Thyroid Cancer Awareness Month is a good time to look at how thyroid cancer care is changing. While getting a cancer diagnosis is overwhelming, many thyroid cancers are highly treatable with good outcomes.
Fast Facts About Thyroid Cancer
- The thyroid is a small gland in the lower front of the neck that plays a role in metabolism and other essential body processes.
- Thyroid nodules are common, especially among women. Most nodules are not cancer.
- When thyroid cancer is diagnosed, it often affects people at a younger age than many other adult cancers (males at 55, and females at 50).
- Thyroid cancer is diagnosed more often in women.
- In the United States, new thyroid cancer diagnoses have leveled off after a long trend of steady increases. About 44,000 new cases are diagnosed annually.
- More than one million people in the U.S. are living with a positive long-term outlook after a previous diagnosis of thyroid cancer.
Right-Sized Treatment Plans
Many thyroid cancers have an excellent prognosis, and doctors are looking more closely at precisely how much treatment each patient needs. The type, size and location of the cancer all matter. So does the patient’s overall health. The goal is to choose the safest treatment that still gives each patient the best chance for a good outcome.
We believe it is important for patients to have a care team that understands thyroid cancer well. Working with a high-volume thyroid surgeon can help improve outcomes and reduce complications.
For some patients with low-risk thyroid cancer, treatment may be a smaller surgery. For others, it may be watching the cancer closely before deciding on surgery. In rare cases, other targeted treatments may be considered. When patients understand the risks and benefits of each option, they can take part in choosing a treatment plan that fits their diagnosis and goals.
- Less Extensive Surgery. In the past, most patients had their whole thyroid removed followed by radiation treatment. Today, some patients with low-risk thyroid cancer may only need part of the thyroid removed. For the right patient, this can lower the risks of surgery. It may also help the body keep making enough thyroid hormone.
- Active Surveillance. For a small group of patients with very low-risk thyroid cancers, doctors may watch the cancer closely instead of doing surgery right away. This is called active surveillance. This option is only considered when patients meet strict criteria such as a tumor smaller than 1 centimeter, no suspicious lymph nodes and no signs that the cancer is close to or invading important nearby structures. This approach requires a long-term follow-up plan with regular ultrasound imaging and close review by an endocrinology and endocrine surgery team. Active surveillance is not appropriate for everyone. Patients are usually not candidates if the cancer has aggressive features, involves lymph nodes, has spread outside the thyroid, is located near critical structures, or if regular follow-up would be difficult. If the cancer grows, changes, or lymph node disease appears, surgery may become the recommended next step.
Recent studies and guidelines suggest that for carefully selected patients, close observation and early surgery can both lead to excellent outcomes. The key is careful selection. Patients need low-risk tumor features and the ability to stay engaged in follow-up over time.
- Radiofrequency Ablation. Radiofrequency Ablation (RFA) is an image-guided procedure that uses heat to treat a targeted thyroid area through the skin. It is more commonly used for benign thyroid nodules, but guidelines now recognize a narrow role for some very small, low-risk papillary thyroid cancers. RFA may also be an option for patients who may not be able to undergo surgery safely. RFA is not right for most thyroid cancers, and it has important limits. Unlike surgery, it does not remove tissue for full pathology review and may provide less certainty that all cancer cells have been eliminated.
- When to Talk to Your Healthcare Provider. Some thyroid cancers are found because a person or healthcare provider notices a new lump in the neck. Others are discovered during imaging or exams for unrelated reasons. Possible signs include a neck mass, hoarseness, trouble swallowing or a feeling of pressure in the throat. Anyone who notices these changes should bring them to their healthcare provider’s attention.
When it comes to thyroid cancer, more treatment is not always better and less treatment is not always right. The best plan depends on the patient, the cancer and the care team’s experience. We encourage patients to ask questions, understand all reasonable options and take part in treatment decisions with their specialists.