Thyroid cancer on the rise

A little more than a year ago, Amber Skipper had no idea what the thyroid did. Then her baby head-butted her in the neck. The spot swelled, and Skipper, now 29, couldn’t talk.

In the following weeks, she became an expert about the gland, which helps regulate heart rate, blood pressure, body temperature and weight. Doctors diagnosed her with thyroid cancer, which is three times more common in women than men.

The Westfield mother is part of a trend that baffles medical researchers. Thyroid cancer, which affects about 11 people per 100,000 each year, seems to be on the rise.

National Cancer Institute statistics suggest that in recent years the number of cases of this often curable cancer has increased by about 6.5%. Over a decade, this has added up to make thyroid cancer the fastest-rising cancer, said Dr. Tod Huntley, an otolaryngologist and head and neck surgeon with the Center for Ear, Nose, Throat and Allergy in Carmel, Ind.“Ten years ago, if I saw four new thyroid cancer patients a year, it would have been a lot,” said Dr. G. Irene Minor, a radiation oncologist with Indiana University Health Central Indiana Cancer Center. “Now, sometimes I see that many in a month, and I have seen three in a week.”

Thyroid cancer is more common in women younger than 45, Minor said. Doctors don’t know why that’s the case, but thyroid problems in general - such as hyper- or hypo-thyroidism - are more common in women.

Why is it more prevalent?

Experts remain divided on the cause of the increase.

Thyroid Cancer Basics
Thyroid cancer is fairly uncommon, accounting for only 1.2% of all new cancers in the United States annually. Although thyroid cancer is still a cancer that requires treatment and lifelong monitoring, and can have debilitating effects on patients, survival rates are, high, with 95% of all thyroid cancer patients achieving what would be considered a cure, or long-term survival without reoccurrence.

Thyroid cancer affects women two to three times more than men. Besides what appears to be a hormonal or gender connection, the causes of thyroid cancer are, for the most part, not known.

There are four types of thyroid cancer: Papillary, Follicular, Medullary, and Anaplastic.

Papillary cancer is the most common type of cancer, perhaps because papillaries are quite common in the thyroid gland. Papillary cancer mostly involves one side of the thyroid and sometimes spreads into the lymph nodes. The cure rate is very high.

Follicular cancer, the second most common type of thyroid cancer, is somewhat more malignant than papillary. The thyroid gland is comprised of follicles which produce thyroid hormones that are essential for growth and development of all body tissues. This cancer doesn’t usually spread to the lymph nodes, but it may spread to arteries and veins of thyroid gland and more distantly (lung, bone, skin, etc), though that is uncommon. Follicular cancer is more common in older people. Again, the long -term survival rate is high.

Medullary thyroid cancer is the third most common type of thyroid cancer, and usually originates in the upper central lobe of the thyroid. It spreads to the lymph nodes earlier than papillary or follicular cancers. It differs from papillary and follicular cancer, however, in that it does not arise from cells that produce thyroid hormone, but instead from C cells. These C cells make the hormone calcitonin. This type of cancer can run in families, and also has a good cure rate.

Some attribute it to better screening. Many smaller tumors are picked up on ultrasounds or scans done for other reasons, said Dr. Michael Moore, a head and neck surgeon with Indiana University Simon Cancer Center.

Autopsies conducted on people who died for non-thyroid-related reasons reveal that as many as 80% of people older than 60 have a thyroid lump or malignancy that went undiagnosed, Moore said.

Some think that better screening alone can’t explain the increase in thyroid cancer. A recent study showed that the increase is not just in smaller tumors, which might have to do with detection, but also in larger ones, Huntley says.

“There is definitely something going on,” he said. “How much is due to increased surveillance and detection and how much is due to an actual biological change in disease prevalence, we don’t know, but we know it’s both.”

Types of Thyroid Cancer
There are different types of thyroid cancer but the most common, occurring in 80% of cases, is known as Differentiated Thyroid Cancer (papillary, follicular or mixed papillary and follicular forms). Provided a careful history is obtained, 5-10% of patients with Differentiated Thyroid Cancer will have a positive family history. Anaplastic Thyroid Cancer is a rare type of cancer with a poor prognosis. Occasionally individuals develop lymphoma of the thyroid gland or with metastasis from other cancer types. Medullary Thyroid Cancer is a rare tumor, arising not from the follicular cells that produce the thyroid hormone but from C-cells which are also present in the thyroid.

In approximately 25% of cases there may be involvement of other endocrine glands such as the adrenal, and parathyroid glands. Problems with intestinal motility or special physical features (long arm span, neurinomas, or small bumps, on the lips and tongue) may also be evident. This combination of features is known as multiple endocrine neoplasia syndrome and is a hereditary condition for which the gene is known. It is currently recommended that all patients with medullary thyroid cancer benefit from genetic counselling and/or genetic screening that is offered in specialized centres across Canada. Patients with medullary cancer should ensure that family members are aware of the genetic screening that is predictive of future disease development. Genetic screening is more sensitive than traditional biochemical tests and examinations. If an individual has the genetic mutation leading to multiple endocrine neoplasia and medullary thyroid cancer there is a 50% chance of passing it onto their children.

Obesity, radiation exposure and diets low in fruits and vegetables are three potential culprits, Huntley says. Also, the more dental X-rays a person has, the higher the risk, studies show.

Often, thyroid cancer has no symptoms but is diagnosed when a person or physician notices a lump in the neck. When symptoms do occur, they can include difficulty swallowing or the sensation of a lump in the throat or voice changes.

In Skipper’s case, she had felt something in her neck but thought it was a swollen lymph node. She had been prone to bronchitis and fatigue, but she attributed that to being a working mother with two small children.

When she learned she had cancer, she was optimistic. Numbers were on her side. The five-year survival rate for thyroid cancer is 97%.

Last October, she had her thyroid and many lymph nodes removed and underwent treatment with radioactive iodine. She now takes a daily replacement thyroid hormone pill.
Separated from family

Because the iodine is radioactive, Skipper had to be isolated from her family for seven days. She ached to see her two young daughters, now 4 and 2, as well as her husband, Ryan, who would leave her food outside her door.

Four years ago, Valerie Schaewe had a spot on her neck that swelled to the size of an egg. A biopsy was inconclusive, but doctors recommended the mass be removed.

The nodule wasn’t cancerous, so the Irvington, Ind., mother kept half her thyroid. Her doctor warned her that a mass might form on the remaining side of her thyroid if she had more children.

Sure enough, about six months after the birth of her second son in May, Schaewe, 39, felt a lump in her throat and had difficulty swallowing. Her doctor did an ultrasound and saw a large mass. She had a second operation.

“I fall into that 2% of cases that you don’t know until you get in there what you’re dealing with,” she said.

Nor is she alone. Argentina’s president, Cristina Fernandez, recently had her thyroid removed for what doctors thought was a cancerous nodule. Only after the operation did they determine that the mass was not cancer.

Skipper has undergone two radioactive iodine stints, the first after surgery then one a year later to see if any cancer remained.

In the year since her operation, Skipper started eating more organic foods and taking vitamins. She plans to complete a marathon this spring. Doctors may not be able to tell her why she got cancer, but she wants to make sure she stays healthy. She also has become a medical assistant to help others who are sick.

Her second isolation lasted two days. But in the end, she got the results she wanted: She is cancer-free.


Shari Rudavsky at 317-444-6354

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