Papillary thyroid cancer (PTC): Symptoms and more

سرطان تیروئید پاپیلاری چیست؟ علائم+عوارض+تشخیص و درمان

Table of Contents

What is papillary thyroid cancer (PTC)?

Papillary thyroid cancer begins in the follicular cells of your thyroid that produce thyroglobulin (a protein). This is the most common type of thyroid cancer. Your thyroid is a small butterfly-shaped gland located under your skin in the front of your neck. It is part of your endocrine system and controls many important functions of your body by producing and releasing (secreting) certain hormones.

PTCs tend to grow very slowly and usually only grow in one lobe of your thyroid gland.

Type of PTC

There are different types of papillary thyroid cancers. Of these, the follicular subtype (also called the mixed papillary-follicular type) is the most common. Other subtypes of papillary cancer are not as common and tend to grow and spread more quickly. They are:

Classic or simple papillary carcinoma

It is the most common type of PTC and is known for the presence of characteristic papillary structures in the tumor tissue. This type of cancer includes all thyroid papillary carcinoma with a size smaller than 1 cm. Also, they do not change in size and are relatively benign.

TSV long cell papillary carcinoma

Cancer cells are longer and more rectangular, and this type of cancer is usually more aggressive than the classic type and may have poorer outcomes. This type of cancer usually occurs in people over 50 years old. They are also larger and may grow beyond the thyroid gland. The probability of necrosis and mitotic activity is higher in this type. As a result, long cell papillary cancer is classified as malignant thyroid cancer.

Columnar papillary carcinoma (CCV)

Cancer cells have a columnar shape and can be more aggressive than the classic type. These types of cancerous masses are rare and cannot be diagnosed clinically.
Diffuse Sclerosing Variant of Papillary Thyroid Cancer
This type of cancer is usually associated with sclerosis (extensive fibrosis) and calcium deposits and can be more aggressive.

Solid Variant of Papillary Thyroid Cancer

Most of the cells are hard and solid structures and this type can also be more aggressive.

Who does papillary thyroid cancer affect?

Papillary thyroid cancer can affect anyone, but it usually occurs in adults and middle-aged people. Women are more likely to develop PTC than men.

Although PTC is rare in children, it is still the most common thyroid cancer in children.

How common is papillary thyroid cancer?

Thyroid cancer is a relatively common cancer, and papillary thyroid cancer is the most common type, accounting for 80-85% of all thyroid cancer cases.

Is papillary thyroid cancer serious?

Some types of cancer are serious because they require medical treatment and have the potential to spread to other parts of your body (metastasize). Papillary thyroid cancer has symptoms that can be detected early to prevent its spread. It can be successfully treated and is rarely fatal.

Where does papillary thyroid cancer spread first?

Papillary thyroid cancer is most likely to spread (metastasize) to the lymph nodes in your neck first. Lymph nodes are small bean-shaped structures that are part of your body’s lymphatic and immune system.

How often does papillary thyroid cancer spread?

Even though papillary thyroid cancer grows slowly, PTC often spreads to the lymph nodes in your neck.

About 30% of people diagnosed with papillary thyroid cancer have metastatic disease, which has spread to other parts of their body.

What are the symptoms of papillary thyroid cancer?

The main symptom of papillary thyroid cancer is a painless lump or nodule in your thyroid gland. PTC usually does not cause other symptoms.

In rare cases, you may experience pain in your neck, jaw, or ear from PTC. If the nodule is large enough to compress your windpipe or esophagus, it may cause difficulty breathing or swallowing.

Lump in your neck that you can see or feel
Hard time swallowing (you might have pain or find that food or pills get stuck)
Sore throat or hoarseness that doesn’t go away
Swollen lymph nodes in your neck
Trouble breathing, especially when you lie down

What causes papillary thyroid cancer?

Scientists do not yet know the exact cause of papillary thyroid cancer, but they have identified risk factors that increase the risk of PTC, including radiation exposure and certain genetic conditions.

Radiation exposure and papillary thyroid cancer

The rate of papillary thyroid cancer is higher in people with a history of significant exposure to ionizing radiation. This exposure can be due to:

High-dose external beam radiation treatments to your neck, especially in childhood, are used to treat cancer or some non-cancerous conditions.
Exposure to radiation from nuclear power plant disasters. The 1986 Chernobyl nuclear accident resulted in a 3- to 75-fold increase in PTC cases in fallout areas.

Genetics and papillary thyroid cancer

Several genetic (inherited) conditions are associated with PTC, including:

Familial adenomatous polyposis (Gardner’s syndrome): Familial adenomatous polyposis (FAP) is a rare inherited disease in which a person develops multiple precancerous polyps in their large intestine (colon and rectum). People with FAP are also at risk of developing tumors in other areas of their body, including the thyroid. Gardner syndrome and FAP are caused by inherited mutations in the APC gene.
Werner syndrome: Werner syndrome is a rare condition characterized by the appearance of abnormally accelerated aging (progeria). People with Werner syndrome are prone to cancer. The most common cancer in Werner syndrome is thyroid cancer. More than 80 different mutations of the WRN gene have been identified in people with this disease.
Carney complex type 1: Carney complex is a condition characterized by an increased risk of various types of tumors, including thyroid tumors. Mutations in the PRKAR1A gene cause most cases of complex Karni.

Only 5% of all thyroid papillary cases are related to this genetic condition.

How is papillary thyroid cancer diagnosed?

Papillary thyroid cancer usually appears as a lump or nodule in your thyroid gland. You may notice it or your doctor may discover it during a routine neck exam. Sometimes, a nodule is discovered accidentally with imaging tests that you have for other medical reasons.

Your doctor may order the following tests to help diagnose PTC:

Imaging tests: Your doctor may perform imaging tests to identify nodules in your thyroid. These tests may include thyroid ultrasound, CT scan (computed tomography), and/or magnetic resonance imaging (MRI).

Fine-needle aspiration (needle biopsy): Your doctor will probably want to take a small tissue sample, called a biopsy, from your thyroid nodule using a very fine needle. A pathologist looks at the tissue under a microscope to see if there are cancer cells and, if so, what type of thyroid cancer it is.

Your doctor may also recommend genetic counseling to see if you have a genetic condition that may cause PTC and may cause other types of tumors.

How is papillary thyroid cancer treated?

Treatment for papillary thyroid cancer depends on the size of the tumor and whether the cancer has spread (metastasized).

Thyroid surgery

Surgery is the most common treatment for PTC. Depending on the size and location of the tumor, your surgeon may remove part of the thyroid gland (lobectomy) or all of your gland (thyroidectomy). If there is cancer in the lymph nodes in your neck, your surgeon may remove the affected lymph nodes at the time of primary thyroid surgery or as a second procedure.

If you have a total thyroidectomy, you will need to take thyroid hormone replacement medication for the rest of your life.

Dr. Ahmed Fanaei, a thyroid and parathyroid surgeon, is an active member of the American Thyroid Association (ATA) with more than 20 years of experience. He is known as the golden claw thyroid surgeon and has a history of performing more than 5000 successful thyroid surgeries. Contact us to schedule an appointment.

Radioactive iodine treatment (radioactive iodine)

Thyroid cells and papillary thyroid cancer cells absorb iodine. For this reason, doctors sometimes use a form of radioactive iodine to destroy all remaining normal thyroid tissue and potentially cancerous thyroid tissue left after a thyroidectomy.

Radiation therapy:

Radiation therapy kills cancer cells and stops their growth. External beam radiation therapy uses a device to deliver high-energy beams directly to the tumor site. Internal radiation therapy (brachytherapy) involves placing radioactive seeds in or around the tumor.

Chemotherapy:

Intravenous (IV) drugs or oral chemotherapy drugs kill cancer cells and stop cancer growth. Very few people with thyroid cancer need chemotherapy.

What are the side effects of papillary thyroid cancer treatment?

Permanent hypothyroidism (low thyroid hormone levels) is an expected side effect of thyroidectomy and radioactive iodine therapy. For this reason, if you undergo one or both of these treatments, you will need to take thyroid hormone replacement drugs for the rest of your life.

Possible complications of thyroid surgery include:

Infection.
Accidental removal or damage to your parathyroid glands, which help regulate your blood calcium levels.
Damage to your recurrent laryngeal nerve, which is behind your thyroid gland, results in hoarseness and a weak voice.

Potential side effects of radioactive iodine treatment include:

nausea and vomiting
Sialadenitis (salivary gland swelling).
Transient thyrotoxicosis (too much thyroid hormone in your body).
Pulmonary fibrosis (a lung disease that occurs when lung tissue is damaged and scarred).
sterility.
A small risk of leukemia, breast or bladder cancer.

Can papillary thyroid cancer be prevented?

Most people with thyroid cancer have no known risk factors, so most cases of papillary thyroid cancer cannot be prevented.

Exposure to radiation, especially during childhood, is a known risk factor for PTC. For this reason, doctors no longer use radiation to treat less serious conditions. Imaging tests such as X-rays and CT scans also expose children to radiation, but at much lower doses. It is not known how much it may increase the risk of PTC.

If you have a family history of thyroid cancer, you may want to get genetic counseling to see if you have inherited conditions that put you at risk for PTC. If this is the case, your healthcare provider may recommend that you have preventive surgery to remove the thyroid gland before cancer develops.

Can you survive papillary thyroid cancer?

The survival rate for papillary thyroid cancer is very high. More than 90 percent of adults with PTC survive at least 10 to 20 years after treatment.

When should I see my healthcare provider about papillary thyroid cancer?

If you have been diagnosed with papillary thyroid cancer, you should see your doctor regularly to monitor the progress of your treatment. You also need long-term monitoring every six to 12 months to check for cancer recurrence (when it comes back) for at least five years.

If you have had your thyroid removed or had radioactive iodine as part of your treatment, you will need to take thyroid hormone medication for the rest of your life. Your doctor will want to monitor your thyroid hormone levels throughout your life to make sure the dosage is working for you.

What is non-papillary thyroid cancer?

Non-papillary thyroid cancer refers to types of thyroid cancer that are not papillary carcinoma, which is the most common type. These can include the following:

Follicular thyroid cancer: This type originates from the follicular cells of the thyroid and occurs more often in areas where there is insufficient iodine intake from the diet. It is generally considered less aggressive than papillary cancer, but it can spread to other organs such as the lungs or bones.

Medullary thyroid cancer: This type arises from C cells and is known to be more aggressive and less differentiated than papillary or follicular cancers, can spread to lymph nodes and other organs, and often has high levels of calcium. It releases tonin and carcinoembryonic antigen (CEA), which may be detected by a blood test.

Anaplastic thyroid cancer: A rare and very aggressive form of thyroid cancer that is thought to sometimes arise from an existing pap.