Medullary Thyroid Cancer – Symptoms, Treatment, Prognosis


What is Medullary Thyroid Cancer?

Medullary Thyroid Cancer or MTC is a thyroid carcinoma that came from the parafollicular C cells of our thyroid gland. It is the one that is responsible for producing calcitonin that lowers the blood levels of calcium in our body.

Medullary Thyroid Cancer


Medullary Thyroid Cancer Showing Growth of Tumor in the Neck Area

The result of the treatment will depend on the severity of the disease, the tumor condition, and the efficiency of treatments given (especially surgical interventions). Surgical interventions are proven to be effective if the condition is diagnosed early. Radioiodine, a treatment that is commonly used in other types of cancers, is not effective against Medullary Thyroid Cancer.

Medullary Thyroid Cancer Symptoms

  • Lump – Patients may notice a lump at the base of the neck, this can be more noticeable when swallowing.
  • Respiratory problems – This is due to the pressure produced by the lump to the respiratory tract.
  • Diarrhea – This is due to the high levels of calcitonin in our blood that causes increased production of intestinal electrolytes.
  • Loss of weight and bone pain – These are late symptoms and also an indication of the spread of the cancer cells to other parts of the body (bones, gastrointestinal, and other adjacent organs).
  • Jaundice – Occurs in patients who have systemic spread of the cancer cells (liver).
  • Flushing – This can be a general symptom that can be also associated with other conditions.
  • Lethargy – This indicates a spread of the cancer cells in the brain. This can be present, but it is mostly uncommon.

Causes of Medullary Thyroid Cancer

Like all other cancers, there is no clear condition. There are many studies that have been conducted in order to reveal the real cause of Medullary Thyroid Cancer, the facts that have been gathered are the risk factors associated with MTC. These are the risk factors associated with MTC:


  • Genes – In most of oncology cases (cancer), the most common risk factor is the genes, also a family history of Goiter is also a risk factor of having MTC.
  • Exposure to Radiation – Radiation causes mutation of our cells, people who work in a place where radiation exposure is common is at risk.
  • Inherited Genetic Syndrome – There are some genetic syndromes that make a person vulnerable to Medullary Thyroid Cancer.

Diagnosis

  • Physical Exam – Lumps are palpable in the base of the neck, if a lump can be palpated, please consult your physician.
  • Blood Tests – Blood tests are valuable for checking if the patient has an increased secretion of Thyroid Stimulating Hormone, this hormone is associated with Goiter, which is a risk factor to MTC.
  • Biopsy – It is a procedure to extract sample cells from your thyroid to see if cancer cells are present.

Treatment of Medullary Thyroid Cancer

Treatment will vary depending on the severity of the condition and of course, your preferences. These are the treatment options that are available for the patients are:

Chemotherapy

This is a drug based treatment option that kills the cancer cells that cause the condition. A major side-effect of this treatment is that innocent cells or the healthy cells are also affected, especially the cells that multiply quickly such as your hair cells and your nails cells. This is because chemotherapeutic drugs are specially made to target cells that reproduce quickly, cancer cells, are cells that reproduce quickly.


Radiation Therapy

There are two types of radiation therapy, external and internal radiation therapy. I listed the difference of the two types.

Internal Radiation

This method uses radioactive iodine for this type of cancer. Although I stated earlier that this will be useless in treating MTC, this can be useful after the thyroid removal. That is why this is a preferred method to destroy the remnants of the thyroid tissue after removal and also to treat recurring thyroid cancer.

Advantage:

Generally, iodine is taken by the thyroid cells, in this case, there is a low chance of harming normal and healthy cells in our body.

Disadvantage:

Side-effects are the main disadvantages of this type of treatment.

  • Dry Mouth
  • Dry Eyes
  • Change in the sense of smell and taste
  • Nausea and Vomitting
  • Pain, especially in the location where the cancer cells have spread.

External Radiation

This method uses a machine that produces a high-energy beam that contains radiation. It is usually used to destroy cancer cells that have spread (e.g. Bones). Please note that there will be markings on your screen made by your physician, make it sure that it doesn’t get erased.


Advantage:

This type of radiation uses a beam that only kills the cancer cells locally. This way the side-effects tend to be local than sytemic.

Disadvantage:

Side-effects are local. It includes:

  • Pain
  • Redness
  • Inflammation
  • Itchiness

Hormone Therapy

This is commonly for the patients that have their thyroid removed. This treatment method has two purpose, one is to supply the hormones that the thyroid is producing and it will suppress the production of Thyroid Stimulating Hormone, this hormone is believed to be a cause to stimulate the cancer cells left behind by the surgery to grow and multiply.

Surgery

This is a method to remove the source of the cancer cells out of our body. It can be removed partially and totally that will depend on the severity of the condition. The purpose is simple, remove the cancer-producing organ.

Even though there are treatments available for MTC, Thyroid cancer can return. That is also possible even if your thyroid has been removed. This is due to remnant cancer cells that were spread to other areas before the removal of your thyroid. This recurrence often appear after 10 to 20 years after the treatment of thyroid cancer. You may want to ask where thyroid cancer will recur if there is no thyroid, to answer your questions, I listed the most common location of recurrence. Please see the list below:

a. Lymph Nodes around the neck

b. Lungs

c. Bones

d. Remnants of the thyroid tissue after the surgery

The recurrence of thyroid cancer can also be treated. You just need to make appointments to your doctor so that the recurrence can be detected as soon as possible.

Prognosis

The prognosis varies depending on the calcitonin levels in the blood of the patient, According to some studies, the survival rate is related to the calcitonin levels in the blood.

Survival rate

80% to 86% of the patients are able to survive after five years, and 75% of that is able to survive for 10 years.

Staging

Stage I (T1, N0, M0): Tumor is 2.0 cm or less and has not spread outside the (T1) thyroid. It has not grown up to the nearby (N0) lymph nodes or (M0) distant sites.

Stage II: These are the conditions:

  • T2, N0, M0: The tumor is more than 2.0 cm, but less than 4.0 cm across and has not grown outside the (T2) thyroid. It has not grown up to the nearby (N0) lymph nodes or (M0) distant sites.
  • T3, N0, M0: The tumor is larger than 4.0 cm or has spread slightly outside the (T3) thyroid, but it has not grown up to the nearby (N0) lymph nodes or (M0) distant sites.

Stage III (T1 to T3, N1a, M0): The tumor is any size and may have spread slightly outside the (T1 to T3) thyroid. It has grown out up to the lymph nodes around the thyroid in the (N1a) neck, but not to (M0) distant sites.

Stage IVA: These are the conditions:

  • T4a, any N, M0: The tumor is any size and has spread beyond the thyroid gland and into nearby tissues of the (T4a) neck. It may or may not have grown up to the (any N) nearby lymph nodes. It has not spread to (M0) distant sites.
  • T1 to T3, N1b, M0: The tumor is any size and may have spread slightly outside the (T1 to T3) thyroid gland. It has grown up to the certain lymph nodes in the neck (cervical nodes) or to lymph nodes in the upper part of the chest (superior mediastinal nodes) or at the back of the (N1b) throat (retropharyngeal nodes) but not to (M0) distant sites.

Stage IVB (T4b, any N, M0): The tumor is any size and has spread either back towards the spine or into a (T4b) nearby large blood vessels. It may or may not have grown up to the (any N) nearby lymph nodes, but it has not spread to the (M0) distant sites.

Stage IVC (any T, any N, M1): The tumor is any size and may or may not have spread outside the (any T) thyroid. It may or may not have grown up to the (any N) nearby lymph nodes. It has grown up to the (M1) distant sites.

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