Medullary Thyroid Cancer

Medullary Thyroid Cancer


We should start by pointing out that this type of cancer is considered to be the third most frequently diagnosed cancer. In this article, we’ll throw light upon common symptoms in case of medullary thyroid cancer, treatment procedures, future prognosis and the procedure of diagnosing the disease.

Medullary tumors are the third most frequently diagnosed tumors out of all thyroid cancers. Actually, the number of these tumors amounts to 3 % of all thyroid cancer cases.

What are the most frequently occurring medullary thyroid cancer symptoms? Unlike the symptoms of papillary and follicular thyroid cancers where the symptoms are caused by cells producing certain hormones, the symptoms of the medullary thyroid cancer come from the C cells of the thyroid. Doctors also call the cells parofollicular.

These cells are responsible for the production of a certain hormone called calcitonin. This hormone has nothing to do with keeping metabolism under control the way thyroid hormone does it. Below you’ll find information on the measurement of this hormone production. It is, as a rule, measured after a surgical operation so that to see whether there is still cancer inside your organism and whether it’s developing.

In comparison with such well-differentiated cancers like papillary or follicular cancer, this cancer is less often effectively cured. However, the cure rates turn out to be higher than in case of anaplastic thyroid cancer. In general, 10-years survival rates amount to 90 % if the disease is spread only within the thyroid gland. The rates amount to 70 % if it has affected the cervical lymph nodes and to 20 % if it has invaded in the areas located nearby.

Common Сharacteristics of Medullary Thyroid Cancer

  • It is to occur in 4 clinical settings (you’ll find information on it below) and can be associated with other various endocrine tumors.
  • Most often, these are women who face it, not men. Cases when it is inherited are an exception.
  • There occur regional metastases (meaning that the cancer has invaded in the neck lymph nodes). The metastases have a tendency to occur on the early stage of the disease.
  • Metastases in the organs located quite far occur on the late stages. Your liver, bone, brain and adrenal medulla are subjects to it.
  • The disease has nothing to do with being exposed to radiation.
  • As a rule, the cancer starts in the upper central lobe of the thyroid.
  • As for poor prognosis, it can refer to men who are older than 50, cases when a patient has metastases in the organs located quite far, and patients who suffer from other endocrine tumors that occur because of the MEN II-B syndrome.
  • Residual disease that is followed by a surgical operation or cases of the disease recurrence are possible to detect by measuring the level of calcitonin. Actually, you’re to measure the level of the hormone every 4 months during the first few years. Then, you are to do it every 6 months for the rest of your life.

Medullary Thyroid Cancer Occurs in 4 Clinical Settings

Current Management of Medullary Thyroid Cancer

Sporadic. The number of such like cases amounts to 80 % out of all medullary thyroid cancer cases. As a rule, they are unilateral and are not connected with the disease that occur in other endocrine glands. These are exactly women who face such like diseases most often, the ratio is 3:2. The period when they occur is 40 to 60 years old. One third of the patients will suffer from intractable diarrhea. It occurs due to an increased gastrointestinal secretion and hypermotility the reason of which are the hormones secreted by the tumor. The list of the hormones involves calcitonin, prostaglandins, serotonin and VIP.

  • MEN II-A or Sipple Syndrome. Multiple neoplasia syndromes (or MEN for short) are a group of endocrine disorders that occur in tandem with each other and in one patient. They seem to run in a family since they are inherited. Any type of disorders that occur in group of 3 men are considered to be syndromes.
  • In case of Sipple syndrome there occurs: C cell neoplasia, pheochromocytoma and hyperparathyroidism.
  • Since the syndrome is considered to be inherited, it should be pointed out that the reason for it are defects in the gene that helps to keep the growth of endocrine tissues under control. Consequently, approximately 50 % of children are subjects to having the defective gene. Due to this, men as well as women have similar risks of facing the syndrome. Such like people have a risk of being diagnosed with medullary carcinoma once they are in their 30s.
    – MEN II-B. The patients suffering from the syndrome may as well have medullary carcinoma and pheochromocytoma (although hyperparathyroidism is quite rare). Instead of it the patients suffer from mucosal ganglioneuromas (tumor that occur in the mouth) and a Marfanoid habitus.
  • In case of MEN II-A, inheritance is autosomal dominant. However, it can occur by itself, without being inherited. MEN II-B patients may suffer from medullary carcinoma that occurs in their 30s. Bear in mind that here both, males and females, have equal risks. In case of MEN II-A, pheochromocytoma is to be detected before any surgical operation is carried out. The crux of the matter here is that the pheochromocytoma should be removed first so that to eliminate the risk of severe hypertensive episodes while doctors will perform an operation on either thyroid or parathyroid.
    – Inherited medullary carcinoma that is considered to have no connection to endocrinopathies. Actually, this form of medullary carcinoma is known to be less aggressive than any other such like diseases. It occurs when a patient is between 40 and 50 years old.

Management of Medullary Thyroid Cancer

Unlike in cases of papillary or follicular cancers, there exists little controversy when doctors discuss the way to treat medullary thyroid cancer. Once an endocrinologists evaluates endocrine conditions and provides you with the necessary treatment, you are to receive total thyroidectomy. Besides, the patients with such like disorders should undergo a surgical operation to remove all lymph nodes as well as fatty tissues located in the central area of the neck. Besides, the lymph nodes and the fatty tissue that surround them within the side of the neck where the tumor was located before are to be removed as well.

Radioactive Iodine and Medullary Thyroid Cancer

Even though thyroid cells have the cellular mechanism that absorbs iodine, medullary thyroid cancer doesn’t start in this type of thyroid cells. Consequently, this therapy is not effective for the treatment of medullary thyroid cancer. The same can be said about medullary cancers that develop to the areas located quite far. The crux of the matter is that it is impossible to detect with the help of iodine scanning that helps to define how spread the tumor is in case of papillary or follicular cancer.

What Kind of Long-term Follow up Should be Provided?

Apart from the usual follow up, there is a need to receive chest X-ray and measure calcitonin level every year. Serum calcitonin is effective in the follow up of medullary thyroid cancer since there are no other hormones in your organism that are responsible for the production of this hormone. A high level of serum calcitonin that was low before and was followed by a total thyroidectomy proves that there is a case of the disease’s recurrence.

Under good conditions, doctors will remove all of the thyroid as well as lymph nodes in the neck harboring metastatic spread during a surgical operation. Then, there will be a zero level of calcitonin after the operation. However, this happens rarely and the level of calcitonin remains quite high. Still, it is lower than before the operation. You are to check the level every 6 months. Once it increases, a more diligent examination is recommended to find the source.

Drawing Conclusions on Medullary Thyroid Cancer

There are several treatment options you have in case you’re dealing with medullary thyroid cancer. The list of them involves external beam radiation and thyroidectomy. You are to talk it over with your doctor to find the right treatment option in your case.

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