Medullary thyroid cancer
Medullary thyroid cancer is a rare type of thyroid cancer. The American Thyroid Association says that the disease is present in 1–2 percent of cancers of the thyroid in the United States. The first sign of it is usually the appearance of a painless lump in the front of a person’s neck. If caught early, this cancer is often very treatable.
MTC starts in specialized thyroid cells known as parafollicular cells, or C cells. These C cells release a hormone called calcitonin, which controls the levels of calcium in a person’s blood. Unlike other types of thyroid cancer, MTC can sometimes run in families. When a person inherits MTC from a parent, it is known as familial medullary thyroid cancer (FMTC). Nevertheless, around 75 percent of MTC cases are sporadic, which mean that the individual with the condition did not inherit it from a parent.
Early signs
Because MTC tends to develop slowly, people in the early stages of the disease usually have no symptoms. For this reason, early diagnosis of MTC is not common. When symptoms do appear, they typically consist of a painless lump in the front of a person’s neck or throat. This lump corresponds with the cancerous mass of cells that is growing inside the thyroid.
Common symptoms
Common symptoms of MTC can include:
- swelling in the neck near the thyroid gland, which corresponds to enlarged lymph nodes
- cough, sometimes producing blood
- difficulty swallowing, sometimes causing pain
- shortness of breath
If the condition progresses, symptoms may become more severe, and people can also experience other signs. These may include:
- a large mass in the neck
- pain in the neck, jaw, or ear
- choking sensations
- People with cancer that has spread to the nerves that control the vocal cords may also experience hoarseness or changes in their voice.
In the advanced stages of MTC, high levels of calcitonin produced by the tumor can cause diarrhea and flushing.
When to see a doctor
A doctor should assess lumps in the neck. Anyone who notices a persistent lump or swelling just below the Adam’s apple should see a doctor, especially if the symptoms coincide with any of the following signs:
- unexplained hoarseness that does not go away after a while
- difficulty swallowing
- a sore throat that does not get better
- pain in the neck
However, not all neck lumps are cancer. Many other less severe conditions can cause a lump in the neck, such as swollen lymph nodes. Needless to say, not all neck masses are cancerous. In some medical conditions, the neck masses are caused by swelling of the lymph nodes.
Medullary Thyroid Cancer Diagnosis
After a clinical examination, a history of the patient, and a medical history for the final diagnosis of cancer, the specialist asks the patient to do the following:
- thyroid ultrasound, to examine the structure of the nodule
- thyroid scan, to learn if the nodule is hot, warm, or cold (this test is typically performed when the thyroid is overactive)
- fine needle aspiration, to collect a sample of the nodule for testing in a laboratory
- blood tests, to check your levels of thyroid hormones and thyroid stimulating hormone (TSH)
Medullary Thyroid Cancer Treatment
As to the best way to treat medullary thyroid cancer: the answer is surgery. After you have been assessed and treated for any associated endocrine conditions, such as pheochromocytomas, (if present) all patients undergo a total thyroidectomy in which all lymph nodes and fatty tissues in the central area of the neck are removed. Since the goal of surgery is to achieve a comprehensive removal of the entire thyroid gland and all of the affected and high at-risk lymph nodes of the neck, this requires an expert thyroid cancer surgeon who is capable of accomplishing the procedure by addressing all of the neck disease while maintaining the patient’s appearance, function, and quality of life. In this way, all critical structures, including the nerves to the voice box and all parathyroid glands which are not directly affected by cancer are preserved.
References
https://www.medicalnewstoday.com/articles/322518#outlook
https://www.healthline.com/health/thyroid-nodule#prevention
https://www.endocrineweb.com/conditions/thyroid-cancer/thyroid-cancer-medullary-cancer
