Medullary thyroid cancer care

Medullary thyroid cancer (MTC), also known as medullary thyroid carcinoma, is a rare form of thyroid cancer that accounts for less than 2% of all thyroid cancers and occurs mostly in older adults. Medullary thyroid cancer can occur sporadically or as part of a hereditary condition called multiple endocrine neoplasia.

What is medullary thyroid cancer

Medullary thyroid cancer forms inside your thyroid gland, the butterfly-shaped gland at the front of your neck. Inside your thyroid gland are cells known as parafollicular cells, also called C cells. These cells make the hormone calcitonin that controls the level of calcium in your blood. Medullary thyroid cancer forms in these cells, making elevated calcium levels in your blood a telltale sign of this type of thyroid carcinoma.

Thyroid cancer is a broad term that encompasses several types of cancer that form in the thyroid. These types of cancer include medullary thyroid carcinoma, papillary thyroid cancer, follicular thyroid cancer and anaplastic thyroid cancer.

What is the difference between thyroid cancer and medullary carcinoma?

The main difference between thyroid cancer in general and medullary carcinoma lies in the specific cells from which they originate and their associated characteristics.

Some distinguishing traits of medullary cancer include:

• Origins: Thyroid cancer can originate from follicular cells or parafollicular cells. When it comes to medullary thyroid cancer, all cases are in the parafollicular cells.
• Hormone production: Medullary carcinoma cells typically create more calcitonin, whereas other types of thyroid cancer may not involve abnormal hormone production.
• Genetic factors: Medullary thyroid cancer can be sporadic or hereditary, while other types of thyroid cancer may have different genetic factors involved.

Medullary thyroid cancer symptoms

Symptoms of medullary thyroid cancer can vary from person to person, and some people may not experience any symptoms in the early stages. However, as the cancer progresses, the following symptoms may become noticeable:

• Presence of a thyroid nodule, a painless lump, on the front of the neck
• Enlargement of the thyroid gland
• Difficulty swallowing
• Hoarseness or voice changes
• Difficulty breathing
• Neck pain
• Swollen lymph nodes
• Weight loss
• Flushed skin
• Bone pain
• Fatigue
• Diarrhea or constipation

Many of these symptoms may be caused by other conditions. Contact your provider If any of these symptoms persist or if you notice any unusual changes in your neck.

Diagnosing medullary thyroid cancer

Medullary thyroid cancer is typically diagnosed through a comprehensive exam, which includes a review of medical history, imaging tests and labs.

During your exam, your doctor will inquire about any family history of thyroid cancer and conduct a physical exam of your thyroid gland. They’ll check for a neck lump or any noticeable enlargement.

To evaluate thyroid function and calcitonin levels, your doctor may order blood tests. Elevated calcitonin levels may signal the presence of medullary thyroid cancer.

If cancer is suspected based on blood tests and your physical exam, you may undergo additional testing, including:

• Biopsy: A small piece of thyroid tissue is extracted for microscopic examination to confirm the presence of cancer.
• Core needle biopsy: If the fine needle aspiration biopsy results are inconclusive, a larger needle may be used to obtain tissue from the thyroid gland.
• Digital imaging tests: Ultrasound, MRI, PET scan, or CT scan may be utilized to obtain detailed images of the thyroid gland.
• Fine needle aspiration biopsy: Cells are extracted from a lump using a thin needle for microscopic analysis, aiding in cancer detection.

Following a confirmed diagnosis of medullary thyroid cancer, further assessments may be conducted, potentially including surgery to remove the thyroid gland for both diagnostic and therapeutic purposes.

Medullary thyroid cancer treatment

Medullary thyroid cancer is treatable if found early and if it hasn’t spread to other parts of the body.

Treatment options for medullary thyroid cancer depend on various factors, including the stage of cancer, your overall health and treatment preference. Treatment for medullary thyroid cancer could include:

• Surgery: A thyroidectomy, the partial or total removal of the thyroid gland, is the most common treatment for most types of thyroid cancer, including medullary cancer. Your surgeon may also perform a lymph node dissection to remove the lymph nodes if the cancer has spread there.
• Radiation therapy: Radiation therapy uses high-energy beams to kill cancer cells. It may be recommended after surgery to destroy any remaining cancer cells or to treat cancer that cannot be surgically removed. External beam radiation therapy is commonly used for medullary thyroid cancer.
• Radioactive iodine therapy: This treatment may be used for medullary cancer that has spread to other parts of the body and produces excessive amounts of calcitonin. The iodine is absorbed by the thyroid cells and the radiation kills the cells.
• Chemotherapy: This is usually used only if the cancer has spread to distant organs or if other treatments aren’t effective.

Through a collaborative care approach, your multidisciplinary care team at Advocate Health Care will tailor a treatment plan for you to address your specific condition and needs.