Cricket fans are holding thumbs that SA cricket vice-captain, Nicky Bojé, will make a complete recovery. Bojé, who has thyroid cancer, recently had his thyroid removed. What are the symptoms and treatment of thyroid cancer? Thyroid cancer is not as common as many other types of cancer. Yet, about 2000 new cases are diagnosed in South Africa each year.

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Although it can occur in any age group, it is most common in people over age 30 years. Only 25 percent of all cases are male.

It is less aggressive in young people. In most cases, the cancer can be completely removed with surgery. The five-year survival rates are more than 90 percent.

The thyroid
This butterfly-shaped gland at the base of your neck is situated below your Adam's apple. The thyroid absorbs iodine from your food to produce thyroxine and triiodothyroxine. These hormones play a major role in many aspects of the body's metabolism, from regulating body temperature, heart tempo, the tempo of burning calories to the tempo of the production of protein.

The thyroid (or more precisely the parathyroid) also produces calcitonin, a hormone essential in the regulation of the concentration of calcium in your blood.

Symptoms
Most patients with thyroid cancer present with a thyroid nodule, but without any other symptoms. However, many people – some researchers estimate more than 10 percent of the population – may have thyroid nodules, with 95 percent of the nodules being non-cancerous.

Although early thyroid cancer often does not cause any symptoms, a small percentage of patients show symptoms such as hoarseness, neck pain, and enlarged lymph nodes.

As the cancer grows, even patients who were initially symptom-free, may start to show some of the following symptoms:

• A lump, or nodule, in the front of the neck just below the Adam's apple. This lump may grow rapidly;
• Hoarseness or difficulty speaking in a normal voice, because the lump is close to the vocal cords;
• Swollen lymph nodes, especially in the neck;
• Difficulty swallowing or breathing;
• Pain in the throat or neck;
• Trouble breathing, in more advanced cases.

These symptoms are not sure signs of thyroid cancer. Other conditions such as an infection or inflammation of the thyroid gland, or a benign thyroid nodule could also cause these symptoms. All these conditions are highly treatable.

Although these symptoms do not mean that you have thyroid cancer, anyone with these symptoms should see a doctor as soon as possible.

If a person has symptoms that suggest thyroid cancer, the doctor may perform a physical exam and ask about the patient's personal and family medical history. The doctor also either obtains a sample of the nodule during a surgical biopsy or by ways of a fine needle aspiration (by sticking a fine needle into the nodule to sample cells). Laboratory tests on these cells and imaging tests to produce pictures of the thyroid and other areas, are used to confirm the clinical diagnosis.

Types of thyroid cancer, cure rates and treatment
There are four types of thyroid cancer. The most common types of thyroid cancer respond best to treatment.

The four types of thyroid cancer are:

• 1. Papillary and mixed papillary/follicular thyroid cancer (including papillary carcinoma and adenocarcinoma). This is the most common type and occurs in 75 percent of cases. It develops from the thyroid follicle cells and thus affects the production of thyroxine and triiodothyroxine. It is most common in women 30 to 50 years of age. They grow slowly. Although they can spread to the lymph nodes even in early stages of the cancer, this fact does not affect the excellent cure rates. In younger patients the cure rates are higher than 95 percent if diagnosed early and treated correctly. Typical treatment involves complete surgical removal of the affected lobe, as well as almost complete removal of the unaffected lobe. The cure rates are lower in older people with large tumours. However, even tumours that have spread to the lungs or bone can be treated.
• 2. Follicular and Hurthke cell cancer (including follicular carcinoma and follicular adenocarcinoma) in 15 percent of cases. In younger people, the cure rates are higher than 95 percent. Typical treatment involves complete surgical removal of the affected lobe, as well as almost complete removal of the unaffected lobe. Follicular tumours are less likely to spread to the lymph nodes, but more likely to involve the blood vessels within the thyroid gland. It may spread to the lungs and bone.
• 3. Medullary thyroid cancer occurs in 7 percent of cases. These tumours arise from the calcitonin-producing C cells and tend to spread to the lymph nodes, even from an early stage before a lump is detected. This necessitates the complete surgical removal of the thyroid and of the lymph nodes on the sides and front of the neck. Some forms of medullary thyoroid cancer are hereditary, but these are fortunately slower growing.
• 4. Anaplastic thyroid cancer occurs in 3 percent of cases, tends to be very aggressive, and has a poor prognosis. In most cases it has spread to other organs – first to the lymph nodes and windpipe, and then to the lungs and bone. There is little chance of removing all the malignant tissue during surgery. Treatment with radio-active iodine is not usually successful.
• 5. Thyroid lymphoma is extremely rare. This form of cancer originates in lymphocytes, a type of white blood cell.

Your GP may refer you to doctors who specialise in treating cancer. Specialists who treat thyroid cancer include surgeons, endocrinologists, medical oncologists, and radiation oncologists. This team will decide whether you need surgery alone or surgery and radio-active iodine treatment.

Treatment generally begins within a few weeks after the diagnosis.

In addition to surgery, chemotherapy with radio-active iodine is a unique option in the treatment of some cases of thyroid cancer since no other types of cells but thyroid cells can absorb iodine. The remaining thyroid cells absorb and concentrate the radio-active iodine in the cells leading to radiotherapy from within the cells themselves. The patient will not suffer the usual side-effects of external radiotherapy such as nausea, pain and hair loss.

Patients with small pappilary cancers may not need radio-active iodine therapy because the cancers are often completely removed with surgery. Patients with medullary thyroid cancer cannot benefit from the radio-active treatment because these cancerous thyroid cells have lost their ability to absorb iodine.

What Bojé might be going through
Patients who have their thyroid glands removed are often uncomfortable for the first few days after surgery. However, medicine can usually control their pain. It is also common for patients to feel tired or weak. The length of time it takes to recover from an operation varies for each patient.

After surgery to remove the thyroid and nearby tissues or organs, such as the parathyroid glands, patients may need to take medication containing the thyroid hormone, as well as vitamin D and calcium to replace the lost functions of these glands. In a few cases, certain nerves or muscles may be damaged or removed during surgery. If this happens, a patient may have voice problems or one shoulder may be lower than the other.

Causes and risk factors
The DNA damage to thyroid cells may be caused by radiation exposure to the thyroid (exposure to atomic weapons, accidental exposure at nuclear power plants and accidents such as 1986 Chernobyl disaster), ageing, or in some cases, genetics.

Children are especially vulnerable to radio-active exposure damage. More than 2000 children developed thyroid cancer after the Chernobyl disaster because they consumed milk, fruit and vegetables contaminated by radio-active iodine particles during the fallout.

Certain factors will increase your risk to develop thyroid cancer:

• 1. Exposure to radio-active iodine particles
• 2. If one of your parents had been diagnosed with Medullary thyroid cancer known as MEN 2A or MEN 2B, you have a 50 percent chance to develop thyroid cancer. You may want to opt for genetic screening.
• 3. If you have a hereditary tendency to develop large polyps in your colon, as well as a rare inherited disease that causes lesions on the face, in the mouth and on the hands and feet, risk for thyroid cancer is increased.
• 4. A diet low in iodine. This is uncommon in people using table salt with added iodine.
• 5. Women are two to three times more likely to develop thyroid cancer. The reasons are unclear.
• 6. Women who were pregnant when they were 30 years or older, are at greater risk.
• 7. In general thyroid cancer is more common among young adults.
• 8. Caucasians are more at risk than black people.

- Main source: The US National Institutes of Health
 

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