATIENTS BILL OF RIGHTS

Stevie JoEllie's Cancer Care Fund endorses and supports the following version of The Cancer Patients' Bill of Rights

• All private, health insurers and all managed care plans shall cover in full all cancer screening and early detection protocols pursuant to the best evidence of appropriate screening protocols.

• Every person diagnosed with a suspicious tissue growth (“neoplasia") which has a reasonable, medical probability of being malignant shall have a right to immediate referral to a specialist, board-certified in cancer diagnosis and treatment.

• Every patient with a confirmed diagnosis of cancer shall have a right to treatment by a multi-disciplina­ry team of oncology specialists, including but not limited to, medical oncologists, surgical oncolo­gists, radiology oncologists, plastic surgeons, rehabilitation specialists, and counseling.

• Every cancer patient, whether in treatment or after treatment, shall have the right to use a medical specialist as his/her primary care physician with full insurance coverage for same and without penalty within a managed care plan.

• Every competent, adult cancer patient shall participate in the formation of his/her treatment and rehabilitation plan and his/her pain management protocol.

• Every hospital or research center rendering care to cancer patients shall respect such patients?advance directives for discontinuation of care. If such hospital or research center for policy or religious reasons cannot respect advance directives, the patient or the patient’s designated representative shall be so informed as soon as possible.

• Medical treatment facilities shall make every effort to acquaint each cancer patient with a re­covering cancer patient who shall serve as the inpatient’s personal counselor and advocate.

• Cancer diagnostic testing and cancer treatment side effects shall be minimized to the extent prac­tical under current standards of treatment.

• Cancer patients have the right to continuity of care, including post-discharge aftercare.

• Cancer patients shall receive from the primary, cancer treatment provider continuous and lifelong monitoring of health and emotional well-being with particular emphasis on vigilance for cancer recurrence and for long-term after effects of cancer treatment.

• Cancer patients have the right to lifelong, continuing education on all aspects of cancer prevention, diagnost­ic tests, and treatment protocols.

• Cancer patients have a right to participate in unapproved alternative or complimentary cancer treatments and to have their healthcare plan or health insurance provider pay for such treatments with certain noted restrictions.

• A competent, adult cancer patient may participate in alternative, unapproved treatments if he/she has received from his/her primary healthcare provider a written statement of such treatments?known or probable risks and a written statement disclosing any readily available, known failures of such treatment.

• A parent or legal guardian of a minor or in­competent adult patient shall have the right to petition a Probate Court or Family Court of com­petent jurisdiction to allow access to alternative or complimentary treatments.

• Payment from any source for such treatment shall be escrowed in a trust account and shall not be released to the provider of the unapproved treatment until the patient’s primary healthcare provider certifies to the trustee that the alternative treatment has been a “cancer treatment benefit" to the patient.

• Cancer patients shall participate in their own pain management and shall have the right to have their pain complaints believed, the right to aggressive pain management, and the right to know what limitations on pain management are the policy of the primary healthcare provider.

• Aggressive pain management with all available medication, including opiates, shall not first require invasive procedures for pain management such as, but not limited to, surgery, nerve or tissue destruction, or the implantation of electronic anti-pain devices.

• The potential for drug addiction shall be evaluated, fully explained to the patient, but shall not be the sole criterion for not using available medications nor for discontinuing pain relief by medication.

• At the end of life, every competent adult or his/her legal representative shall have the right to re­quest all available, pain management protocols, including opiates which might hasten death. 

• No lawfully licensed physician shall be sanctioned for prescribing aggressive pain management even if death by sedation is a possible contraindication.

• No physician shall participate directly in physician-assisted suicide which shall be defined as deliberate administration of pain medication at a deliberately lethal dose with the intent of hastening a patient’s death.

• Cancer survivors have a right to gainful employment commensurate with their talents and abilities, without regard to their history of cancer diagnosis.

• Cancer survivors have a right to be included in employers group healthcare plans without pre­judice against pre-existing cancer diagnosis.

• Cancer survivors have a right to private health insurance at reasonable cost without prejudice against pre-existing cancer diagnosis if such patients have been in remission for at least two years.

For more information please visit our website www.sjccfthynet.org

SJCCF SUPPORT GROUP POLICY

THYROID CANCER COFFEE BREAK SUPPORT GROUPS: Thyroid Cancer Awareness, Community Health Education and Peer to Peer Support Network for thyroid cancer patients, survivors and loved ones nationwide.

RELATIONSHIP: The relationship between  Stevie JoEllie's Cancer Care Fund, Inc. and each local Thyroid Cancer Coffee Break Support Group is strictly limited to those matters contained in the SJCCF-Thyroid Cancer Coffee Break Support Group Facilitator's Manual.

Each local Thyroid Cancer Coffee Break Support Group is a separate, independent entity that is not controlled by  Stevie JoEllie's Cancer Care Fund, and to which Stevie JoEllie's Cancer Care Fund seeks to provide helpful information and support. Local groups are initially organized by a local volunteer, usually a thyroid cancer  survivor or caregiver/partner/parent.

Thyroid Cancer Coffee Break Support Group facilitators can be thyroid cancer survivors, pediatric thyroid cancer parents, caregivers or patient/survivor "partners", professionally trained facilitators from a local healthcare institution or organizations and pastoral care ministries.

FUNDING: Stevie JoEllie's Cancer Care Fund has no funds to financially support local Thyroid Cancer Coffee Break Support Groups, so organizers seek space that is available free for public use, such as libraries, hospitals, cancer centers, colleges or churches ect..

EXPENSES: If both the space and facilitators are free, there are few expenses required to set up and maintain each group. Start-up costs include the photocopying of flyers and a press release, postage (for mailers) and coffee and refreshments for the first few meetings. All of these costs were about than $200 in 2010.

In many cases the photocopying can be donated by a local printing company or support group hosting facility. A savy support group leader will also arrange for donated refreshements for the first few meetings. Subsequently you can arrange for support group members to collaborate and "donate" refreshments for everyones enjoyment. The critical cost is the time each volunteer gives to the group.

HOW  CAN SJCCF HELP LOCAL SUPPORT GROUPS?

1. Promote  local and independent Thyroid Cancer Coffee Break Support Groups in its promotional campaigns through Newsletters and Internet Marketing including social media networks.
2. Help locate and connect your group with experienced support group facilitators as a resource to new facilitators in your area.
3. Locate and advise of Free workshops for support group facilitators in your area as well as during our national conference.
4. Make available templates of press releases, flyers and posters support group facilitators can adapt for local use.
5. Make available sample letters sent by Stevie JoEllie's Cancer Care Fund and other facilitators to physicians and organizations.
6. Maintain a referral network database for newly diagnosed thyroid cancer patients, partners, parents, caregivers and survivors.
7. Maintain a database of all past and present members of local Thyroid Cancer Coffee Break Support Groups

Maintaining SJCCF-Thyroid Cancer Coffee Break Affiliation:  To maintain its affiliation with SJCCF-Thyroid Cancer Coffee Break each local group must send in an annual report by August 1 of each year. This report will include a current list of the facilitator(s) and other volunteers, a list of participants (including telephone numbers plus postal and e-mail addresses), the contact person and address for the group, the name and address of where the group meets and the name and telephone number for the contact person at that site.

Maintaining the history of each group: Each group should have a volunteer keep the history of the group. This doesn't have to be extensive, but it should include the date and place the group started, samples of flyers and press releases, articles from local media, annual membership lists and the names and addressess of the group's facilitators and other volunteers.

Name of the Group:  We ask that all groups working with Stevie JoEllie's Cancer Care Fund use the name Thyroid Cancer Coffee Break as part of the group identification. Examples: Thyroid Cancer Coffee Break Clifton NJ, Thyroid Cancer Coffee Break of  Orlando FL,  Thyroid Cancer Coffee Break of  San Diego CA and so on.

THE SUPPORT GROUP FACILITATOR'S ROLE:

• Facilitators: Make sure participants are comfortable and have a chance to aks the questions they need to ask and share as much as they are willing to share about their concerns and experience.

• Seating: sitting in a circle makes it easier to hear and see everyone. It also feels a lot friendlier and relaxing in a circle of "friends"

• Group Session Length: The length of the session is up to the organizers of each group. Most groups run about  90 minutes.

• Group Meeting Day: In our experience the best day to meet is probably late morning or early afternoon on Saturday or Sunday for most people who volunteer their time.

• Special Considerations: For those members, especially new members, who are hypothyroid and working, meeting in the evening after work is difficult at best. Meeting on Saturday means that some of Jewish thyroid cancer survivors will not be able to attend. Meeting on Sunday means that some of  Christian thyroid cancer survivors will not be able to attend.

What is the ideal support group meeting schedule in a large urban area?  One on Saturday; one on Sunday; one in the evening during the week; and one mid-day during the week. But there are few cities large enough to support four groups and we realize it is virtually impossible for volunteers to manage this schedule without the commitment and dedication of at least 4-6 support group moderators.

• Atmosphere: -The facilitator should strive to make the "feel" of the room as "kitchen-table" friendly as possible. This must be a place of nurturing and should feel as welcoming as possible. It is very useful to have a welcome volunteer for each session, someone who makes sure every member is greeted and "looked after" when they first arrive before the session begins. 

• Food and creature comforts: -Having coffee and healthy snacks help make the atmosphere welcoming, but the facilitator is NOT responsible for these goodies. The members of the group are responsible; if they want it, let them help you out by bringing in snacks and making coffee. They'll feel as though they're contributing and you won't feel burdened. 

• How many facilitators? - Two is ideal. Three is better. Four is optimal. It's important for the Group Leader or facilitator NOT to carry the full responsibility of the group. Having co-facilitators means that vacations, illness and the need for personal time or life events can all be handled easily without disrupting the support group schedule once the group begins meeting.

• "Other" Support Group "jobs" or key supportive roles: In general, the support group leader and one or two facilitators can take on all of the tasks necessary to maintain and nurture a local support group. However, it helps to avoid burn-out of volunteers and to insure continuity in case of illness to invite others from the group to take responsibility for some of the tasks such as:

1. Contact Person -- this person's name, phone and e-mail are listed in all promotional material and publicity for the group
2. Co-Facilitator -- facilitates support group sessions in a rotating basis;
3. Publicist or Public Relations Coordinator -- handles all the publicity and outreach;
4. Site Coordinator -- the person who is the liaison between the group and the site.

KEY POINTS:  The facilitator should ALWAYS begin first because most people feel very uncomfortable talking in a group at first. Facilitators can encourage introductions to go around the circle during each meeting, but make everyone aware that individuals start sharing when they're ready, hopscotching around the circle once the "support" group session begins because many people can't listen to what is being said if they feel the pressure of being next "in line" to talk.

• Format - As the facilitator of the first support group, Thyroid Cancer Coffee Break of  Clifton NJ, which began in October 2008, I followed the model I observed at The Survivorship Wellness Community support groups. Participants introduced themselves and talked about their thyroid cancer history.

• Structure- The overall structure for the model above then is: introductions, beginning with the facilitator(s), followed by others in a circle and then "support" discussions in no particular order.  If there are at least three or four people in a session, the conversation will go where those present want it to go. Other than making sure each person has a chance to talk and no one monopolizes the floor, the less structure the better for our purposes.

• Advice -The official policy of the Stevie JoEllie's Cancer Care Fund's  Advisory Board of Directors is that the organizers and facilitators of local Thyroid Cancer Coffee Break support groups affiliated with Stevie JoEllie's Cancer Care Fund  do NOT give medical advice. Nor do they endorse specific medical treatments.

Stevie JoEllie's Cancer Care Fund encourages treatment option discussions and supportive long term wellness ideas in an environment where each bit of advice is framed in a "share-my-personal-experience-with-you-discussion-forum" followed by the suggestion for the participant to see her/his doctor or get a second opinion before making any decision about treatment.

It is our experience that as members of a group become friends, they will offer advice to each other and to new members of the group with authority. The facilitator, however, should always make sure that during each support group session we remind our members that each person's clinical condition is unique and that as such what works for one person may not work for another, therefore, we "share" our personal experiences as such; personal experiences that may or may not be useful to others  as individuals.

What about outside facilitators? The ideal is to have a professionally trained facilitator who facilitates the group as part of her/his work or simply as a way to support your efforts from time to time. Hospitals, teaching centers, such as medical schools, and organizations have facilitators available. However, it is important not to get bogged down looking for a professional to facilitate on a regular basis. After all, it's more important to have a safe place for those newly diagnosed or facing treatment for the first time, a place where they can find others who've had similar experience.

Some organizations and many institutions will not permit support groups to meet unless one of its trained facilitators co-facilitates the group. In many cases, this is to limit the organization's or facility risk for liability. At some point, Stevie JoEllie's Cancer Care Fund may want to do the same thing, but for now, we're just a group of survivors, caregivers, partners and parents dedicated to helping ourselves and others.

Who May Attend a Thyroid Cancer Coffee Break? Local Support Groups  are generally open to all; patients, partners, caregivers, parents and survivors of thyroid cancer or whoever the local group is comfortable with and the decision is made locally by both the support group facilitators and the support group members.

• " Survivors" is defined in the broadest sense: those with the disease, their families, friends, colleagues and care givers. If groups are large enough, members may wish to separate into two groups for part of the session: one for those with thyroid cancer and one for their friends and families.

Separate groups are often very helpful for spouses, significant others and parents or caregivers to have a chance to talk with others having similar experiences. Each group can decide if those who are not thyroid cancer survivors may attend (students, physicians or other healthcare professionals). Occasionally, someone with a related thyroid condition (hypothyroidism, for example) may ask to attend; each group should establish its own policy.

Prepared by Wilma Colon Ariza, Founder

Stevie JoEllie's Cancer Care Fund

Email: sjccfthynet@gmail.com

CANCER FACTS FOR LATINOS

• Hispanic women have higher incidence rates of cervical (16.8 rate per 100,000), liver (5.6 rate per 100,000), and stomach (10.0 rate per 100,000) cancer compared to non-Hispanic White women (9.2 rate per 100,000, 2.8 rate per 100,000, and 5.1 rate per 100,000 respectively) (Rates are age-adjusted to the 2000 US standard population).

Source: "Cancer Facts and Figures 2004" American Cancer Society. table 1, pp. 23.

• Hispanic men have higher incidence rates of stomach and liver cancer than non-Hispanic White men (18.1 rate per 100,000, and 13.8 rate per 100,000 compared to 11.2 rate per 100,000, and 7.3 rate per 100,000 respectively), (Rates are age-adjusted to the 2000 US standard population).

Source: "Cancer Facts and Figures 2004", American Cancer Society. table 1, pp.23.

• Hispanics (23%) are also more likely not to have had Pap smears than their non-Hispanic White counterparts (17%). Source: "National Healthcare Disparities Report." U.S. Department of Health and Human services, Agency for Healthcare Research and Quality. pp. 42. July 2003.

• Breast cancer (89 rate per 100,000), colon cancer (32.9 rate per 100,000), and lung cancer (24.4 rate per 100,000) are the most commonly diagnosed cancer among Hispanic women.

• Prostate cancer (137.2 rate per 100,000), colon cancer (49.8 rate per 100,000), and lung cancer (46.1 rate per 100,000) are the most commonly diagnosed cancer among Hispanic men. Source: "Cancer Facts and Figures 2004", American Cancer Society. table 1, pp.23.

• According to 2001 data, the rate of incidence for stomach cancer is more than twice in Hispanic women (9.3 per 100,000 population) than non-Hispanic White women (3.5 per 100,000 population).

Source: "Health, United States 2004 With Chartbook on Trends in the Health of Americans." National Center for Health Statistics. Hyattsville, Maryland: 2004. page 210.

THYROID CANCER SUPPORT GROUPS MATTER

A cancer diagnosis can cause enourmous anxiety. People fear body changes, possible pain, loss of income, adjustments in their personal relationships, and other unwelcomed changes imaginary and real associated with their cancer diagnosis. Because they have so much anxiety in their lives when they are newly diagnosed, during and after treatment, people with cancer sometimes becoem upset, frightened or suspicious for no apparent reason. If this happens, family and friends may need to make a special effort to be reasurring, supportive and comforting.

If you are the "patient" during the course of your illness, you may express anger or hostility toward those around you. Though this can be upsetting to family members and friends, it may help to remember that people often displace their anger and frustrations with a trying situation by projecting those feelings onto people close to them. It is difficult to express your anger at the disease to towards the disease itself (the real cause of your frustration and sadness), so you instead feel angry with family and friends, or whoever happens to be close at hand. Those people, unfortunately, usually bear the brunt of this anger.

Sometimes, people with cancer become childlike and dependent during illness. This may be a way of letting the family know they feel helpless or weak. Though the range of daily activities may be limited by the disease, it is usually best for you to continue accepting as much responsibility as possible for your unique personal ability and circumstances. Continuing to be a responsible, productive adult (to the extent that is possible) supports your sense of confidence and control, while becoming completely dependent on others can make you feel more helpless and victimized by your illness.

Living with cancer includes learning how to cope with the practical and emotional aspects of your diagnosis, as well as learning how to treat your cancer. The emotional impact may be overlooked by your healthcare team. Developing the necessary coping skills to manage the wide range of emotions a cancer diagnois and cancer treatment will no doubt cause you to experience from day to day is a challenging learning process, but when you cope more effectively, reduce your anxiety, and try to focus your energy on enhancing your quality of life, you will be able to manage your medical care effectively.

Meditation, visualization and deep breathing exercises can be excellent ways to relax when you are dealing with stress. Make a tape of soothing easy listening music and listen to it as you relax focused solely on the music and your breathing. Don't be afraid to ask those you live with for privacy when you need it to read a good book, listen to music, pray or simply relax on your own.

THYROID CANCER SURVIVAL RATES

Male vs Female Mortality Rates Tables

Survival rates indicate the percentage of people who survive the disease for a specific period of time after their diagnosis. In most cases, statistics refer to the five-year survival rate. The five-year survival rate is the percentage of people who are alive five years after diagnosis, whether they have few or no signs or symptoms of cancer, are free of disease, or are receiving treatment. 

Survival rates are based on large groups of people; they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and thyroid cancer treatment and responses to treatment vary greatly.

Thyroid Cancer Prognosis: Survival Rates

Survival rates can be calculated by different methods for different purposes. The thyroid cancer survival rates presented here are based on the relative survival rate. The survival rate measures the survival of thyroid cancer patients in comparison to the general population to estimate the effect of cancer.

The overall five-year relative thyroid cancer survival rate from 1995-2001 was 96.6 percent.

The five-year relative thyroid cancer survival rates by race and sex were:

• 94.4 percent for Caucasian men.
• 97.7 percent for Caucasian women.
• 89.2 percent for African American men.
• 95.4 percent for African American women.

Impact of the Stage in Thyroid Cancer Prognosis

The stage of thyroid cancer plays a role in the thyroid cancer prognosis. Based on historical data:

• 58 percent of thyroid cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage).

• 35 percent of thyroid cancer cases are diagnosed after the cancer has spread to regional lymph nodes or directly beyond the primary site (regional stage).

• 5 percent of thyroid cancer cases are diagnosed after the cancer has already metastasized (distant stage).

• 2 percent of thyroid cancer cases had staging information that was unknown.

The corresponding five-year relative thyroid cancer survival rates were:

• 99.5 percent for localized
• 96.4 percent for regional
• 60.0 percent for distant
• 85.4 percent for unstaged.

Final Thoughts on Thyroid Cancer Prognosis

Cancer patients and their loved ones face many unknowns. While some people find that it is easier to cope when they know the statistics, other people find statistical information confusing and frightening, and they think it is too impersonal to be of use to them. 

The doctor who is most familiar with a patient's situation is in the best position to discuss the thyroid cancer prognosis, and to explain what the statistics concerning thyroid cancer may mean for that person. At the same time, it is important to understand that even the doctor cannot tell the patient exactly what to expect because a person's prognosis may change if the cancer progresses, or if treatment is successful. 

Seeking information about the thyroid cancer prognosis is a personal decision. It is up to each patient to decide how much information he or she wants to know and how to deal with it.

TYPICAL THYROID CANCER TREATMENT REVIEW

1. Thyroid cancer is usually diagnosed by sticking a needle into a thyroid nodule or removal of a worrisome thyroid nodule by a surgeon.

2. The removed thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign (95-99% of all nodules that are biopsied) or malignant (less than 1% of all nodules, and about 1-5% of nodules that are biopsied).

3. The pathologist decides the type of thyroid cancer: papillary, follicular, mixed papilofollicuar, medullary, or anaplastic.

4. The entire thyroid is surgically removed; sometimes this is done during the same operation where the biopsy takes place. He/she will assess the lymph nodes in the neck to see if they also need to be removed. In the case of anaplastic thyroid cancer, your doctor will help you decide about the possibility of a tracheostomy.

5. About 4-6 weeks after the thyroid has been removed, the patient will undergo radioactive iodine treatment. This is very simple and consists of taking a single pill in a dose that has been calculated for the patient. The patient goes home and avoids contact with other people for a couple of days (so they are not exposed to the radioactive materials).

6. A week or two after the radioactive iodine treatment the patient begins taking a thyroid hormone pill. No one can live without thyroid hormone, and if the patient doesn't have a thyroid anymore, he or she will take one pill per day for the rest of their life. This is a very common medication (examples of branded drug names include Synthroid, Levoxyl, and Armour Thyroid).

7. Every 6-12 months the patient returns to his endocrinologist for blood tests to determine if the dose of daily thyroid hormone is correct and to make sure that the thyroid tumor is not coming back. The frequency of these follow up tests will vary greatly from patient to patient. Endocrinologists are typically quite good at this and will typically be the type of doctor that follows this patient long-term.


FOR MORE INFORMATION TALK TO YOUR DOCTOR.

THYROID CANCER PROGNOSIS

People facing thyroid cancer are naturally concerned about what the future holds.Thyroid cancer is a serious disease in which cancer cells first develop in the thyroid gland.Understanding thyroid cancer and what to expect can help patients and their loved ones:

Plan the course of treatment: surgery, radiation therapy, and chemotherapy are some of the options for treating thyroid cancer.

Think about lifestyle changes

Make decisions about their quality of life, finances and more (such as healthcare proxy, healthcare directives, children's guardianship, power of attorney or last will and testament.

Many people with thyroid cancer want to know their thyroid cancer prognosis. They may ask their doctor or search for thyroid cancer statistics on their own. An estimated 30,180 Americans have been newly diagnosed with thyroid cancer every year since 2006 and that information alone may create more questions than answers.

What Is a Thyroid Cancer Prognosis?

A prognosis is a medical opinion as to the likely course and outcome of a disease. In other words, the prognosis is the chance that a patient will recover or have a recurrence (return of the cancer). There are many factors that can affect a person's prognosis, which include:

• The type and location of the cancer.
• The stage of the disease (the extent to which the cancer has metastasized, or spread).
• Its grade (how abnormal the cancer cells look, and how quickly the cancer is likely to grow and spread)
• The person's age, general health, and response to treatment.

When doctors consider a person's prognosis, they carefully examine all of the factors that could affect that person's disease and treatment, and then try to predict what might happen.

The doctor bases the thyroid cancer prognosis on information researchers have collected over many years about hundreds, or even thousands, of people with cancer. When possible, the doctor will use statistics based on groups of people whose situations are most similar to that of an individual patient.

The doctor may speak of a favorable thyroid cancer prognosis if the cancer is likely to respond well to treatment. The thyroid cancer prognosis may be unfavorable if the cancer is likely to be difficult to control. However, it is important to remember that a prognosis is only a prediction -- the doctor cannot be absolutely certain about the outcome for a particular patient.

Factors Influencing a Thyroid Cancer Prognosis

The thyroid cancer prognosis will depend on:

(1)The stage of thyroid cancer (see Thyroid Cancer Staging).

(2)The type of thyroid cancer cells and how tthey look under a microscope.

(3)The patient's age and general health.

The prognosis is better for patients younger than 40 years of age who have cancer that has not spread beyond the thyroid.

THYROID CANCER TYPES

There are several types of thyroid cancer: papillary, follicular, medullary, anaplastic, and variants.

Papillary and follicular thyroid carcinomas ~~Referred to as well-differentiated thyroid cancer and account for 80–90% of all thyroid cancers. Variants include tall cell, insular, columnar, and Hurthle cell. Their treatment and management are similar. If detected early, most papillary and follicularthyroid cancer can be treated successfully.

Medullary thyroid carcinoma (MTC) ~~ Accounts for 5-10% of all thyroid cancers. Medullary cancer is easier to treat and control if found before it spreads to other parts of the body. There are two types of medullary thyroid cancer: sporadic and familial. Genetic testing (of the RET protooncogene should be performed in all patients with MTC to determine whether there are genetic changes that predict the development of MTC. In individuals with these genetic changes, removal of the thyroid during childhood has a high probability of being curative.

Anaplastic thyroid carcinoma ~~ The least common and accounts for only 1–2% of all thyroid cancer. This type is difficult to control and treat because it is a very aggressive type of thyroid cancer.

Treatments for thyroid cancer include surgery, radioactive iodine treatment, external beam radiation therapy, and chemotherapy. In most cases, patients undergo surgery to remove most of the thyroid gland, and are treated with thyroid hormone replacement therapy.

For those with papillary and follicular thyroid cancer, the dose of thyroid hormone replacement is usually high enough to suppress thyroid stimulating hormone (TSH) well below the range that is normal for someone not diagnosed with thyroid cancer, to help prevent the growth of cancer cells while providing essential thyroid hormone to the body.

Factors associated with thyroid cancer include a family history of thyroid cancer, gender (women have a higher incidence of thyroid cancer), age (the majority of cases occur in people over 40, although thyroid cancer affects all age groups from children through seniors), and prior exposure of the thyroid gland to radiation.

While the prognosis for most thyroid cancer patients is very good, the rate of recurrence can be up to 30%, and recurrences can occur even decades after the initial diagnosis. Therefore, it is important that patients get regular follow-up examinations to detect whether the cancer has re-emerged. Monitoring should continue throughout the patient’s lifetime.

Periodic follow-up examinations can include a review of the medical history together with selected blood tests appropriate for the type of cancer and stage of treatment (TSH, thyroglobulin, CEA, and calcitonin levels), physical examination, and imaging techniques (ultrasound, radioiodine whole body scan, chest X-ray, CT, MRI, PET, and other tests).

Metatastic Thyroid Cancer (spread to distant locations)
Guidelines from American Thyroid Association (2006)

The guidelines cover diagnosis, surgery, staging, radioiodine ablation, post-therapy scans, TSH suppression, thyroglobulin testing, ultrasound, RAI scans, other imaging techniques, metastatic disease, and many other topics. The thyroid cancer specialist physicians who developed the guidelines included many Thyroid Cancer medical advisors and conference and workshop speakers.

THYROID CANCER BASICS

What is cancer of the thyroid? 

Cancer of the thyroid is a disease in which cancer (malignant) cells are found in the tissues of the thyroid gland. The thyroid gland is at the base of the throat. It has two lobes, one on the right side and one on the left. The thyroid gland makes important hormones that help the body function normally. It is one of the few cancers that has increased in newly diagnosed incidence rates over the past decade worldwide.

Fast Facts

• There are expected to be 11% more new cases in 2008 than in 2007 in the United States. 
• The American Cancer Society estimates that there will be about 37,340 new cases of thyroid cancer in the U.S. in 2008. 
• Of newly diagnosed thyroid cancer cases, about 28,410 will occur in women and about 8,930 will occur in men. 
• About 1,590 people (910 women and 680 men) will die of thyroid cancer in 2008.
• Thyroid Cancer is three times more more common in women than in men regardless of age or race. 
• Most patients newly diagnosed with thyroid cancer the past decade are between 25 and 50 years old. 
• Many patients, especially in the early stages of thyroid cancer, do not experience symptoms. 
• As thyroid cancer develops, symptoms can include a lump or nodule in the front of the neck, hoarseness or difficulty peaking, swollen lymph nodes, difficulty swallowing or breathing, and pain in the throat or neck.
• People who have been exposed to large amounts of radiation, or who have had radiation treatment for medical problems in the head and neck such as childhood cancer have a higher chance of getting thyroid cancer later in life. In many cases "secondary" thyroid cancer may not occur until 20 years or longer after the initial radiation treatment. 

You should see a  doctor immediately if there is a lump or swelling in the front of the neck or in any other parts of the neck. Your doctor should  "feel" and examine your neck and thyroid for nodules, tumors or "lumps"during your annual physical examination.

If a nodule or abnormality is found The doctor may order blood tests and special scans to see whether a lump in the thyroid is making too many or too little hormones. If your doctor forgets to check your neck, you can gently remind him that you would like him or her to please check your neck for abnormalities "just in case".

Thyroid Cancer is the most common endocrine cancer worldwide

Depending on your physical test results, neck check and individual risk factors your doctor may want to take a small amount of tissue from the thyroid. This is called a biopsy. To do this, a small needle is inserted into the thyroid at the base of the throat and some tissue is drawn out. The tissue is then looked at under a microscope to see whether it contains cancer.

There are four main types of cancer of the thyroid (based on how the cancer cells look under a microscope): papillary, follicular, medullary, and anaplastic.

The individual chance of  recovery or survival (prognosis) depends on the type of thyroid cancer, whether it is just in the thyroid or has spread to other parts of the body (stage), and the patient's age and overall health. Some types of thyroid cancer grow much faster than others but overall most thyroid cancers have a good cure and survival rate if diagnosed early and treated properly.

Thyroid Cancer Genetics: Could it be inherited?

The genes in our cells carry the hereditary information from our parents. An abnormal gene has been found in patients with some forms of thyroid cancer such as medullary thyroid cancer. If medullary thyroid cancer is found, the patient may have been born with a certain abnormal gene which may have led to thyroid  cancer. Family members may have also inherited this abnormal gene.

Tests have been developed to determine who has the genetic defect long before any cancer appears therefore, it is important that the patient and his or her family members (children, grandchildren, parents, brothers, sisters, nieces and nephews) see a doctor about tests that will show if the abnormal gene is present.

These tests are confidential and can help the doctor help patients. Family members, including young children, who don't have cancer, but do have this abnormal gene, may reduce the chance of developing medullary thyroid cancer by having surgery to safely remove the thyroid gland (thyroidectomy).

Remember to talk to your doctor about your personal risk factors such as a family history of thyroid cancers.                                

CAN CANCER BE PREVENTED ?

Although there is no guaranteed way to prevent cancer, people can reduce their risk (chance) of developing cancer by:

• not using tobacco products
• choosing foods with less fat and eating more vegetables, fruits, and whole grains
  exercising regularly and maintaining a lean weight
• avoiding the harmful rays of the sun, using sunscreen, and wearing clothing that protects the skin
• talking with a doctor about the possible benefits of drugs proven to reduce the risk of certain cancers

Although many risk factors can be avoided, some, such as inherited conditions, are unavoidable. Still, it is helpful to be aware of them. It is also important to keep in mind that not everyone with a particular risk factor for cancer actually gets the disease; in fact, most do not. People who have an increased likelihood of developing cancer can help protect themselves by avoiding risk factors whenever possible and by getting regular checkups so that, if cancer develops, it is likely to be found and treated early. Treatment is often more effective when cancer is detected early.

Screening exams, such as sigmoidoscopy or the fecal occult blood test, mammography, and the Pap test, can detect precancerous conditions (which can be treated before they turn into cancer) and early-stage cancer. The National Cancer Institute is conducting many cancer prevention studies to explore ways to reduce the risk of developing cancer. These studies are evaluating dietary supplements, chemopreventive agents, nutrition, personal behaviors, and other factors that may prevent cancer.

Does cancer always cause pain?

Having cancer does not always mean having pain. Whether a patient has pain may depend on the type of cancer, the extent of the disease, and the patient's tolerance for pain. Most pain occurs when the cancer grows and presses against bones, organs, or nerves. Pain may also be a side effect of treatment. However, pain can generally be relieved or reduced with prescription medicines or over-the-counter drugs recommended by the doctor. Other ways to reduce pain, such as relaxation exercises, may also be useful.

Pain should not be accepted as an unavoidable part of having cancer. It is important for patients to talk about pain so steps can be taken to help relieve it. The fear of addiction or “losing control” should not stop patients from taking pain medication. Patients who take medications for cancer pain, as prescribed by their doctor, rarely become addicted to them. In addition, changing the dose or type of medication can usually help if the patient has troublesome side effects.

Are clinical trials (research studies) available? Where can people get more information about clinical trials?

Yes. Clinical trials are an important treatment option for many cancer patients. To develop new, more effective treatments, and better ways to use current treatments, the National Cancer I is sponsoring clinical trials in many hospitals and cancer centers around the country. Clinical trials are a critical step in the development of new methods of treatment. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the NCI's Cancer Information Service (CIS) (see below) at 1–800–4–CANCER and in the NCI booklet Taking Part in Cancer Treatment Research Studies, which is available at http://www.cancer.gov/publications on the Internet. 


This booklet describes how research studies are carried out and explains their possible benefits and risks. Further information about clinical trials is available at http://www.cancer.gov/clinicaltrials

HOW IS CANCER TREATED ?

Cancer treatment can include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. The doctor may use one method or a combination of methods, depending on the type and location of the cancer, whether the disease has spread, the patient's age and general health, and other factors. Because treatment for cancer can also damage healthy cells and tissues, it often causes side effects.

Some patients may worry that the side effects of treatment are worse than the disease. However, patients and doctors generally discuss the treatment options, weighing the likely benefits of killing cancer cells and the risks of possible side effects. Doctors can suggest ways to reduce or eliminate problems that may occur during and after treatment.

Surgery is an operation to remove cancer. The side effects of surgery depend on many factors, including the size and location of the tumor, the type of operation, and the patient's general health. Patients have some pain after surgery, but this pain can be controlled with medicine. It is also common for patients to feel tired or weak for a while after surgery. Patients may worry that having a biopsy or other type of surgery for cancer will spread the disease. This is a very rare occurrence because surgeons take special precautions to prevent cancer from spreading during surgery. Also, exposing cancer to air during surgery does not cause the disease to spread.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells in a targeted area. Radiation can be given externally by a machine that aims radiation at the tumor area. It can also be given internally; needles, seeds, wires, or catheters containing a radioactive substance are placed directly in or near the tumor. Radiation treatments are painless.

The side effects are usually temporary, and most can be treated or controlled. Patients are likely to feel very tired, especially in the later weeks of treatment. Radiation therapy may also cause a decrease in the number of white blood cells, which help protect the body against infection. With external radiation, it is also common to have temporary hair loss in the treated area and for the skin to become red, dry, tender, and itchy.

There is no risk of radiation exposure from coming in contact with a patient undergoing external radiation therapy. External radiation does not cause the body to become radioactive. With internal radiation (also called implant radiation), a patient may need to stay in the hospital, away from other people, while the radiation level is highest. Implants may be permanent or temporary. The amount of radiation in a permanent implant goes down to a safe level before the person leaves the hospital. With a temporary implant, there is no radioactivity left in the body after the implant is removed.

Chemotherapy is the use of drugs that kill cancer cells throughout the body. Healthy cells can also be harmed, especially those that divide quickly. The doctor may use one drug or a combination of drugs. The side effects of chemotherapy depend mainly on the drug(s) and the dose(s) the patient receives. Hair loss is a common side effect of chemotherapy; however, not all anticancer drugs cause loss of hair.

Anticancer drugs may also cause temporary fatigue, poor appetite, nausea and vomiting, diarrhea, and mouth and lip sores. Drugs that prevent or reduce nausea and vomiting can help with some of these side effects. Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends.

Hormone therapy is used to treat certain cancers that depend on hormones for their growth. It works by keeping cancer cells from getting or using the hormones they need to grow. This treatment may include the use of drugs that stop the production of certain hormones or that change the way hormones work. Another type of hormone therapy is surgery to remove organs that make hormones. For example, the ovaries may be removed to treat breast cancer, or the testicles may be removed to treat prostate cancer.

Hormone therapy can cause a number of side effects. Patients may feel tired, or have fluid retention, weight gain, hot flashes, nausea and vomiting, changes in appetite, and, in some cases, blood clots. Hormone therapy may also cause bone loss in premenopausal women. Depending on the type of hormone therapy used, these side effects may be temporary, long lasting, or permanent.

Biological therapy uses the body's immune system, directly or indirectly, to fight disease and to lessen some of the side effects of cancer treatment. Monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors are some types of biological therapy. The side effects caused by biological therapy vary with the specific treatment. In general, these treatments tend to cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after the treatment stops.

COMMON SYMPTONS OF CANCER

Cancer can cause a variety of symptoms. Possible signs of cancer include the following:

• new thickening or lump in the breast or any other part of the body such as your neck, armpit or groin
• new mole or an obvious change in the appearance of an existing wart or mole
• a sore that does not heal
• nagging cough or hoarseness
• changes in bowel or bladder habits
• persistent indigestion or difficulty swallowing
• unexplained changes in weight
• unusual bleeding or discharge

When these or other symptoms occur, they are not always caused by cancer. They can be caused by infections, benign tumors, or other problems. It is important to see a doctor about any of these symptoms or about other physical changes. Only a doctor can make a diagnosis. A person with these or other symptoms should not wait to feel pain because early cancer usually does not cause pain.

If symptoms occur, the doctor may perform a physical examination, order blood work and other tests, and/or recommend a biopsy. In most cases, a biopsy is the only way to know for certain whether cancer is present. During a biopsy, the doctor removes a sample of tissue from the abnormal area. A pathologist studies the tissue under a microscope to identify cancer cells.

WHAT CAUSES CANCER ?

Scientists have learned that cancer is caused by changes in genes that normally control the growth and death of cells. Certain lifestyle and environmental factors can change some normal genes into genes that allow the growth of cancer. Many gene changes that lead to cancer are the result of tobacco use, diet, exposure to ultraviolet (UV) radiation from the sun, or exposure to carcinogens (cancer-causing substances) in the workplace or in the environment.

Some gene alterations are inherited (from one or both parents). However, having an inherited gene alteration does not always mean that the person will develop cancer; it only means that the chance of getting cancer is increased. Scientists continue to examine the factors that may increase or decrease a person's chance of developing cancer.

Rarely, several generations of the same family will develop the same type of cancer at rates much higher than those that occur in the population overall. Often, the family members are passing on mutated genes that impart a higher than average risk for developing this particular cancer. By studying the genetic profiles of these affected families, researchers are learning which genes are involved in cancer's development. Kidney cancer families are a good example of this. When scientists discovered the gene changes involved in the inherited form of renal cancer, they were able to use this information to better detect and diagnose sporadic or randomly occurring new cases of this cancer type.

                                    Only about 2 to 5 percent of cancers run in families this way.

Although being infected with certain viruses, such as the human papillomavirus (HPV), hepatitis B and C (HepB and HepC), and human immunodeficiency virus (HIV), increases the risk of some types of cancer, cancer itself is not contagious. A person cannot catch cancer from someone who has this disease. Scientists also know that an injury or bruise does not cause cancer.

"Cancer Pathways" 

WHAT IS CANCER ?

About 2.4 million new cases of cancer will be diagnosed in the United States in 2009, and more than 550,000 people will die of the disease (1). Cancer is the second leading cause of death in this country. However, improvements in cancer detection, diagnosis, and treatment have increased the survival rate for many types of cancer. About 64 percent of all people diagnosed with cancer will be alive 5 years after diagnosis, but so many types and stages of cancer; what is the basic or general definition of cancer ?

Cancer is a group of many related diseases that begin in cells, the body's basic building blocks. To understand cancer, it is helpful to know what happens when normal cells become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells as they are needed to keep the body healthy. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. The extra cells form a mass of tissue called a growth or tumor. Not all tumors are cancerous; tumors can be benign or malignant.

Benign tumors are not cancer. They can often be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. Cancer cells invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system.

Blood vessels include a network of arteries, capillaries, and veins through which the blood circulates in the body. The lymphatic system carries lymph and white blood cells through lymphatic vessels (thin tubes) to all the tissues of the body. By moving through the bloodstream or lymphatic system, cancer can spread from the primary (original) cancer site to form new tumors in other organs. The spread of cancer is called metastasis.

"HOW CANCER DEVELOPS "