Head & Neck Oncology Program

Thyroid Cancer

Stages and Treatment Options

If a patient is diagnosed with thyroid cancer, the doctor will order more tests to find out if cancer cells have spread to other parts of the body. This process, called staging, helps the doctor to plan the patient’s treatment.

The stages that describe each of the four types of thyroid cancer are listed below:

For papillary carcimona:

Stage I: Cancer is only in the thyroid and may be found in one or both lobes.
Stage II: In patients younger than 45 years of age, cancer has spread beyond the thyroid. In patients older than 45 years of age, cancer is only in the thyroid and is larger than one centimeter (about 1/2 inch).
Stage III: Cancer is found in patients older than 45 years of age and has spread outside the thyroid (but not outside of the neck) or has spread to the lymph nodes.
Stage IV: Cancer is found in patients older than 45 years of age and has spread to other parts of the body, such as the lungs and bones.
Recurrent: The cancer has come back after it has been treated. It may come back in the thyroid or in another part of the body.

For follicular carcinoma:

Stage I: Cancer is only in the thyroid and may be found in one or both lobes.
Stage II: In patients younger than 45 years of age, cancer has spread beyond the thyroid. In patients older than 45 years of age, cancer is only in the thyroid and larger than one centimeter (about 1/2 inch).
Stage III: Cancer is found in patients older than 45 years of age and has spread outside the thyroid (but not outside of the neck) or to the lymph nodes.
Stage IV: Cancer is found in patients older than 45 years of age and has spread to other parts of the body, such as the lungs and bones.
Recurrent: The cancer has come back (recurred) after it has been treated. It may come back in the thyroid or in another part of the body.

For medullary carcinoma:

Stage I: Cancer is less than one centimeter (about 1/2 inch) in size.
Stage II: Cancer is between one and four centimeters (about 1/2 to 1 1/2 inches) in size.
Stage III: Cancer has spread to the lymph nodes.
Stage IV: Cancer has spread to other parts of the body.
Recurrent: The cancer has come back (recurred) after it has been treated. It may come back in the thyroid or in another part of the body.

For anaplastic carcinoma:

There is no staging system for anaplastic cancer of the thyroid. This type of cancer of the thyroid grows faster than the other types.

Treatment and Side Effects

There are four primary treatments for patients with cancer of the thyroid:

surgery
radiation therapy
hormone therapy
chemotherapy

Surgery

Surgery is the most common treatment of cancer of the thyroid. A doctor may remove the cancer using one of the following operations:

Lobectomy: This procedure removes only the side of the thyroid where the cancer is found. Lymph nodes in the area may be taken out (biopsied) to see if they contain cancer.
Near-total thyroidectomy: Most of the thyroid is removed.
Total thyroidectomy: The entire thyroid is removed.
Lymph node dissection: The lymph nodes in the neck that contain cancer are removed.

Side effects of surgery: The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

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Radiation Therapy

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation for cancer of the thyroid may come from a machine outside the body (external radiation therapy) or from drinking a liquid that contains radioactive iodine. Because the thyroid takes up iodine, the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells.

Side effects of radiation therapy: The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

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Hormone Therapy

Hormone therapy uses hormones to stop cancer cells from growing. In treating cancer of the thyroid, hormones can be used to stop the body from making other hormones that might make cancer cells grow. Hormones are usually given as pills.

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Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

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This page was last updated on: March 5, 2008.