Thyroid cancer treatments

Our thyroid cancer treatment program uses a number of options to treat the disease. Which is appropriate for you depends on many factors, including the stage, type and progression of the cancer. Your multidisciplinary team of thyroid cancer experts will answer your questions and recommend treatment options based on your unique diagnosis and needs.

Common options for treating thyroid cancer include:

Chemotherapy

Chemotherapy is sometimes used to sensitize anaplastic thyroid cancers to external beam radiation therapy (EBRT).

The potential side effects of chemotherapy may include nausea, vomiting, hair loss and mouth sores. Your care team will use multiple measures to help reduce or moderate chemotherapy-related symptoms. Prior to receiving chemotherapy for thyroid cancer, you may receive pre-medications to help make symptoms more tolerable.

Hormone therapy

Patients with thyroid cancer who have had most or all of their thyroid gland removed by surgery need to take daily hormone supplements in order to maintain their bodies’ normal metabolism.

Maintaining normal or above-normal levels of thyroid hormone in the blood may help reduce the amount of thyroid stimulating hormone (TSH) made by the pituitary gland. TSH is a regulatory hormone that stimulates the growth of the thyroid gland, and may also stimulate thyroid cancer cells. Normally, the pituitary gland makes more TSH when levels of thyroid hormone are low, so increasing these levels can send a signal to reduce production of thyroid stimulating hormone, and potentially help to keep some thyroid cancers from recurring.

If you need to take thyroid hormone therapy, your care team at City of Hope will work with you to find the right dosage, and will help you manage potential side effects.

Radiation therapy

Radiation treatment options for thyroid cancer include:

External beam radiation therapy (EBRT) directs a beam of radiation from outside the body at cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Examples of EBRT include 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy^® and stereotactic radiosurgery. Specific advantages of EBRT for thyroid cancer may include:

• EBRT is an outpatient procedure. This technique does not carry the standard risks or complications associated with major surgery for thyroid cancer, which may include surgical bleeding, post-operative pain or the risk of stroke, heart attack or blood clot.
• The procedure itself is painless.
• EBRT poses no risk of radioactivity to you or others with whom you have contact. So, as you undergo EBRT, you may continue normal activities with family and friends.

Intensity modulated radiation therapy (IMRT) uses advanced software to plan a precise dose of radiation, based on tumor size, shape and location. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3D geometrical shape of the tumor, including concave and complex shapes. If you have previously had radiation therapy for thyroid cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you.

Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy tissue from harmful doses of radiation.

Radioactive iodine therapy for thyroid cancer may be used alone or in combination with other treatments, such as surgery. Treatment with radioactive iodine is used most frequently for thyroid cancers that have spread to the lymph nodes and other parts of the body.

Because almost all iodine in your bloodstream gets taken up by the thyroid gland, radioactive iodine (I-131) may be used to destroy the thyroid gland and thyroid cancer cells in lymph nodes or other parts of the body. For this procedure, the radioactive iodine is taken into the body either in liquid or capsule form.

Radioactive iodine therapy is only recommended for differentiated cancer, such as papillary or follicular thyroid cancers. It is not used to treat medullary or anaplastic thyroid cancers, because these types of cancer cells do not take up iodine.

Radioactive iodine for thyroid cancer will cause your body to give off radiation for a period of time, and this requires special precautions to prevent others from being exposed. If your doctors think treatment with I-131 may be an option for you, they will discuss the possible risks and benefits with you, as well as necessary precautions, and help you to make an informed decision.

TomoTherapy^® combines a form of intensity modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. With this technology, we deliver more precise radiation to match complex tumor shapes while avoiding sensitive structures. Using built-in CT scanning to confirm the shape and position of the tumor before each treatment, TomoTherapy may reduce radiation exposure to healthy tissues and organs.

TomoTherapy may offer the following potential advantage for thyroid cancer patients:

• It uses built-in CT scanning to confirm the exact shape and location of a uterine tumor seconds before your treatment begins.
• It targets hard-to-reach thyroid tumors by sculpting small, powerful and precise radiation beams at the tumors from a full 360 degrees.
• It lessens treatment-related side effects by reducing damage to nearby healthy tissue.
• It avoids radiation exposure to muscle tissue, the spine, lungs and other sensitive organs.

Surgery

A few different types of surgeries may be used to treat thyroid cancer:

Lobectomy: For small, well-differentiated tumors that have not spread beyond the thyroid gland, a lobectomy may sometimes be performed. In this type of thyroid cancer surgery, the lobe containing the cancer is removed, leaving the other healthy lobe behind. This may reduce the need to take thyroid hormone treatment after surgery, since a functioning part of the thyroid remains.

Thyroidectomy: In this procedure, most or all of the thyroid gland is removed by surgery (total, near-total or subtotal thyroidectomy). This type of surgery for thyroid cancer is used for most patients. However, because very little or no functioning thyroid tissue is left behind, patients will need to take daily thyroid hormone replacement pills afterwards.

Lymph node removal: When the surgeon suspects that the thyroid cancer cells have spread to nearby lymph nodes, they will remove the enlarged or suspicious nodes in order to remove as much of the cancer as possible. This thyroid cancer surgical procedure is usually performed at the same time as the surgery on the primary tumor.

Targeted therapy

Targeted therapy drugs are designed to seek out a specific characteristic in cancer cells, such as a gene mutation or a protein, and attach themselves to those cells. Once attached, these drugs may kill the cells or may help other therapies, such as chemotherapy, work better.

Among the drugs used in targeted therapy are so-called kinase inhibitors, which target specific enzymes called protein kinases that help regulate cell growth. Other targeted drugs, called angiogenesis inhibitors, are designed to prevent tumors from establishing new blood supplies.

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