Thyroid Cancer (cont.)
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Thyroid Cancer Treatment
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Surgery to remove all cancer in the neck and any cancerous lymph nodes is the initial therapy for most thyroid cancers. Complications are rare when the procedure is performed by an experienced thyroid surgeon.
Radioactive Iodine using I-131 is typically used as a follow-up to surgery, or "adjuvant" treatment in papillary and follicular thyroid cancers. This treatment is usually given two to six weeks following thyroid surgery. It involves giving high doses of I-131 in a liquid or pill form. Patients undergoing this treatment must restrict their dietary intake of iodine for approximately five to14 days before the treatment and must restrict their contact with children and pregnant women for three to seven days after treatment. The goals of this treatment include destruction of any remaining thyroid tissue in the neck, a reduction in cancer recurrence rate, and improved survival.
Radiation treatment, known as external-beam radiation therapy, is used in patients with cancer that cannot be treated with surgery or is unresponsive to radioactive iodine, as well as for older patients with cancer that has distant spread. Radiation is sometimes combined with chemotherapy.
Classical chemotherapy is rarely useful, but sometimes tried for progressive diseases unresponsive to radioactive iodine or radiation.
There are two new FDA approved targeted agents for the treatment of metastatic medullary thyroid carcinoma. These drugs are vandetenib (Capresa) and cabozantinib (Cometriq). In addition, the drug Lenvima (levatinib) has recently received FDA approval for the treatment of refractory differentiated thyroid cancers of papillary and follicular type. Levima appears possibly more effective than sorafenib (Nexavar), also approved for these patients with differentiated (papillary and follicular) thyroid cancer patients who are no longer responsive to radioactive iodine.
Treatments for the four thyroid cancer types
Papillary thyroid cancer responds to treatment with surgery and radioactive iodine.
Follicular thyroid cancer responds to treatment with surgery and radioactive iodine treatment.
Medullary thyroid cancer must be treated with surgical removal of the entire thyroid gland in addition to complete removal of all neck lymph nodes and fatty tissue. This type of cancer does not respond to radioactive iodine therapy and has a much lower cure rate than either papillary or follicular thyroid cancer. After surgery, patients should be followed every six to 12 months with blood calcitonin and CEA levels to watch for recurrence.
Anaplastic thyroid cancer often cannot be cured with surgery by the time of diagnosis (due to spread of the disease). This cancer is not responsive to radioactive iodine and may require radiation and chemotherapy, or even tracheotomy if the disease is locally advanced and is causing impingement on an airway.
Medically Reviewed by a Doctor on 1/8/2016
Stephanie L Lee, MD, PhD, FACE
Sonia Ananthakrishnan, MD
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