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Thyroid Cancer - A Patient's Story

At 29 years of age, she had just delivered her first child, who was then six weeks old. Her husband noticed a swelling on her neck and after a scan and a needle test of the lump, the doctor broke the news: "I'm sorry, the lump in your neck is a thyroid cancer." For this young mother the world was challenging enough right now, what with breast feeding her first child. Now she would have to deal with undergoing treatment for cancer.

Thyroid cancer is three times more common in women than men.Its cause is not fully understood but it is associated radiation exposure. For example, the radiation fallout at Chernobyl in 1986 correlated with a significant increase a decade later in thyroid cancer diagnoses among children who had been exposed to radiation. There is also a known familial risk if someone in the family has been diagnosed with thyroid cancer. In the medullary type of thyroid cancer, genetic testing has such a high predictive value that individuals at risk are advised to have thyroid surgery to prevent cancer development. Fortunately, the majority of the thyroid cancers have no familial link and the prognosis is excellent.

However, my clinical experience has brought many unexpected surprises overthe years such that one cannot make any assumption in the treatment of patients’ thyroid cancers.

The diagnosis of thyroid cancer is usually not difficult and is made by a needle biopsy or sometimes open surgery biopsy. In a patient with a thyroid lump, suspicion of cancer arises when there is a change in the voice (as the voice nerve runs intimately behind the thyroid gland and can be invaded by cancer), a feeling of the lump being fixed to the neck structures, or an association with a neck swelling, such as a lymph node.

Having established the diagnosis of thyroid cancer, the main treatment of such cancers will be a complete surgical removal of such a mass. A common question from patients who have done their own research about the cancer and the risk of surgery would be: "Doc, will I be able to talk after surgery?" One of the risks of thyroid surgery is that of voice impairment or even breathing difficulties. Good surgical technique is vital to preserving the integrity of the laryngeal nerves. There is also the need to preserve the calcium balance hormone glands (known as parathyroid glands) as a failure to preserve sufficient parathyroid tissue will lead to a long term need for oral calcium supplements.

Our young mother who had thyroid cancer underwent a successful total removal of the thyroid and also the removal of some of lymph glands of the neck. Fortunately, there were no complications from the surgery. She was then informed about the next phase of the treatment: radiation therapy in the form of an oral dose of radiation-tagged iodine six weeks after the surgery.

The young mother’s main concern was if the radiation would affect her baby. Radio-iodine remains in the body for about 2 weeks, so a period of physical separation is crucial in order not to place the baby at risk.

The treatment of thyroid cancer is well studied and the tri-modality treatment protocol of surgery, radio-iodine and suppression of cancer regrowth by thyroxine is the cornerstone of thyroid cancer treatment. There are situations where the use of external beam radiation is required but this is uncommon – it is usually reserved for large invasive cancers or poorly differentiated grade of thyroid cancers.

A year from her first radio-iodine treatment, our young mother was told that the blood test suggested that there were still some cancer cells that needed to be dealt with. Consequently, she underwent another round of radiation isolation. Two years after the second radiation treatment, with the doctor’s encouragement, the young mother is ready for baby number two.

A study I conducted of 150 Singaporean thyroid cancer patients revealed that thyroid cancer survivors have a good (near normal) quality of life. In particular, having a vocation and family support were directly related to avoiding this sense of “helplessness” after cancer diagnosis.

In summary, thyroid cancer is in general a very treatable disease. Although thyroid cancers usually do not have early warning signs, the diagnosis is not difficult to establish. The treatment results are excellent if the tri-modality of surgery, radio-iodine and thyroid hormone intake is done well. She remainswell today. Her second child is preparing for PSLE and the elder is in the ninth Grade.

DR Luke Tan is an ENT - Head and Neck Surgeon in Private Practice at Mount Elizabeth Medical Centre, with a special interest in thyroid, head and neck cancers. He obtainedspecialist training in head and neck cancer surgery at the University of Texas Medical Branch. He holds adjunct Associate Professorship and was the former Head of the University Department of ENT - Head & Neck Surgery at National University Hospital Singapore.

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