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Thyroid Cancer Treatment Options By Stages [I to IV]


The thyroid cancer treatment depends on many factors including the type of thyroid cancer, stage, age, and performance status of the patient, along with other factors.

Following are the preferred treatment approaches for different types and stages of thyroid cancer but the final decision is taken by the oncologist after complete assessment of the patient.

STAGE AND TYPE TREATMENT
Stage I-II DTCs Stage I-II DTCs are generally treated with surgery (lobectomy or total thyroidectomy) with or without radioiodine therapy (depending on the size of tumor and extent of invasion) as the standard treatment.
Stage III DTCs Stage III DTCs are generally treated with surgery (total thyroidectomy) along with radioiodine therapy (if the disease is iodine-sensitive) or external beam radiation therapy (EBRT) as the standard treatment.
Stage IV DTCs Stage IV DTCs sensitive to iodine are generally treated with radioiodine therapy as the standard treatment.
Stage IV DTCs that are not sensitive to iodine therapy can be treated with thyroid-suppression therapy, targeted therapy, or EBRT as per physician’s discretion. Surgery and EBRT may also be employed for palliation of symptoms of advanced disease.
Stage I-II MTCs Stage I-II MTCs are generally treated with surgery (total thyroidectomy) with or without EBRT as the standard treatment.
Stage III-IV MTCs Stage III-IV MTCs are generally treated with surgery (total thyroidectomy) along with thyroid hormone therapy and EBRT or targeted therapy as the standard treatment.
Palliative chemotherapy may also be employed for palliation of symptoms of advanced disease.
Genetic testing is generally recommended in MTCs so that other family members can also be screened and treated, as appropriate.
Stage IV Anaplastic thyroid cancer Anaplastic thyroid cancers are generally already widespread at the time of diagnosis. Rarely, when the disease is confined to locoregional area, surgery (total thyroidectomy) to remove the thyroid and regional lymph nodes can be performed.
For extensive disease, EBRT and/or chemotherapy are generally employed as standard treatment.

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Following is the brief description of various treatment types commonly employed for thyroid cancer:

  1. Surgery: Surgery is the treatment of choice for most early-stage DTCs and MRCs and some cases of anaplastic thyroid cancers that have not spread to distant body parts and can be completely removed by a surgical procedure.

    The main objective of surgery is to remove the primary tumor tissue along with some affected lymph nodes (if detected by imaging tests or during the procedure). Following are some commonly employed surgical procedures for the treatment of thyroid cancer:

    Lobectomy: In this surgical procedure, only the affected lobe of the thyroid gland is removed (generally along with the isthmus). This surgery is usually employed for low-risk, small DTCs (<1 cm) confined to one lobe of the thyroid gland without any lymph node involvement.

    The advantage of this procedure is that the patient can retain one lobe of the thyroid gland and will not require thyroid hormone supplementation after surgery. Radioiodine therapy cannot be given after this surgery as most of the iodine will be absorbed by the remnant thyroid.

    Total Thyroidectomy: In this surgical procedure, the entire thyroid gland is removed. Some of the suspected lymph nodes may also be removed during this procedure, especially in case of medullary or anaplastic thyroid cancers.

    Since all of the thyroid tissue is removed, thyroid supplementation is required after this surgery. The advantage of this procedure is that radioiodine therapy can be employed for ablation of any remaining (or recurrent) disease.

    Surgery for thyroid cancer may be associated with the risk of complications, such as temporary or permanent hoarseness or loss of voice, damage to the parathyroid glands leading to low blood calcium level and associated symptoms, infection, excessive bleeding, blood clots in the neck, etc.

  2. Radioiodine (RAI) Therapy: In this technique, therapeutic dose of radioiodine I-131 (much higher than that used for radioiodine scan) is administered to the patient. The iodine is taken up by the thyroid cancer cells (including the normal cells if any).

    The radiation from the iodine can destroy the thyroid cells that have concentrated the radioiodine, without much effect on the nearby healthy cells. This treatment is usually employed for destroying any remaining thyroid cells after total thyroidectomy or iodine-sensitive advanced-stage disease.

    The radioiodine therapy can only work in the presence of a sufficiently high level of TSH, which is achieved by administration of thyrotropin. Radioiodine therapy may be associated with side-effects like nausea, vomiting, swelling or tenderness in the neck or salivary glands, dry mouth, low sperm count in males, and irregularity in menstrual cycles in females.

  3. Thyroid Hormone Therapy: This treatment approach includes taking thyroid hormones at slightly higher dose than normal daily after surgical removal of the thyroid gland. This serves two purposes, first it provides necessary thyroid hormone supplementation for maintaining body’s normal metabolism, and secondly, it helps in reducing the growth of any remaining/recurrent thyroid cancer cells by decreasing the TSH level in blood.

    It can also be combined with other treatment modalities such as EBRT or chemotherapy for the treatment of some locally advanced or metastatic thyroid cancers. Side-effects of prolonged thyroid hormone therapy may include rapid or irregular heartbeat and osteoporosis.

  4. External Beam Radiation Therapy (EBRT) for Thyroid Cancer: Radiation therapy uses high-energy x-rays or other high-energy radiations which are directed to the affected area to kill cancerous cells. EBRT is generally used when radioiodine therapy cannot be used for the treatment, for example, in case of MTCs, anaplastic thyroid cancers, and iodine resistant advanced stage DTCs. Sometimes, EBRT is used as palliative therapy to relieve pain, bleeding, and obstructive symptoms associated with the advanced-stage disease.

  5. Targeted Therapy: Targeted drugs are designed to target a specific gene or protein characteristic of the thyroid cancer cells. Examples of targeted drugs that are active against different types of thyroid cancer include Sorafenib and Lenvatinib for papillary or follicular thyroid cancer; Vandetanib and Cabozantinib for medullary thyroid cancer; and Dabrafenib and trametinib for anaplastic thyroid cancer.

    These drugs are generally used in the treatment of advanced-stage thyroid cancers not responsive to radioiodine or thyroid hormone therapy. The side effects associated with targeted therapy vary according to the drug used. The side effects of targeted therapy are generally mild, but these can be severe in some cases.

  6. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly-growing cancer cells. Chemotherapy may be employed for the treatment of anaplastic thyroid cancers or for some advanced-stage MTCs that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with EBRT to accelerate the benefit achievement.

    Many pharmaceutical companies are conducting a number of clinical trials to find out new drugs and drug-combinations with increased efficacy and specificity to target thyroid cancer cells. Chemotherapy may be associated with side effects due to its effect on normal body cells apart from cancerous cells.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating thyroid cancer:

  • Prolongation of life
  • Reduction of symptoms
  • Improvement of overall quality of life
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