A Closer Look: Thyroid Cancer Facts and Figures

According to Endocrine Today. Thyroid cancer research indicates that the disease is being increasingly diagnosed in the U.S., although most healthcare professionals agree that its mortality rate has slightly decreased recently.

Currently, the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program estimates that one in 111 Americans will be diagnosed with some form of thyroid cancer during his or her life.

Put another way, 44,670 people in the U.S. will be diagnosed with thyroid cancer in a given year, according to SEER. While approximately 1,700 Americans will die of the disease in that time, this reflects a slight decrease in the national mortality rate compared to that of 35 years ago.

Physicians and diagnosticians want to know what caused the decrease in deaths.

The news source reported that many endocrinologists are investigating whether the dip is due to more effective treatment methods or better cancer screening, which is catching smaller papillary thyroid tumors earlier.

In a 2006 study, healthcare professionals with the Department of Veteran Affairs estimated that nearly half of the increase in thyroid cancer diagnoses over a 15-year period was due to the detection of tumors under one centimeter in diameter.

While some doctors agree that improvements in early detection have contributed to the falling morality rate, others told the news organization that few patients - between 1 and 2 percent - die each year from papillary thyroid tumors under two centimeters in diameter.

They added that thyroid cancer is simply a numbers game and that the disease affects a larger number of Americans than ever before, even with the moderate decrease in its lethality. Ultimately,  detection and chemotherapy are the two most effective weapons against thyroid cancers of all types, since it is largely unclear what causes the disease.

Other than radiation, health experts cannot say for sure what triggers thyroid cancer, a malady that affects nearly 1 percent of Americans in their lifetimes, according to the National Institutes of Health.

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

10,000 Strong Against Thyroid Cancer

FOR IMMEDIATE RELEASE

January 27, 2011

Orlando Florida

10,000 Strong Against Thyroid Cancer

Stevie JoEllie's Cancer Care Fund differs greatly from other cancer care groups in that our focus is on patient assistance and access to care not research funding. The reason is simple, thyroid cancer is the fastest increasing newly diagnosed cancer in America today regardless of age, sex, race or ethnic background.

At a time of unprecedented unemployment rates, increasing "benefit" cuts by the private and public sector newly diagnosed thyroid cancer patients and survivors facing lifelong healthcare needs and seeking some form of access to medical care assistance has increased by 52% in the past year. While there are over 1,000 organizations nationwide dedicated exclusively to thyroid cancer research funding SJCCF is the sole organization focused exclusively on helping to relieve the financial burden on the patient and family living "with" thyroid cancer.

But we cant do it alone and we need your help and support today more than ever. We are enclosing a link to our 2011 Cause 10,000 Strong Against Thyroid Cancer. Our goal is to raise $100,000 via Causes.com by 12/31/2011 to continue developing and help sustain our access to care grant program for thyroid cancer patients and survivors.

Every one can help by donating a single dollar or sharing this donation link with your friends, family and network http://www.causes.com/sjccfthynet

                            

Disclosure: Stevie JoEllie's Cancer Care Fund is a Project Of United Charitable Programs Inc., a 501(c)3 Public Charity Tax ID #20-4286082 Program #102442.  Donations are tax deductible as allowed by law. All funds raised by Stevie JoEllie's Cancer Care Fund are received by UCP, which, for internal operating purposes, allocates the funds to the Project (SJCCFThyNet). The Program Manager, then makes recommendations for disbursements which are reviewed by UCP for approval


                    TOGETHER WE CAN SAVE LIVES.

################

Roger Ebert's Unveils New Prosthethic Chin After Thyroid Cancer Treatment

While discussing his recovery options with a professor at University of Illinois at Chicago (UIC), movie critic and former screenwriter Roger Ebert recently discovered that prostheses could give him the chin and jawline that thyroid cancer surgery largely removed.

Ebert will unveil his new prosthetic mandible on "Ebert Presents at the Movies," his newest television show, according to the New York Daily News.

In his personal journal published by the Chicago Sun-Times, Ebert wrote that the prosthesis is the end result of two years of work done by a group of artists, physicians and anaplastologists, which are health care experts specializing in the creation of prosthetics.

The critic wrote in the Sun-Times that shortly after undergoing surgery to remove papillary thyroid cancer, as well as his salivary glands and a section of his lower jaw, he "studiously avoided" looking in the mirror.  Now, he has released a photo of himself wearing a new prosthetic jaw molded from silicone, which Ebert said will give the illusion of a normal jawline from a distance.

In his journal, he recounted meeting with Professor David Reisberg of UIC and asking the craniofacial specialist if he might wear a false beard to cover the lower half of his face.

Reisberg recommended a more advanced solution. By taking three-dimensional laser scans of Ebert's facial features and of a bust of his face created prior to his surgery, the physician was able to model a new jaw made of silicone.

After employing the help of a UIC orthotics expert and an anaplastologist from Milwaukee, Reisberg has presented Ebert with what essentially is a new lower jaw, colored to match his skin tone and shaped to fit directly to his face.  Ebert reported being very pleased with the result.

The movie critic also made headlines in 2010 when a Scottish text-to-speech company created a personalized electronic voice for him, using thousands of hours of footage and audiotape of Ebert talking.  Happy with his recovery and prosthesis, in his journal Ebert vowed to "flaunt it."

Papillary thyroid tumors account for 70 percent of all instances of thyroid cancer, according to Columbia University Medical Center.

Exposing Our Children to Thyroid Cancer ?

Children living in the United States during the 1950s were exposed to radioactive iodine, or I-131, fallout during nuclear testing at the Nevada Test Site. The fallout of I-131 after a mushroom cloud eruption, allowed “considerable amounts [of radioactive iodine] to be deposited onto pasture and to be transferred to people in dairy foods,” wrote Steven L. Simon, André Bouville and Charles E. Land in a 2006 article .

Basically, grazing animals ate grass contaminated with radioactive iodine, which then passed into the animal’s milk, and when people drank the milk, the radioactive iodine was absorbed by their thyroid gland and caused cancer. Land, a National Cancer Institute senior investigator, predicted between 7,500 and 75,000 excess thyroid cancer cases resulted from the Nevada testing.

Cherry Wunderlich, a volunteer for the Thyroid Cancer Survivors’ Association , said she believes her thyroid cancer was caused by radioactive fallout. Wunderlich calculated her exposure risk from the Nevada testing by visiting the National Cancer Institute’s I-131 information web page . Because she was a young child, living on a cattle ranch near the Nevada site during the testing era, and drank farm-fresh milk her risk was higher than many Americans.

One would assume that Cherry wouldn’t be the only Wunderlich child to be diagnosed with thyroid cancer.

"Of my five siblings, I was the only one to develop thyroid cancer,” Wunderlich said. She was diagnosed with thyroid cancer in 1999, almost four decades after her exposure.

Fallout doesn't explain increase in cases:

Even so, experts say fallout probably plays a minor role in the current increase. “My guess is that there’s got to be some thyroid cancers due to fallout, but it’s not what’s causing this big increase,” said Dr. Elaine Ron, a National Cancer Institute senior investigator.

Dr. Michael Tuttle, a thyroid cancer specialist at Memorial Sloane Kettering Hospital agrees. Most of the patients he treats for thyroid cancer were born a decade or more after nuclear testing ceased in the United States in 1961.  Because of the similarities between the 1950s and modern-day discussions, Tuttle said his concern is that “we’ve exposed our kids” to something 20 or 30 years ago, probably with well-meaning intentions.

The timing – the development of disease two or three decades after exposure – isn’t unique to Americans. From her study of 90,000 Japanese atomic bomb survivors, Ron said there’s a suggestion that a person’s risk of developing thyroid cancer peaks 15 to 30 years after radiation exposure.

The radiation-induced thyroid cancer model is the best model experts have, Tuttle said. Because the model shows the childhood thyroid is much more sensitive to radiation as a cause of cancer, he said he would assume it’s more sensitive to any other cause.

What else were kids exposed to?

“For me, I’d be looking at what kids were exposed to when they were less than 5 years old that then 15 or 20 years later led to the development of thyroid cancer, be it something they were wearing or eating or breathing or exposed to something external,” Tuttle said.

He said if you think about all the chemicals introduced in the 1960s and 1970s – ranging from everything in toothpaste to flame retardant materials in baby beds and baby blankets – they are chemicals that children were not exposed to in the 1940s or 1950s.

“It makes me wonder if we didn’t do something back then that we’re now seeing the consequences of,” Tuttle said.

About The Author: Wilma Ariza is the Founder and Development Director of Stevie JoEllie's Cancer Care Fund a Project of United Charitable Programs Inc., a 501(c)(3) Public Charity Tax ID 20-4286082 Progam 102442. In 2008 her daughter Stevie JoEllie was diagnosed with State II Follicular Thyroid Cancer a few weeks after her 21st Birthday and "survived" two thyroid cancer recurrences. Ms. Ariza was also diagnosed with cancer (leiomyosarcoma) the same week of her daughters diagnosis. They fought cancer together and today they are both doing well, dedicated to advocating and promoting thyroid cancer awareness, access to care grants and free supportive services for thyroid cancer patients and survivors nationwide.

Cancer Survivorship 101

You've completed treatment for cancer and you've been told it's time to look ahead. But what do you need to know to navigate this new part of the cancer journey?

It's rare to find a woman who hasn't been personally affected by cancer -either she knows a friend who has been diagnosed, has had a family member who has been diagnosed or has been through the fire herself. What many women might not know is tha the number of women affected by cancer is expected to rise dramatically in the near future as baby boomers reach the peak ages at which most cancers are diagnosed and as the survivor rate for most cancers continue to improve.

With these growing numbers the oncology community has initiated efforts to reach out to this significant and growing population, recognizing the needs that exist among cancer survivors and their friend and families for awareness, information, and support to sustain optimal health and happinees.  Specifically, recent efforts have focused on the needs of survivors following treatment  -- as they enter a new phase of life: survivorship -- and recognize different needs and priorities in this population facing a "new normal".

AM I A SURVIVOR? 

The meaning of "survivorship" and "cancer survivor"  continue to evolve as survival times and cure rates improve among patients diagnosed with cancer in the new millenium. Historically, the definition of "cancer survivor " was an individual who was "cancer free" for at least five years; now, however, the term generally refers to any individual who has been diagnosed with cancer and is still living.

Some advocacy groups who wish to honor the family members and close friends who have endured the emotional journey of a cancer diagnosis include this group in their definition of "survivor".   And some, who don't identify with the word "survivor" at all for one reason or another, might choose to refer to themselves as "thrivers" or another word with which they more closely identify.

Whatever term you feel comfortable with, know that as a survivor of cancer you have a reason to celebrate. You've made it through the fear and the confusion of a diagnosis of cancer, some have  persevered through grueling therapy and made it to the end of treatment. The unforgiving side effects, severe emotional roller-coaster rides, and life changes you have undergone have no doubt been difficult. But now the cancer has been controlled or eradicated by treatment. Now you have the opportunity to embrace life anew as a cancer survivor.

NOW WHAT?   

First, congratulate yourself for getting where you are today: you made it through treatment! Let yourself dream about the future. Take time to consider how your outlook on life may have changed as a result of this amazing  journey. Some cancer survivors, like me,  actually express gratitude for their diagnosis, feeling that their journey with cancer has brought about newfound meaning to their life and changed their priorities and focus, oftenfor the better.  This sense of gratitude can present a wonderful opportunity to thank your supportive care network -- family and friends-- for their compassion, commitment, help and love as they celebrate this milestone with you.

Give yourself permission to grieve. Understand that many cancer survivors experience a pendulum of emotions following the completion of therapy. If your first response at the end of treatment is not gratitude and celebration don't think that there is something wrong with you. Even though your treatment is finished and the cancer is under control, fear and anxiety of a recurrence or  the long term side effects of therapy may still weigh heavily on your psyche or may pop up when you least expect it.

Sadness, elation, depression, joy, fear, anger and other strong emotions may surface at any time following the end of your or a loved one's cancer treatment. Financial issues related to your diagnosis, a return to work or the inability to resume work, relationship and physical changes -- all may become new areas of concer in your life. At this time remember that numerous support groups exists for cancer survivors and take advantage of comfort connecting with other cancer survivors can provide.

By being able to relate with your cancer experience, this important network can answer questions and provide tips with a perspective that only comes from someone who has been through the diagnosis and treatment of cancer, facing similar challenges and concerns.  But organized support groups don't appeal to all survivors and there is no agreed upon definition of who or what can make up a support system; often people find inspiration, strength, and peace among people, situations, or ideas that surprise them. Seek out the support network -- official or otherwise-- that meets your needs.

    

THE BIG PICTURE

If you are a cancer survivor, you are part of a growing community or population in the United States and around the world. Research efforts focused on long term survivorship issues continue to expand, as the oncology community has become committed to understanding increased risks for cancer survivors as well as to providing means by which these risks can be minimized or prevented.

As a survivor you can take a proactive role in this part of your cancer journey by requesting a long term care plan from your oncologist or primary care physician and asking lots of questions about the long term follow- up care you will need. By working with your healthcare team, you can help, you can help achieve your optimal health, vitality and happiness. Support groups are available for emotional, spiritual, financial and other assistance, and healthcare specialists can provide essential components to reducing or preventing post treatment complications and side effects through  their expertise.

Taking Levothyroxine at Bedtime May be Best for hypothyroid patients

According to new research, those who take levothyroxine, a synthetic thyroid hormone, at bedtime may cut their levels of the thyroid stimulating hormone (TSH) thyrotropin as well as boost free thyroxine (F4 hormone) and triiodothyronine (T3 hormone) levels in patients with hypothyroidism, according to Endocrine Today.

For the study, researchers at Maastad Hospital Rotterdam in the Netherlands divided patients with hypothyroidism into two groups. For three months, some participants received a placebo in the morning and one capsule of levothyroxine at bedtime, while others were given levothyroxine in the morning and placebo at bedtime. After three months, the groups switched treatments.

The results showed that those who received levothyroxine at bedtime decreased TSH levels compared to those who were given the pill in the morning. This method of delivery also increased F4 and T3 levels.

"After our study was completed, more than half of the patients decided to continue with bedtime intake of levothyroxine," the researchers wrote, reports the news source.

According to the National Center for Biotechnology Information, levothyroxine is used to treat hypothyroidism. Without this hormone, the body cannot function properly, resulting in poor growth, slow speech, lack of energy, weight gain, hair loss, dry skin and increased sensitivity to cold.

 

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Radioactive Iodine Dosage for Thyroid Cancer Treatment

Radioactive iodine, I-131, can both cause and treat thyroid cancer. This and other isotopes were recognized as a cancer risk in the survivors of the nuclear bombs at Hiroshima and Nagasaki. Researchers found that higher doses can be used to destroy malignant thyroid tissue that may remain after surgical treatment. I-131 is produced in nuclear medicine reactors, and has a half-life of about 8 days. It decays into the inert gas xenon by emitting an electron and a gamma ray.

Radiation therapy for most cancers is done with an external beam. Thyroid cancer is exceptional because the tissue absorbs most of the iodine in the diet. Thus, radioactive iodine can deliver energy to the tumor cells very efficiently. The electrons are absorbed mostly by the tumor, while the gamma rays have a longer range.

A recent article reports that the optimum dose of radioiodine is a topic for discussion. There are two ways to calculate it: (1) bone marrow dose limited, or (2) lesion-based. Dosages from 1.1 to 21.4 GBq (gigabecquerels) have been reported. The Becquerel is a radioactive decay rate, equal to one disintegration per second.

Radioiodine therapy is simple and painless; the patient simply swallows the prepared dose. Most of it will be absorbed by thyroid tissue. The part that is not absorbed will be excreted in the urine over a period of about 2 days. Half of the absorbed dose will decay over the first 8 days. Over the next 8 days, half of the remaining amount will decay. This process continues until the last atom has decayed: the radioactive decay rate drops by half over each time span of the half-life (8 days for this isotope).

The patient will emit enough radiation to set off security detectors at airports and federal buildings for approximately months after treatment. Pregnancy is not recommended for at least six months to one year. Breast feeding is not allowed after radioiodine therapy. The patient should sleep alone and avoid prolonged contact with others for at least three or four days.

Clearly, there are risks to high doses of I-131. When you are radioactive enough to endanger others, you are subjecting your entire body to ionizing radiation. However, metastatic cancer is a serious risk as well. The authors of Reference 1 note there is evidence for both over-treatment and under-treatment, and more attention is needed to individualized therapy.

References:

1. Lassmann M et al, “Dosimetry and thyroid cancer: the individual dosage of radioiodine”,

Endocrine-Related Cancer 2010; 17:R161 – R172.

2. Radiation information from the Centers for Disease Control: http://www.bt.cdc.gov/radiation/pdf/measurement.pdf

3. More information online:  

http://www.radiologyinfo.org/en/info.cfm?pg=radioiodine

SOURCE:  Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Thyroid Cancer "Staging"

Staging is the process of finding out if and how far a cancer has spread. The stage of a cancer is one of the most important factors in choosing treatment options and predicting your chance for cure and long-term survival.

Staging is based on the results of the physical exam, biopsy, and imaging tests (ultrasound, CT scan, MRI, chest x-ray, and/or nuclear medicine scans), which are described in the section, "How is thyroid cancer diagnosed?"

The TNM Staging System

A staging system is a standard way for the cancer care team to summarize how large a cancer is and how far it has spread. Ask your doctor to explain thyroid cancer staging in a way that you understand so that you can take a more active role in making informed decisions about your treatment.

The most common system used to describe the stages of cancers is the American Joint Committee on Cancer (AJCC) TNM system. The TNM system describes 3 key pieces of information:

•T indicates the size of the main (primary) tumor and whether it has grown into nearby areas.

•N describes the extent of spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells that are important in fighting infections. Cells from thyroid cancers can travel to lymph nodes in the neck and chest areas.

•M indicates whether the cancer has spread (metastasized) to other organs of the body. (The most common site of spread of thyroid cancer is to the lungs. The next most common sites are the liver and bones.)

Numbers or letters appear after T, N, and M to provide more details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means "cannot be assessed because the information is not available."

T Categories for Thyroid Cancer:

TX: Primary tumor cannot be assessed

TO: No evidence of primary tumor

T1: The tumor is 2 cm (slightly less than an inch) across or smaller and has not grown out of the thyroid.

T1a: The tumor is 1 cm (less than half an inch) across or smaller and has not grown outside the thyroid.

T1b: The tumor is larger than 1 cm but not larger than 2 cm across and has not grown outside of the thyroid.

T2: The tumor is between 2 cm and 4 cm (slightly less than 2 inches) across and has not grown out of the thyroid.

T3: The tumor is either larger than 4 cm or it has begun to grow a small amount into nearby tissues outside the thyroid.

T4a: A tumor of any size that has grown extensively beyond the thyroid gland into nearby tissues of the neck, such as the larynx (voice box), trachea (windpipe), esophagus (tube connecting the throat to the stomach), or the nerve to the larynx. This is also called moderately advanced disease.

T4b: A tumor of any size that has grown either back toward the spine or into nearby large blood vessels. This is also called very advanced disease.

T  Categories for Anaplastic Thyroid Cancers:

T4a: Tumor is still within the thyroid.

T4b: Tumor has grown outside of the thyroid.

N  Categories for Thyroid Cancer:

NX: Regional (nearby) lymph nodes cannot be assessed.

N0: No spread to nearby lymph nodes.

N1: The cancer has spread to nearby lymph nodes.

N1a: Spread to lymph nodes around the thyroid in the neck (called pretracheal, paratracheal, and prelaryngeal lymph nodes).

N1b: Spread to other lymph nodes in the neck (called cervical) or to lymph nodes behind the throat (retropharyngeal) or in the upper chest (superior mediastinal).

M Categories for Thyroid Cancer:

M0: No distant metastasis.

M1: Distant metastasis is present, involving distant lymph nodes, internal organs, bones, etc.

Stage Grouping:  Once the values for T, N, and M are determined, they are combined to find the stage. Stage is expressed as a Roman numeral from I through IV, with letters used to divide a stage into substages. Unlike most other cancers, thyroid cancers are grouped into stages in a way that considers both the subtype of cancer and the patient's age.

Papillary or follicular thyroid carcinoma (differentiated thyroid cancer) in patients younger than 45

Younger people have a low likelihood of dying from differentiated (papillary or follicular) thyroid cancer. The TNM stage groupings for these cancers take this fact into account. So, all people younger than 45 years with papillary thyroid cancer, for example, are stage I if they have no distant spread and stage II if they have distant metastases beyond the neck or upper mediastinal lymph nodes.

• Stage I (any T, any N, M0): The tumor can be any size (any T) and may or may not have spread to nearby lymph nodes (any N). It has not spread to distant sites (M0).

• Stage II (any T, any N, M1): The tumor can be any size (any T) and may or may not have spread to nearby lymph nodes (any N). It has spread to distant sites (M1).

Papillary or follicular thyroid carcinoma (differentiated thyroid cancer) in patients 45 years and older:

• Stage I (T1, N0, M0): The tumor is 2 cm or less across and has not grown outside the thyroid (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage II (T2, N0, M0): The tumor is more than 2 cm but not larger than 4 cm across and has not grown outside the thyroid (T2). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage III: One of the following applies:

• T3, N0, M0: The tumor is larger than 4 cm or has grown slightly outside the thyroid (T3), but it has not spread to nearby lymph nodes (N0) or distant sites (M0).

• T1 to T3, N1a, M0: The tumor is any size and may have grown slightly outside the thyroid (T1 to T3). It has spread to lymph nodes around the thyroid in the neck (N1a) but not to distant sites (M0).

Stage IVA: One of the following applies:

• T4a, any N, M0: The tumor is any size and has grown beyond the thyroid gland and into nearby tissues of the neck. It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant sites (M0).

• T1 to T3, N1b, M0: The tumor is any size and may have grown slightly outside the thyroid gland (T1 to T3). It has spread to certain lymph nodes in the neck (cervical nodes) or to lymph nodes in the upper chest (superior mediastinal nodes) or behind the throat (retropharyngeal nodes) (N1b) but not to distant sites (M0).

• Stage IVB (T4b, any N, M0): The tumor is any size and has grown either back to the spine or into nearby large blood vessels (T4b). It may or may not have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0).

• Stage IVC (any T, any N, M1): The tumor is any size and may or may not have grown outside the thyroid (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant sites (M1).

Medullary Thyroid Carcinoma:

•  Stage I (T1, N0, M0): The tumor is 2 cm or less across and has not grown outside the thyroid (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II: One of the following applies:

• T2, N0, M0: The tumor is more than 2cm but not larger than 4 cm across and has not grown outside the thyroid (T2). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

• T3, N0, M0: The tumor is larger than 4 cm or has grown slightly outside the thyroid (T3), but it has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage III (T1 to T3, N1a, M0): The tumor is any size and may have grown slightly outside the thyroid (T1 to T3). It has spread to lymph nodes around the thyroid in the neck (N1a) but not to distant sites (M0).

Stage IVA: One of the following applies:

• T4a, any N, M0: The tumor is any size and has grown beyond the thyroid gland and into nearby tissues of the neck (T4a). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant sites (M0).

• T1 to T3, N1b, M0: The tumor is any size and may have grown slightly outside the thyroid gland (T1 to T3). It has spread to certain lymph nodes in the neck (cervical nodes) or to lymph nodes in the upper chest (superior mediastinal nodes) or behind the throat (retropharyngeal nodes) (N1b) but not to distant sites (M0).

Stage IVB (T4b, any N, M0): The tumor is any size and has grown either back towards the spine or into nearby large blood vessels (T4b). It may or may not have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0).

Stage IVC (any T, any N, M1): The tumor is any size and may or may not have grown outside the thyroid (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant sites (M1).

Anaplastic/undifferentiated thyroid carcinoma:

All anaplastic thyroid cancers are considered stage IV, reflecting the poor prognosis of this type of cancer.

Stage IVA (T4a, any N, M0): The tumor is still within the thyroid and may be resectable (removable by surgery). It may or may not have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0).

Stage IVB (T4b, any N, M0): The tumor has grown outside the thyroid and is not resectable. It may or may not have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0).

Stage IVC (any T, any N, M1): The tumor is any size and may or may not have grown outside of the thyroid (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant sites (M1).

Recurrent  Thyroid Cancer

This is not an actual stage in the TNM system. Cancer that comes back after treatment is called recurrent (or relapsed). Thyroid cancer usually returns in the neck, but it may reappear in another part of the body (for example, lymph nodes, lungs, or bones). Doctors may assign a new stage based on how far the cancer has spread, but this is not usually as formal a process as the original staging. The presence of recurrent disease does not change the original, formal staging.

If you have any questions about the stage of your cancer or how it affects your treatment, do not hesitate to ask your doctor.

Last Medical Review: 10/12/2010


Last Revised: 01/12/2011

You Have Thyroid Cancer: Now What?

People with cancer often want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices.

No matter how professional, educated or analytical you are normally, the shock and stress after a cancer diagnosis can make it hard to remember what you want to ask your healthcare provider. There are several ways to ensure you remember and understand everything your provider tells you:

(1) Ask a family member or friend to come to the appointment with you. This person can remind you of questions you want to ask or they want to understand and also help you remember, later, what the doctor said. It can be easier for you emotionally over the long run to have this "key" person keep your family and friends informed of your medical condition. This will help your family and friends feel included without burdening you with answering too many questions or having to repeat the same things over and over.

(2) Make a list of questions. There is right or wrong number of questions. No silly question and no set timeline for all your questions to asked or answered.

(3) Be honest about your symptons and about how you feel both physically and emotionally.

(4) Ask your healthcare provider if you my use a tape recorder during appointments for later review. If this is not possible take notes or have your family member or friend take notes for you.

(5) Ask for clarification if you do not understand what you are being told. Sometimes, without realizing it, providers use terms their patients are not familiar with and do not understand. If you don't understand something it's important to ask for clarification.

(6) Remember to keep an open mind and the channels of communication open with your loved ones. You may want their help in making decisions or helping you sort things out, so keeping them up to date and informed may be in your best interest.

Remember, everyone has a different style of communication. That's why the perfect health care provider for one person may not be a good match for YOU! Consider what you value in a doctor. Some people feel more comfortable with a provider who will share information in a clinical and businesslike manner. They expect their medical provider to be a medical expert rather than a friend.

Other people want their provider to have an excellent "bedside manner". They value a provider who can address both their emotional health and medical needs. Many people whose illnesses require treatment over long periods of time prefer this kind of friendly relationship with their doctor. After you have thought about what it is you want and prefer as a patient, the next step is to look at how you communicate with the doctor you have chosen.

Thyroid and Neck Self Exam

Thirty million Americans have some growth or nodule on the thyroid gland. To detect a thyroid abnormality early, follow these easy steps:

Stand In Front Of Mirror

Stretch Neck Back

Swallow Water

Look for Enlargement in Neck

(below the Adam's Apple, above the collar bone)

Feel Area to Confirm Enlargement or Bump

If A Problem Detected, See An Endocrinologist or Primary Physician

ADDITIONAL INFORMATION

To view a full version of ``The Neck Check,'' or receive additional information about the American Association of Clinical Endocrinologists (AACE), visit the association's web site: http://www.aace.com.

THYROID CANCER FACTS

Strikes Just As Many People As Cervical & Liver Cancer

30,000,000 Suspected of Having Benign or Cancerous Thyroid Gland Nodules

3,000,000 Suspected of Having Thyroid Cancer, Thousands of Unknown Victims

About 34,000 People in U.S. Newly diagnosed & teated for Thyroid Cancer Each Year

Currently, There are 200,000 Thyroid Cancer Patients in the U.S.

Often Goes Undetected Because Patients Do Not Experience Any Early Warning Signs and Symptons.

Possible Thyroid ancer Signs: Nodules or Bumps on Gland or Enlargement of Thyroid Gland or Goiter.

10-15 million Americans Have Nodules That May Be a Sign of a Thyroid Disorder but not thyroid cancer.

Most Thyroid Cancers are Cured by Surgical Removal of Gland or Radioactive-Iodine Treatments If Cancer is Discovered Early.

Non-Functioning or Surgically Removed Gland Is Treated with Synthetic Hormone Levothyroxine for LIFE.

Afflicts Mostly Women Age 15 - 65 -although the number of pediatric thyroid cancers is increasing in recent years for unknown reasons

Men Who Have Nodules 3X More Likely to Have Cancer

The younger the person with thyroid nodules the more likely nodules will be malignant.

Fine-Needle Tissue Biopsy of Nodule is ``Gold Standard Test'' Recommended by AACE

Cancer Prevalent in People Exposed to Head/Neck Radiation Prior to 1950

Thyroid is Butterfly-Shaped Gland Located in Front of Lower Neck Area

Thyroid Provides Hormones Regulating All Vital Organs

If Untreated, Cancer Grows/Travels to Other Areas of Body

If Detected Early Enough = High Treatment Success Rate

About The Author: Wilma Ariza is the Founder and Development Director of Stevie JoEllie's Cancer Care Fund a Project of United Charitable Programs Inc., a 501(c)(3) Public Charity Tax ID 20-4286082 Progam 102442. In 2008 her daughter Stevie JoEllie was diagnosed with State II Follicular Thyroid Cancer a few weeks after her 21st Birthday and "survived" two thyroid cancer recurrences. Ms. Ariza was also diagnosed with cancer (leiomyosarcoma) the same week of her daughters diagnosis. They fought cancer together and today they are both doing well, dedicated to advocating and promoting thyroid cancer awareness, access to care grants and free supportive services for thyroid cancer patients and survivors nationwide.

Thyroid Cancer 2011 Review

There are about 39,000 new cases of thyroid cancer each year in the US, according to the National Cancer Institute. Females are more likely to have thyroid cancer at a ratio of three to one. Thyroid cancer can occur in any age group, although it is most common after age 30, and its aggressiveness increases significantly in older patients.

Recent studies suggest that childhood cancer survivors are also at an increased risk of developing thyroid cancer as young adults or later on in life.

The majority of patients present with a nodule on their thyroid that typically does not cause symptoms. Remember, over 99% of thyroid nodules are not cancer. But when thyroid cancer does begin to grow within the thyroid gland, it almost always does so within a discrete nodule within the thyroid.  Thyroid cancer is an uncommon type of cancer. The most common (and sometimes only) symptom of thyroid cancer is the development of a painless lump or swelling in the throat.

The Thyroid Gland



The thyroid gland is a butterfly-shaped gland that sits at the base of the throat. It consists of two lobes that sit either side of the windpipe.

The main purpose of the thyroid gland is to release hormones, which are a type of chemical that have a powerful effect on many of the functions of the human body.

The thyroid gland releases three separate hormones:

• triiodothyronine – which is known as T3
• thyroxine – which is known as T4
• calcitonin

The T3 and T4 hormones help regulate the body’s metabolic rate. The metabolic rate is how fast the various processes of the body work, such as how quickly the body burns calories. 

Excess levels of T3 and T4 in the body would make someone to feel overactive and cause them to lose weight. Not enough T3 and T4 would make feel someone feel ‘slow’ and sluggish, and cause them to gain weight.
  

Calcitonin helps control the levels of calcium in your blood. However, calcitonin is not essential for normal health as the body uses other ways to control calcium. Calcium is a mineral that has many important functions, such as building strong bones.

How Common is Thyroid Cancer?

Thyroid cancer is one of the rarer types of cancer, accounting for only 1% of all cancer cases in England. Each year in England and Wales there are an estimated 1,800 new cases of thyroid cancer. Women are two to three times more likely to develop thyroid cancer than men. This may be due to hormonal changes associated with the female reproductive system.

Most cases of thyroid cancer are diagnosed in people who are 30 to 50 years of age. Rates of reported thyroid cases have risen by around 50% over the last 30 years around the world. It is unclear whether this trend represents a true rise, or whether health professional are simply getting better at diagnosing cases of thyroid cancer that in the past would have been overlooked, but the debate continues to include environmental risk factors such as radiation and pesticide use.

Typical Thyroid Cancer Treatment Overview

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 3-6 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.

What's the Prognosis?

Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer (papillary and follicular) are the most curable. In younger patients, both papillary and follicular cancers have a more than 97% cure rate if treated appropriately.

Both papillary and follicular cancers are typically treated with complete removal of the lobe of the thyroid that harbors the cancer, in addition to the removal of most or all of the other side.

The bottom line is that most thyroid cancers are papillary thyroid cancer, and this is one of the most curable cancers of all cancers that humans get. Treated correctly, the cure rate is extremely high.

Medullary cancer of the thyroid is significantly less common, but has a worse prognosis. Medullary cancers tend to spread to large numbers of lymph nodes very early on, and therefore require a much more aggressive operation than the more localized thyroid cancers, such as papillary and follicular. This cancer requires complete thyroid removal plus a dissection to remove the lymph nodes of the front and sides of the neck.

The least common type of thyroid cancer is anaplastic which has a very poor prognosis. Anaplastic thyroid cancer tends to be found after it has spread and is incurable in most cases. It is very uncommon to survive anaplastic thyroid cancer, as often the operation cannot remove all the tumor. These patients often require a tracheostomy during the treatment, and treatment is much more aggressive than for other types of thyroid cancer–because this cancer is much more aggressive.

What About Chemotherapy?

Thyroid cancer is unique among cancers. In fact, thyroid cells are unique among all cells of the human body. They are the only cells that have the ability to absorb iodine. Iodine is required for thyroid cells to produce thyroid hormone, so they absorb it out of the bloodstream and concentrate it inside the cell.

Most  thyroid cancer cells retain this ability to absorb and concentrate iodine. This provides a perfect “chemotherapy” strategy. Radioactive Iodine is given to the patient with thyroid cancer after their cancer has been removed. If there are any normal thyroid cells or thyroid cancer cells remain in the patient’s body (and any thyroid cancer cells retaining this ability to absorb iodine), then these cells will absorb and concentrate the radioactive “poisonous” iodine.

Since all other cells of our bodies cannot absorb the toxic iodine, they are unharmed. The thyroid cancer cells, however, will concentrate the poison within themselves and the radioactivity destroys the cell from within. No sickness. No hair loss. No nausea. No diarrhea. No pain.

Most, but not all, patients with thyroid cancer need radioactive iodine treatments after their surgery. This is important to know. Almost all, however, should have the iodine treatment if a cure is to be expected.

Patients with medullary cancer of the thyroid usually do not need iodine therapy because medullary cancers almost never absorb the radioactive iodine. Some small papillary cancers treated with a total thyroidectomy may not need iodine therapy as well, but for a different reason.

These cancers (medullary and some small papillary cancers) are often cured with simple (complete) surgical therapy alone. This varies from patient to patient and from cancer to cancer. This decision will be made between the surgeon, the patient, and the referring endocrinologist or internist. Remember, radioactive iodine therapy is extremely safe. If you need it, take it.

***********************************

Stevie JoEllie's Cancer Care Fund is working to develop and launch an access to care grant program for thyroid cancer patients and survivors nationwide. Please consider supporting our unique initiative that includes a set aside fund for healthcare access to assist thyroid cancer survivors with medical costs associated with follow up treatment, annual exams,  diagnostics and medications. 

SJCCFThyNet is a project of United Charitable Programs Inc., a 501(c) 3 Public Charity and as such all donations are tax deductible as allowed by law. 

[One time and recurring donations are fast and easy to set up.]

Thyroid Cancer Risks Profile

Thyroid cancer is being diagnosed at rising rates in the United States and many other countries. Thyroid nodules are detected in up to 16 percent of imaging studies performed for other purposes. Microcarcinomas are found in 5.5 to 10.5 percent of thyroid glands removed for conditions other than cancer, and in up to 35 percent of autopsies. However, most of these would not be expected to develop into clinically significant cancers. The incidence of actual diagnosis of thyroid cancer in the United States is 0.3 percent for men and 1 percent for women, according to Reference 1.

Aggressive treatment includes surgical removal of the complete thyroid gland, radioiodine therapy, chemotherapy, and targeted drug therapy. These treatments have serious side effects, so it is important to evaluate the risks of the cancer versus the risks of treatment. Factors that indicate risk for metastasis, recurrence, and death include:

1. Age less than 15 years or greater than 45 years.

2. Males have worse prognosis than females. Women, especially during the reproductive years, have a much higher incidence, but better survival rates.

3. Family history of thyroid cancer.

4. Tumor larger than 2 cm.

5. Distant metastases.

6. Low uptake of iodine by the tumor and/or metastases.

7. Tumor characteristics that can be identified after surgical removal.

The only established risk factor for development of thyroid cancer is exposure to ionizing radiation. Data on this came from the Chernobyl nuclear accident, as well as the survivors of the atomic bomb explosions at Hiroshima and Nagasaki. Fission of uranium produces radioactive iodine, which is absorbed by the thyroid. Ironically, radioactive iodine produced by nuclear medicine reactors is also used in the treatment of thyroid cancer.

A wide variety of chemicals increase the rates of thyroid cancers in rodents, but no association has been demonstrated in humans. A study of 5,554 thyroid cancers in Sweden shows an increased risk from smoking, but no correlation with number of children, previous thyroid disorders, or previous radiotherapy to the neck. Family history had only a weak correlation. Other studies have shown conflicting results. Thus, it is still not clear what are the primary causes of thyroid cancer in the vast majority of patients who have not been exposed to nuclear accidents or bombs.

Research continues into the best treatment plans, depending on risk profiles. See http://clinicaltrials.gov/   for the 257 studies of thyroid cancer currently listed.

Reference:
1. Ward LS et al, “Identifying a risk profile for thyroid cancer”, Arq Bras Endocrinol Metab 2007; 51(5): 713-22.

SOURCE: Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

COMMON THYROID PROBLEMS

The thyroid gland is prone to several very distinct problems, some of which are extremely common. These problems can be broken down into [1] those concerning the production of hormone (too much, or too little), [2] those due to increased growth of the thyroid causing compression of important neck structures or simply appearing as a mass in the neck, [3] the formation of nodules or lumps within the thyroid which are worrisome for the presence of thyroid cancer, and [4] those which are cancerous.

Goiters ~ A thyroid goiter is a dramatic enlargement of the thyroid gland. Goiters are often removed because of cosmetic reasons or, more commonly, because they compress other vital structures of the neck including the trachea and the esophagus making breathing and swallowing difficult. Sometimes goiters will actually grow into the chest where they can cause trouble as well. Several nice x-rays will help explain all types of thyroid goiter problems.

Thyroid Cancer ~ Thyroid cancer is a fairly common malignancy the vast majority of which have excellent long term survival. We now include a separate page on the characteristics of each type of thyroid cancer and its typical treatment, follow-up, and prognosis.

Solitary Thyroid Nodules ~ There are several characteristics of solitary nodules of the thyroid which make them suspicious for malignancy. Although as many as 50% of the population will have a nodule somewhere in their thyroid, the overwhelming majority of these are benign. Occasionally, thyroid nodules can take on characteristics of malignancy and require either a needle biopsy or surgical excision.

Hyperthyroidism ~ Hyperthyroidism means too much thyroid hormone. Current methods used for treating a hyperthyroid patient are radioactive iodine, anti-thyroid drugs, or surgery. Each method has advantages and disadvantages and is selected for individual patients. Many times the situation will suggest that all three methods are appropriate, while other circumstances will dictate a single best therapeutic option. Surgery is the least common treatment selected for hyperthyroidism.

Hypothyroidism ~ Hypothyroidism means too little thyroid hormone and is a common problem. In fact, hypothyroidism is often present for a number of years before it is recognized and treated. There are several causes, but the number one reason for thyroid cancer patients and survivors is alteration or loss of thyroid function as a result of cancer or cancer treatment. Hypothyroidism can even be associated with pregnancy. Treatment for all types of hypothyroidism is usually straightforward.

Thyroiditis ~ Thyroiditis is an inflammatory process ongoing within the thyroid gland. Thyroiditis can present with a number of symptoms such as fever and pain, but it can also present as subtle findings of hypo or hyper-thyroidism.

About The Author: Wilma Ariza is the Founder and Development Director of Stevie JoEllie's Cancer Care Fund a Project of United Charitable Programs Inc., a 501(c)(3) Public Charity Tax ID 20-4286082 Progam 102442. In 2008 her daughter Stevie JoEllie was diagnosed with State II Follicular Thyroid Cancer a few weeks after her 21st Birthday and "survived" two thyroid cancer recurrences. Ms. Ariza was also diagnosed with cancer (leiomyosarcoma) the same week of her daughters diagnosis. They fought cancer together and today they are both doing well, dedicated to advocating and promoting thyroid cancer awareness, access to care grants and free supportive services for thyroid cancer patients and survivors nationwide.

View Author's professional biography on LinkedIn