Methods of treatment

People with thyroid cancer have many treatment options. Depending on the type and stage, thyroid cancer may be treated with surgery, radioactive iodine, hormone treatment, external radiation, or chemotherapy. Some patients receive a combination of treatments.

The doctor is the best person to describe the treatment choices and discuss the expected results.

A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on “The Promise of Cancer Research” has more information about clinical trials.

Surgery is the most common treatment for thyroid cancer. The surgeon may remove all or part of the thyroid. The type of surgery depends on the type and stage of thyroid cancer, the size of the nodule, and the patient’s age.

* Total thyroidectomy—Surgery to remove the entire thyroid is called a total thyroidectomy. The surgeon removes the thyroid through an incision in the neck. Nearby lymph nodes are sometimes removed, too. If the pathologist finds cancer cells in the lymph nodes, it means that the disease could spread to other parts of the body. In a small number of cases, the surgeon removes other tissues in the neck that have been affected by the cancer. Some patients who have a total thyroidectomy also receive radioactive iodine or external radiation therapy.

* Lobectomy—Some patients with papillary or follicular thyroid cancer may be treated with lobectomy. The lobe with the cancerous nodule is removed. The surgeon also may remove part of the remaining thyroid tissue or nearby lymph nodes. Some patients who have a lobectomy receive radioactive iodine therapy or additional surgery to remove remaining thyroid tissue.

Nearly all patients who have part or all of the thyroid removed will take thyroid hormone pills to replace the natural hormone.

After the initial surgery, the doctor may need to operate on the neck again for thyroid cancer that has spread. Patients who have this surgery also may receive I-131 therapy or external radiation therapy to treat thyroid cancer that has spread.

These are some questions a person may want to ask the doctor before having surgery:

* What kind of operation will I have?

* How will I feel after the operation?

* What will you do for me if I have pain?

* How long will I be in the hospital?

* Will I have any long-term effects?

* When can I get back to my normal activities?

* What will my scar look like?

* What is my chance of a full recovery?

* Will I need to take thyroid hormone pills?

* How often will I need checkups?

Radioactive iodine therapy (also called radioiodine therapy) uses radioactive iodine (I-131) to destroy thyroid cancer cells anywhere in the body. The therapy usually is given by mouth (liquid or capsules) in a small dose that causes no problems for people who are allergic to iodine. The intestine absorbs the I-131, which flows through the bloodstream and collects in thyroid cells. Thyroid cancer cells remaining in the neck and those that have spread to other parts of the body are killed when they absorb I-131.

If the dose of I-131 is low enough, the patient usually receives I-131 as an outpatient. If the dose is high, the doctor may protect others from radiation exposure by isolating the patient in the hospital during the treatment. Most radiation is gone in a few days. Within 3 weeks, only traces of radioactive iodine remain in the body.

Patients with medullary thyroid cancer or anaplastic thyroid cancer generally do not receive I-131 treatment. These types of thyroid cancer rarely respond to I-131 therapy.

Hormone treatment after surgery is usually part of the treatment plan for papillary and follicular cancer. When a patient takes thyroid hormone pills, the growth of any remaining thyroid cancer cells slows down, which lowers the chance that the disease will return.

After surgery or I-131 therapy (which removes or destroys thyroid tissue), people with thyroid cancer may need to take thyroid hormone pills to replace the natural thyroid hormone.

People may want to ask these questions about radioactive iodine (I-131) therapy or hormone therapy:

* Why do I need this treatment?

* What will it do?

* Will I need to stay in the hospital for this treatment?

* Will it cause side effects? What can I do about them?

* How long will I be on this treatment?

* How often will I need checkups?

External radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the neck or at parts of the body where the cancer has spread.

External radiation therapy is local therapy. It affects cancer cells only in the treated area. External radiation therapy is used mainly to treat people with advanced thyroid cancer that does not respond to radioactive iodine therapy. For external radiation therapy, patients go to the hospital or clinic, usually 5 days a week for several weeks. External radiation may also be used to relieve pain or other problems.

These are some questions a person may want to ask the doctor before having external radiation therapy:

* Why do I need this treatment?

* When will the treatments begin? When will they end?

* How will I feel during therapy? Are there side effects?

* What can I do to take care of myself during therapy?

* How will we know if the radiation is working?

* Will I be able to continue my normal activities during treatment?

* How often will I need checkups?

Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat thyroid cancer. Chemotherapy is known as systemic therapy because the drugs enter the bloodstream and travel throughout the body. For some patients, chemotherapy may be combined with external radiation therapy.

Patients may want to ask these questions about chemotherapy:

* Why do I need this treatment?

* What will it do?

* Will I have side effects? What can I do about them?

* How long will I be on this treatment?

* How often will I need checkups?

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