October 15, 2021 by John Fernandez
Spotlight on Thyroid Cancer, An Increasingly Common Cancer Among Women
When actress Sofia Vergara recently opened up on television about her experience with thyroid cancer, she helped shine a spotlight on this increasingly common cancer.
The Emmy-winning Modern Family actress has revealed through numerous interviews that she was diagnosed at age 28 in 2000. A young mother at the time, she had her thyroid removed and she underwent radiation treatment. Today, at 49, she says she takes thyroid medicine daily, is healthy and grateful that her condition was caught early during a routine exam.
Although thyroid cancer is detected and diagnosed even more commonly today, treatment has evolved in the past two decades, says Robert Udelsman, M.D., chief of endocrine surgery and director of the Endocrine Neoplasia Institute at Miami Cancer Institute. For certain types of thyroid cancer, a conservative approach may be called for. Not everyone needs to have their thyroid immediately removed.
“There has been a really dramatic change in the management of thyroid cancer in the past 10 to 15 years,” Dr. Udelsman explains. “This is where precision medicine and experienced teams of physicians and other healthcare providers are essential. It’s not just how to operate, or how to give radiation oncology or medical oncology — it’s when not to give it, when observation alone is perfectly adequate and reasonable.”
Understanding Thyroid Cancer
The American Cancer Society estimates there will be about 44,280 new cases of thyroid cancer diagnosed in 2021, with about 2,200 deaths. The condition is especially common in women, who are three times more likely to develop thyroid cancer than men. While the disease can be found in any gender at any age, it’s most frequently found in women in between age 30 and 65.
Thyroid cancer occurs when genetic mutations emerge in the cells of this butterfly-shaped gland, which produces hormones that help regulate metabolism, heart rate, blood pressure and body temperature. The abnormal cells have the potential to spread to other parts of the body.
There are different kinds of thyroid cancer. Poorly differentiated and undifferentiated tumors (anaplastic thyroid cancer) are more rare. These tumors grow and spread quickly and present a poorer chance of recovery.
The more common kinds of thyroid cancer (papillary thyroid cancer and follicular thyroid cancer) are far less aggressive and in some cases don’t present a risk to the patient’s life. In these cases, the first course of treatment may be to closely monitor their progression. When treated, they can usually be cured.
“We can watch the cancer over time, rather than immediately subject patients to invasive surgery that often results in them needing to take medication for the rest of their lives,” Dr. Udelsman says.
Geoffrey Young, M.D., chief of head and neck cancer at Miami Cancer Institute, agrees. “A lot of times in the past, most patients would have received a big operation where their entire thyroid would be removed, the lymph nodes in their neck would be removed, and then they would be followed up with radioactive iodine,” Dr. Young says. “But now we have new guidelines and new technologies and things that help us to really individualize and streamline treatment so that we are doing less in a lot of these cases – less biopsies, less aggressive surgery and less radioactive iodine treatment.”
When Treatment Is Required
When intervention is required, radioactive iodine is one of the main modalities of treatment for most thyroid cancers, particularly differentiated thyroid cancers such as papillary and follicular cancer. Radioactive iodine is usually administered in pill form after the thyroid is surgically removed, but it can also be given in liquid form if needed.
“Radioactive iodine is one of the original targeted treatments because the tumor cells take up iodine, so the treatment is selectively treating the tumor cells very effectively,” explains radiation oncologist Noah Kalman, M.D.
However, Dr. Kalman notes, the percentage of patients who require radioactive iodine has decreased, as well as the dose used for these patients.
“Studies have shown that for a large number of patients, a lower dose of radioactive iodine works just as effectively as a higher dose, and that the side effects from treatment are reduced when we are able to use a lower dose,” Dr. Kalman says.
Patients with more aggressive anaplastic thyroid cancer, which does not respond as well to traditional treatments, should have molecular testing to identify particular mutations or gene rearrangements, says hematologist-oncologist Guilherme Rabinowits, M.D.
“Today, we have many active targeted therapies that can act against those mutations and significantly impact the treatment choices for these patients,” Dr. Rabinowits says.
The Value Of Expert Care
The complexity and evolution of care for thyroid cancer means it is more important than ever to seek the kind of expert care patients can find at Miami Cancer Institute.
“The management of thyroid cancer is probably the quintessential example of precision medicine managed by a team of dedicated physicians, nurses and other healthcare providers,” Dr. Udelsman says. “It requires dedicated medical oncologists familiar with dealing with these types of cancers which are normally not very aggressive, but at times can be among the most aggressive cancers that we ever see.”
Staying on the leading edge of care is key because guidelines for treatment are continually revised and updated based on the new scientific evidence, Dr. Young notes.
“We really have gone from one-size-fits-all to individualized care,” Dr. Young says. “This requires multidisciplinary evaluation, where not only is there a surgeon and an endocrinologist, but also a medical geneticist, a radiation oncologist, radiologist, pathologists. All have to be part of the discussion in order for us to individually tailor the treatment for a thyroid cancer patient.”