Thyroid Cancer: Specialists, Diagnosis and Treatment

Thyroid Cancer Treatment: Surgery

Surgery is the primary treatment for thyroid cancer in Singapore. The goal of surgery is to remove the cancerous thyroid gland and any nearby lymph nodes that may contain cancer cells.

The type of surgery performed depends on the size and location of the tumour. In some cases, a partial thyroidectomy may be performed, where only a portion of the thyroid gland is removed. In more advanced cases, a total thyroidectomy may be necessary, where the entire thyroid gland is removed.

During surgery, the patient is placed under general anesthesia, and an incision is made in the neck to access the thyroid gland. The surgeon carefully removes the cancerous tissue while trying to preserve the surrounding healthy tissue as much as possible. If cancer has spread to nearby lymph nodes, those may also be removed during the surgery.

After surgery, the patient will need to take thyroid hormone replacement medication for the rest of their life. This medication replaces the hormones that were previously produced by the thyroid gland and helps regulate metabolism and other bodily functions.

Thyroid Cancer Treatment: Radiation Therapy

Radiation therapy is a type of cancer treatment that uses high-energy radiation beams to kill cancer cells. There are two main types of radiation therapy used in the treatment of thyroid cancer in Singapore: external beam radiation therapy and radioactive iodine therapy.

• External beam radiation therapy involves the use of a machine that delivers high-energy radiation beams to the area where the cancer is located. This treatment is typically used after surgery to destroy any remaining cancer cells or to treat cancer that has spread to nearby lymph nodes or other areas of the body. During external beam radiation therapy, the patient lies on a table while the machine delivers the radiation beams to the affected area. The treatment is typically administered over several weeks, with the patient receiving treatment once a day or a few times a week.
• Radioactive iodine therapy is a type of targeted therapy that uses radioactive iodine to destroy cancer cells. This treatment is typically given after surgery to destroy any remaining cancer cells. During radioactive iodine therapy, the patient takes a pill containing radioactive iodine. Radioactive iodine travels through the bloodstream to the thyroid gland, where it concentrates in the thyroid cells. The radioactive iodine destroys the cancerous thyroid cells while sparing the surrounding healthy tissue. After radioactive iodine therapy, the patient may need to stay in the hospital for a few days to allow the radioactive iodine to pass out of their body. The patient will need to avoid close contact with other people during this time, as they will be emitting radiation.

Radiation therapy is a common treatment option for thyroid cancer. The choice of radiation therapy depends on the type and stage of the cancer and the patient’s overall health.

Thyroid Cancer Treatment: Chemotherapy

Chemotherapy is not typically used as a first-line treatment for thyroid cancer. This is because most types of thyroid cancer are not very responsive to chemotherapy.

However, in some cases where the cancer has spread to other parts of the body or is not responding to other treatments, chemotherapy may be used. Chemotherapy involves the use of drugs that target and kill rapidly dividing cancer cells.

Chemotherapy is usually given as an infusion into a vein or as a pill that is taken orally. The treatment is typically administered in cycles, with a period of rest in between cycles to allow the body to recover.

Thyroid Cancer Treatment: Targeted Therapy

Targeted therapy is a type of cancer treatment that uses drugs to target specific proteins or genes that help cancer cells grow and divide. In Singapore, targeted therapy is becoming an increasingly important treatment option for certain types of advanced thyroid cancers.

One of the main targeted therapy drugs used in the treatment of thyroid cancer is tyrosine kinase inhibitors (TKIs). TKIs are drugs that target specific proteins on the surface of cancer cells, inhibiting their growth and division.

TKIs are typically used to treat advanced or metastatic thyroid cancer that has spread to other parts of the body and is no longer responding to other treatments. TKIs are taken orally, usually once or twice a day, and are generally well-tolerated with fewer side effects compared to chemotherapy.

Thyroid Cancer Treatment: Immunotherapy

Immunotherapy is a type of cancer treatment that helps the patient’s own immune system to identify and attack cancer cells. In Singapore, immunotherapy is not currently a standard treatment option for thyroid cancer, but it is being studied in clinical trials for certain types of advanced thyroid cancers.

One type of immunotherapy being studied for thyroid cancer is immune checkpoint inhibitors. These drugs work by blocking proteins on cancer cells that prevent the immune system from attacking them. By blocking these proteins, immune checkpoint inhibitors can help the immune system recognize and attack cancer cells.

Clinical trials of immune checkpoint inhibitors have shown promising results in some patients with advanced thyroid cancer. However, not all patients respond to these drugs, and some may experience serious side effects, such as inflammation of the lungs, liver, or colon.

Another type of immunotherapy being studied for thyroid cancer is adoptive cell transfer therapy. This involves removing T cells from the patient’s blood, genetically modifying them to recognize and attack cancer cells, and then infusing the modified T cells back into the patient’s bloodstream. This approach is still in the early stages of development and is not widely available.

Are there any Side Effects of Thyroid Cancer Treatment?

Side Effects of Thyroid Cancer Treatment: Surgery 

Surgery is a common treatment option for thyroid cancer in Singapore. While it is generally safe and effective, there are still some potential side effects associated with the procedure. The specific side effects that a patient may experience depend on the extent of the surgery, and other factors such as their overall health and medical history.

Some common side effects of thyroid cancer surgery may include:

• Damage to the parathyroid glands, which can cause hypocalcaemia (low calcium levels) and symptoms such as numbness or tingling in the fingers, toes, or around the mouth, muscle cramps, and seizures.
• Damage to the recurrent laryngeal nerve, which can lead to hoarseness or loss of voice.
• Temporary or permanent difficulty swallowing, depending on the extent of the damage.
• Temporary or permanent changes in thyroid hormone levels, which may require lifelong hormone replacement medication.
• Risks associated with anaesthesia, such as bleeding, infection, or other complications.

Side Effects of Thyroid Cancer Treatment: Radiation Therapy

Radiation therapy is a common treatment option for thyroid cancer in Singapore, but it can also have side effects. Here are some potential side effects of radiation therapy for thyroid cancer:

• Fatigue or tiredness: Radiation therapy can cause fatigue, which may persist for weeks or months after treatment.
• Skin changes: Radiation therapy can cause skin changes in the treated area, including redness, dryness, itching, or peeling. These changes usually resolve within a few weeks after treatment.
• Nausea or vomiting: Some patients may experience nausea or vomiting during or after radiation therapy, but this is less common with modern radiation techniques.
• Difficulty swallowing: Radiation therapy to the neck area can cause inflammation and swelling of the throat, which can make it difficult to swallow.
• Hoarseness or voice changes: Radiation therapy to the neck area can also damage the vocal cords, which can cause hoarseness or changes in the voice.
• Dry mouth or thickened saliva: Radiation therapy can damage the salivary glands, which can lead to dry mouth or thickened saliva.
• Taste changes or loss of taste: Radiation therapy can affect the taste buds, causing changes in taste or loss of taste.
• Hair loss: Radiation therapy to the head and neck area can cause hair loss in the treated area.
• Inflammation of the thyroid gland (thyroiditis): Radiation therapy can cause inflammation of the thyroid gland, which can lead to temporary or permanent changes in thyroid hormone levels.
• Long-term risks: In rare cases, radiation therapy for thyroid cancer can increase the risk of developing other cancers or thyroid problems later in life.

Side Effects of Thyroid Cancer Treatment: Chemotherapy

Chemotherapy is not a common treatment option for thyroid cancer, but it may be used in certain cases.

Here are some potential side effects of chemotherapy for thyroid cancer:

• Nausea and vomiting: Chemotherapy drugs can cause nausea and vomiting. Your doctor may prescribe medication to help prevent or manage these symptoms.
• Hair loss: Chemotherapy drugs can cause hair loss, including hair on the scalp, eyebrows, eyelashes, and body hair.
• Fatigue: Chemotherapy can cause fatigue, which may persist for several weeks after treatment.
• Mouth sores: Some chemotherapy drugs can cause sores in the mouth, throat, and esophagus.
• Decreased appetite: Chemotherapy can cause a decreased appetite and weight loss.
• Increased risk of infection: Chemotherapy can weaken the immune system, increasing the risk of infections.
• Bruising or bleeding: Chemotherapy can lower the number of blood cells, which can lead to an increased risk of bruising or bleeding.
• Peripheral neuropathy: Some chemotherapy drugs can cause damage to the nerves in the hands and feet, leading to numbness, tingling, or pain.
• Skin changes: Some chemotherapy drugs can cause skin changes, including rash, dryness, or sensitivity to sunlight.

Side Effects of Thyroid Cancer Treatment: Targeted Therapy

Targeted therapy is a type of cancer treatment that uses drugs to target specific molecules involved in the growth and spread of cancer cells. While targeted therapy drugs may have fewer side effects than traditional chemotherapy, they can still cause some side effects. Here are some potential side effects of targeted therapy for thyroid cancer:

• Fatigue or weakness: Targeted therapy can cause fatigue, which may persist for several weeks after treatment.
• Nausea or vomiting: Some targeted therapy drugs can cause nausea and vomiting.
• Diarrhea or constipation: Targeted therapy drugs can cause changes in bowel habits, including diarrhea or constipation.
• Skin changes: Some targeted therapy drugs can cause skin changes, including rash, dryness, or sensitivity to sunlight.
• High blood pressure: Some targeted therapy drugs can cause high blood pressure.
• Liver problems: Some targeted therapy drugs can cause liver problems, including abnormal liver function tests or liver damage.
• Decreased appetite: Targeted therapy can cause a decreased appetite and weight loss.
• Risk of bleeding: Some targeted therapy drugs can increase the risk of bleeding.
• Risk of blood clots: Some targeted therapy drugs can increase the risk of blood clots.

Side Effects of Skin Cancer Treatment: Immunotherapy

Immunotherapy is a type of cancer treatment that uses the body’s immune system to fight cancer cells. While immunotherapy can be a promising treatment for some patients with advanced thyroid cancer, it can also cause some side effects. Here are some potential side effects of immunotherapy for thyroid cancer:

• Fatigue or weakness: Immunotherapy can cause fatigue or weakness, which may persist for several weeks after treatment.
• Skin reactions: Some immunotherapy drugs can cause skin reactions, including rash, itching, or blistering.
• Diarrhea or colitis: Immunotherapy can cause inflammation of the digestive tract, which can lead to diarrhea, abdominal pain, or colitis.
• Endocrine dysfunction: Immunotherapy can cause dysfunction of the endocrine glands, including the thyroid gland.
• Infusion reactions: Some patients may experience infusion reactions, including fever, chills, or shortness of breath.
• Liver problems: Immunotherapy can cause liver problems, including abnormal liver function tests or liver damage.
• Lung problems: Some immunotherapy drugs can cause lung problems, including coughing or shortness of breath.
• Kidney problems: Some immunotherapy drugs can cause kidney problems, including abnormal kidney function tests or kidney damage.

What do I need to do if I have Thyroid Cancer?

It is important to remember that thyroid cancer can be treated successfully if caught early. If you have any concerns about your thyroid or notice any changes, do not hesitate to see a healthcare professional for evaluation.

If you suspect that you or your loved one have thyroid cancer, it is advisable to get the support you need. Early detection and diagnosis of thyroid cancer is key to treating the disease.

Regardless of what stage your thyroid cancer may be at, you should schedule an appointment to see an oncologist specialising in thyroid cancer as soon as possible. With the speed of developments in thyroid cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.

Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of thyroid cancer, as well as earlier stages of the disease.

What is Thyroid Cancer?

Definition of Thyroid Cancer

Thyroid cancer is a type of cancer that affects the thyroid gland, which is a butterfly-shaped gland located in the neck that produces hormones that regulate the body’s metabolism. The thyroid gland is made up of different types of cells that can become cancerous.

Thyroid cancer can occur at any age, but it is most commonly diagnosed in people between the ages of 30 and 60. Women are also more likely than men to develop thyroid cancer.

There are different types of thyroid cancer, including:

• Papillary thyroid cancer: This is the most common type of thyroid cancer, accounting for about 80% of all cases. It develops from follicular cells and tends to grow slowly.
• Follicular thyroid cancer: This type of thyroid cancer also develops from follicular cells and accounts for about 10% of all cases. It tends to spread to other parts of the body more quickly than papillary thyroid cancer.
• Medullary thyroid cancer: This type of thyroid cancer develops from C cells, which produce a hormone called calcitonin. Medullary thyroid cancer accounts for about 5% of all thyroid cancer cases.
• Anaplastic thyroid cancer: This is a rare and aggressive form of thyroid cancer that tends to spread quickly and is difficult to treat.

According to the International Agency for Research on Cancer (IARC), in 2020, there were an estimated 586,000 new cases of thyroid cancer worldwide and 42,000 deaths from the disease.

In Singapore, thyroid cancer is the 7th most common cancer among women, with an incidence rate of 8.1 per 100,000 populations in 2018, according to the Singapore Cancer Registry. The incidence of thyroid cancer in Singapore has been increasing over the past few decades, with an average annual increase of 5.2% in women between 1973 and 2017, and 3.8% in men between 1993 and 2017. The mortality rate for thyroid cancer in Singapore is relatively low, with 1.1 deaths per 100,000 population in 2018.

It is worth noting that the incidence of thyroid cancer has been increasing globally over the past few decades, which is partly attributed to the increased use of diagnostic imaging tests such as ultrasound and CT scans, which can detect small thyroid nodules that may not have been detected in the past. However, the majority of thyroid cancers are still highly treatable, and the prognosis for most patients is excellent, with a 5-year survival rate of around 98%.

What are the Signs and Symptoms of Thyroid Cancer?     

The signs and symptoms of thyroid cancer can vary depending on the type and stage of the cancer. Some people with thyroid cancer may not have any symptoms, and the cancer may be detected during a routine physical exam or through imaging tests.

Definition of Thyroid Cancer

• A lump or swelling in the neck: This is the most common symptom of thyroid cancer. The lump may be painless or tender to the touch and may increase in size over time.
• Changes in the voice: Thyroid cancer can affect the nerves that control the voice box, leading to hoarseness or other changes in the voice.
• Difficulty swallowing: A large thyroid tumour can press on the esophagus or trachea, causing difficulty swallowing or breathing.
• Neck pain: Some people with thyroid cancer may experience pain in the neck, ears, or jaw.
• Enlarged lymph nodes: Cancer cells can spread to the lymph nodes in the neck, causing them to become enlarged and tender.
• Fatigue: Thyroid cancer can cause fatigue or weakness, especially if the cancer has spread to other parts of the body.

What are the Stages of Thyroid Cancer?

The staging of thyroid cancer refers to the extent to which the cancer has spread beyond the thyroid gland. The most commonly used staging system for thyroid cancer is the TNM system, which stands for Tumour, Nodes, Metastasis.

Here are the stages of thyroid cancer:

• Stage I: The cancer is confined to the thyroid gland and has not spread to nearby lymph nodes or other parts of the body.
• Stage II: The cancer is still confined to the thyroid gland but has grown larger and may have invaded nearby tissues.
• Stage III: The cancer has spread to nearby lymph nodes but has not spread to other parts of the body.
• Stage IV: The cancer has spread beyond the thyroid gland to nearby tissues or organs, or to distant sites in the body such as the lungs or bones.

Each stage is further divided into subcategories based on the size and extent of the cancer, as well as the number and location of affected lymph nodes. The stage of cancer helps guide treatment decisions and can also provide information about the likely outcome of the disease.

More about Head and Neck Cancer