By Matt McMillen
WebMD Health News
Reviewed by Louise Chang, MD
Brooke Burke, co-host of Dancing with the Stars, announced Thursday that she has thyroid cancer. The 41-year- old mother of four will undergo surgery to have a thyroidectomy, a procedure to remove part or all of the thyroid gland. The thyroid, which is found in the neck, produces hormones that help control the body's metabolism. WebMD spoke with Neil D. Gross, MD, a cancer specialist and surgeon at Oregon Health and Science University in Portland, about the disease. Gross is not involved in Burke's treatment.
What is thyroid cancer?
"Thyroid cancer is a very common cancer that predominantly affects younger women," Gross says. "It's the fifth most common cancer diagnosed in women."
What are the signs and symptoms of thyroid cancer?
"Most of the time, it is diagnosed by accident, or incidentally," Gross says. "A family doctor or obstetrician, both of whom are trained to examine the neck, may spot a suspicious lump during a routine visit, for example. Sometimes it might be picked up first after a car accident, when a patient with whiplash gets a neck X-ray. It's rare for a patient to come in saying 'I feel something' or 'something hurts.' But it is possible that they could feel a lump in the mid to lower portion of their neck. Rarer still is the sudden onset of hoarseness. This happens when the cancerous nodules on the affected side of the thyroid grow large enough to press on nerves from nearby vocal cords, paralyzing them on that side. When that happens, their voice becomes nothing more than a whisper."
Who is at greatest risk of developing thyroid cancer?
"Young women of childbearing years, those under the age of 45, are the most likely to get it. They get it about four times more often than men," Gross says. "Brooke Burke appears to be a very common demographic for this disease."
How is thyroid cancer diagnosed?
"If a family practitioner or obstetrician feels a suspicious lump, they will most often order an ultrasound," Gross says. "If any of the nodules are more than a centimeter in size, a fine needle aspiration biopsy of the thyroid should be done to draw out cells which can then be looked at under a microscope. That's very standard."
What are the risk factors for thyroid cancer?
"There are few known risk factors, and the major one is radiation," he says. "For example, children downwind of Chernobyl grew up with a higher risk of thyroid cancer. Children treated for lymphoma whose chest and neck areas were exposed to radiation therapy also are at higher risk. Some types of thyroid cancer run in the family, but the common ones are sporadic, occurring without any [family] history."
How is thyroid cancer treated?
"Typically, the first treatment is surgery to remove the whole thyroid or a part of it," Gross says. "There's a lot that goes into the decision about how much to remove. It's hotly debated and comes down to details such as how big the nodules are or whether there are nodules on the other side of the thyroid. It's more common to remove the entire thing, though.
The thyroid sits right where a bow tie would be tied, and a 3" to 4" incision is made in the neck to reach it. In general, it's a safe operation that is performed frequently, though the surgeon must be careful not to damage the nearby vocal cord nerves or the parathyroid glands, which regulate calcium. A few months after surgery, patients may undergo iodine radiation therapy, depending on certain details of their cancer, including whether or not it has spread to the lymph nodes."
What can a patient expect after surgery?
"The incision will leave a scar in the neck," Gross says. "However, new types of robotic therapy, which go in through an incision in the arm pit, are available. I have trained in and performed this type of surgery on the thyroid, though not specifically for thyroid cancer.
Patients who have their thyroid removed will have to take thyroid hormone replacement pills on a daily basis because they have no thyroid to produce those hormones naturally any longer. Some patients say they don't feel the same on such pills, but a different formula or brand might help with that. Most patients don't notice the difference."
What's the outlook for patients with thyroid cancer?
"The good news is that thyroid cancer is most often caught in the early stages," Gross says. "It's rare for it to get big before it gets diagnosed. Young women do well."
What advice do you have for patients with thyroid cancer?
"Cancer is scary, and people are terrified of hearing the word cancer," he says. "A lot of what you need to do is reassure them that they are going to be OK, that the prognosis is most often excellent. People can lead a normal life after the disease, but it can be hard to hear that when first confronted with having cancer."
SOURCES: Neil D. Gross, MD, Oregon Health and Science University. Hormone Health Network: "Thyroid Disorders Overview".
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