Diagnosis Disparities in Minorities Study

Results from one study show that despite a lower overall rate of thyroid cancer, African-Americans are generally diagnosed with a higher grade of cancer than in Caucasian populations.

Other studies have been published indicating economic issues chiefly underlie the differences in cancer stage upon diagnosis.

Lower levels of access to medical care due to economic constraints, or the inability to take time off from work have been linked to a longer time between the first symptoms of cancer and the beginning of cancer treatment.

The figure shows the thyroid cancer incidence rates by race and ethnicity for the US male and female in 2007. The thyroid cancer incidence rates are per 100, 000 US population and are age-adjusted to the 2000 US Standard Population 

Results from the study show that African Americans had double the rate of anaplastic thyroid cancer, an advanced and aggressive stage of thyroid cancer, when compared to Caucasian thyroid cancer patients.  African American patients were also twice as likely as Caucasian patients to have tumors larger than four centimeters.

Ask your doctor about screening tests for Thyroid Cancer.

The study used the National Cancer Institute’s database to look at data for the years 1992-2006, tracking five year survival rates of thyroid cancer patients in 17 states. Study data examined the cases of 26,902 patients diagnosed with thyroid cancer during that time.

“We think that the mortality rate is probably due to an access to care issues,” said Christopher Hollenbeak, PhD and lead study author.

“African-Americans were more likely to present with tumors larger than four centimeters, which implies that the tumors sat there and grew a lot longer,” he said.

Papillary and follicular cancer are the most common forms, and usually diagnosed in susceptible populations such as Caucasian or Asian groups. Complete treatment success for papillary and follicular thyroid cancers is close to 90 percent.

Anaplastic thyroid cancers, on the other hand, which were shown to be more commonly diagnosed in African American patients with thyroid cancer, can be fatal much more frequently.

One surgeon interviewed agreed that the difference could be amount of time elapsed from the cancer developing, to being treated. If caught early thyroid cancer treatment usually involves a small surgery, with some patients needing to take a small amount of radioactive iodine to completely destroy the cancer.

"The prevailing theory today is that anaplastic is thyroid cancer that goes haywire from not being treated,” said David Goldberg, MD, co-author of the study and currently a professor at Penn State.

The study was published in the journal Ethnicity & Disease. Authors denied any financial conflict of interest arising from the publication of their results.

Recurrent Thyroid Cancer Treatment

If your thyroid cancer comes back (recurs) after you finish your original treatment, the treatment for the recurrence will depend on where the cancer comes back, the type of cancer you have, the treatment you had before, and your overall health.

If you did not have your thyroid removed when you received your treatment for cancer the first time, you might be treated with a total thyroidectomy.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.

If you already had a thyroidectomy, the doctor might do surgery to remove any cancer that you have still have.

Other treatment options are radioactive iodine and external beam radiation therapy.Radioactive iodine treatment can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

External beam radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

Your doctor might also recommend chemotherapy, possibly in combination with radiation therapy. Chemotherapy drugs are used to kill cancer cells. Although there is no standard chemotherapy or combination of chemotherapy drugs, the following chemotherapies (alone or in combination) are sometimes used to treat recurrent thyroid cancer:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Blenoxane ^® (bleomycin) - Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein, either over 10 minutes or as a continuous infusion for 24 hours, or as a shot into the muscle or under the skin. The dose is based on your size.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

This content has been reviewed and approved by Myo Thant, MD. 

Chemotherapy for Thyroid Cancer

Chemotherapy drugs are used to kill cancer cells. These drugs destroy cancer that is still left after surgery, slow the tumor's growth, or reduce symptoms.

Chemotherapy is not usually used to treat thyroid cancer. But certain chemotherapy drugs are useful in combination with external radiation beam therapy for anaplastic thyroid cancers. Chemotherapy is also used sometimes for thyroid cancers that have continued to grow after treatment with radioactive iodine or external beam radiation therapy. Some of the chemotherapy drugs that are used to treat thyroid cancer are listed below.

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.

• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size and blood count.

• Blenoxane ^® (bleomycin) - Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein, either over 10 minutes or as a continuous infusion for 24 hours, or as a shot into the muscle or under the skin. The dose is based on your size.

• Cytoxan ^® (cyclophosphamide) - Cyclophosphamide belongs to a group of chemotherapy drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Cyclophosphamide can be given by mouth as a pill or liquid, or by a shot into a vein. The dose depends on your size, your type of cancer, and blood count.

• DTIC-Dome ^® (dacarbazine) - Dacarbazine is a chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Dacarbazine is given by a shot in a vein over 20 minutes or longer. The dose and how often you get the medicine depend on your size, your blood counts, and the type of cancer being treated.

• Oncovin ^® (vincristine) - Vincristine belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. It stops cells from dividing, which kills them. Vincristine is given by an injection in a vein over 2 to 5 minutes. The dose and how often you get the medicine depend on your weight, how well your liver is working, and the type of cancer being treated.

• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

• VePesid ^® or Etopophos ^® (etoposide) - Etoposide belongs to the class of chemotherapy drugs known as plant alkaloids. It stops cells from dividing, which kills them. Etoposide can be given by an injection in a vein over 30 to 60 minutes, or at higher doses over 1 to 4 hours. Etoposide can also be given by mouth as a capsule. The dose depends on your size, the type of cancer being treated, and your blood counts.

This content has been reviewed and approved by Myo Thant, MD. 

Radiation Therapy for Thyroid Cancer

Your thyroid gland absorbs nearly all of the iodine in your blood as part of its normal functioning. *Radioactive iodine can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid. The cell takes up the iodine and the radiation in the iodine is released, delivering a lethal dose of radiation to the cancer cells. 

*This treatment is especially useful if you have a papillary or follicular cancer that is larger than 1.5 centimeters or has spread to the neck or other parts of the body. But it is not indicated for small cancers that are only located in the thyroid gland. It is not used for medullary or anaplastic thyroid cancers because these tumors do not take up iodine.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

External beam radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells. It is not used for thyroid cancers that take up iodine and can therefore be more effectively treated with radioiodine therapy. However, it is sometimes used to treat cancers that do not take up iodine (and therefore cannot be treated with radioactive iodine) and have spread beyond the thyroid capsule to reduce the chance that the disease will come back (recur) in the neck. In addition, radiation treatment is usually used to treat anaplastic thyroid cancer.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

This content has been reviewed and approved by Myo Thant, MD. 

Iodine Radioisotope Effective for Bone Mets From Thyroid Cancer

NEW YORK (Reuters Health)- When differentiated thyroid cancer has spread to bone, iodine-131 can help stabilize the disease and significantly reduce pain, a Chinese team reports.

Iodine-131 has been used to treat differentiated thyroid cancer (DTC) for 70 years, the authors note, but it's been very difficult to evaluate its effect on DTC bone metastases.

"The indolent course of DTC requires very large cohorts of patients followed over several decades to confirm significant differences in prognostic factors and treatment efficacy," said Dr. Quan-Yong Luo and colleagues at Shanghai Sixth People's Hospital. "Moreover, DTC patients with bone metastasis are relatively rare."

In a report scheduled for the October print issue of the Journal of Clinical Endocrinology and Metabolism, available online now, the researchers report on 106 such patients treated at their center with oral I-131 therapy, up to 13 times at intervals of 4 to 12 months. Follow-up ranged from 1 to 17 years, with the median being 10.5 years.

Based on changes in serum thyroglobulin, I-131 significantly decreased disease activity in 37 cases (34.9%) and stabilized it in 56 patients (52.8%), the team reports.

Treatment also produced significant pain relief in 39 of 61 patients (63.9%) with painful bone metastases.

Survival rates were 86.5% at 5 years and 57.9% at 10 years, Dr. Luo and colleagues report. Factors independently associated with better prognosis were a solitary bone metastasis, the absence of non-osseous metastases, and bone surgery prior to I-131 therapy.

"In summary, I-131 therapy can significantly decrease or stabilize serum Tg (thyroglobulin) and alleviate bone pain. It can also shrink or stabilize lesions for most DTC patients with bone metastases, and therefore, it is an effective treatment modality for bone metastases from DTC," they write.

SOURCE: http://bit.ly/nup9n4

J Clin Endocrinol Metab 2011.

Coping With Advanced Thyroid Cancer, Metastasis or Recurrence

What to do if your cancer returns or you are diagnosed with advanced cancer for the first time?  There are really two groups of people with metastatic cancer: those who are learning for the first time that they have cancer, and those who were diagnosed earlier and have since experienced a recurrence or metastasis.  But both groups have one thing in common: the cancer is considered advanced. That means we have different needs and different concerns than women and men who  have discovered their cancer early.  Many of us who are facing cancer for a second time or more feel that we already know what to expect. 

Please read this blog post carefully and read it again if you need to because there is a chance that you’ll find  a tip you hadn’t thought of before – one that will make your life easier to manage while fighting cancer. It is published with permission and authored by Monica Knoll Executive Director of Cancer 101 and a Breast Cancer Survivor. 


What do you call it?  There is no one term that we all use to describe cancer  that has spread to other parts of our body. Some of us call the cancer advanced. Others prefer to describe it as metastatic.  This difference in terminology can be confusing. For example what’s the difference between stage 3 or stage 4 cancer  and metastatic cancer? The answer is there is no  difference. Cancer that has spread to other organs is  advancing. 


Some healthcare  professionals describe stage 2  as advanced as well. As a cancer patient, it’s important for you as well as your caregivers to understand what the terms you use to describe you cancer. That way you will be able to make more informed choices about treatments.

• Stage 4 cancer: Cancer that has spread to other organs of the body, most often the bones, lungs, liver, or brain.
• Advanced  cancer: Cancer that has spread to other places in the body and usually cannot be cured.
• Metastatic cancer: Cancer that has spread from the place where it started to other parts of the body.
• Recurrent cancer: Cancer that comes back after treatment. It can come back in the same place as the original cancer or in a different part of the body.

As you can see, we may be using different terms, but we’re  really talking about the same thing.


Living “with” metastatic cancer:   Living “with” cancer is easier said than done. But many of  us do live for years with advanced cancer, despite the fact that we wake up every day with uncertainty in our lives. We all know that everyone dies. But for those of us living with cancer, the idea of our own mortality takes on a very real presence.

It would be easy to fall into depression or self-pity. But  many of us make up our mind early that we don’t want to waste one day feeling depressed or sorry for ourselves. We  may not have any control over how much time we have left, but we can control how we plan to live it. For some of us, our cancer is considered a chronic disease because, with treatments, we can keep our cancer at bay and have a good quality of life for a fairly long time.  I hope the following advice helps you live life to the fullest  despite your cancer. I know it helps me every day.

• Make every day count. If I’m feeling good, I try to be  present in the moment and not take it for granted. Enjoy what you are doing and the people with whom you are spending your time. Enjoy the feeling of feeling good.

• Be good to yourself: Form reasonable expectations of what you can and can’t do.

• Improve your appearance: You might just feel better if you do. Get out of those pajamas; wash your face; put on a little lipstick. Get a manicure or a pedicure and a foot rub. 

• Just Move: Take a walk, a yoga class, or if you are up to it, do something more rigorous. Your  energy and mood will definitely improve. Make sure to talk to your doctor first about exercising. 

• Eat as well as you can! Eat good nutritional foods that will boost your immune system and give you energy. But don’t deny yourself a little treat, too. 

• Music: Listen to music that soothes you when you need to relax. Or pick upbeat, happy music when you need to be cheered up or need a little energy boost. I have a few songs that make me feel great when I hear them. Try the theme song to the movie “Rocky” when you are feeling tired or sad. 

• Count your blessings: I have lived a good life so far and I still do. I have always had food on the table, a roof over my head, a good education, a family who loves me, great friends, and wonderful travels. I then think about people who are living in dire poverty. 

Millions of people in the world have experienced war, and live without food, water, or adequate shelter. Millions have never known what a good day is. While we feel terrible with chemo,  there are millions who are starving. And if I die tomorrow, I know that I have had a great life. If you can, try to take a little time to see what you have and what you have experienced. For me, this gives me peace of mind.

About the Author: Monica Knoll is the Executive Director of Cancer 101. In the fall of 2000, at the age of 36, Monica Knoll was diagnosed with breast cancer.  Her diagnosis and treatment involved taking the gene test and testing positive for the BRAC1 gene, undergoing surgeries, joining a national chemotherapy study, eight rounds of chemotherapy and six weeks of radiation.  She is also the sister of a 14-year breast cancer survivor and daughter of a father who lost his life to esophageal cancer.