TAMPA, Fla. — Thyroid Cancer Awareness Month runs through September and the disease is on track to be the No. 1 diagnosed cancer in women by the year 2030. According to one study, it is already the second most common cause of medical bankruptcy. However, doctors at Moffitt Cancer Center say it is possible to effectively treat the disease in an affordable way, by minimizing over-diagnosis and evaluating patients in a cost-sensitive, evidence-based way.
Approximately 50 percent of women and 10 to 20 percent of men over the age of 50 have a nodule, or lump, on their thyroid gland, a small, butterfly-shaped gland in the base of the neck. These nodules are often discovered by chance, either on physical examination, or during scans performed for some other reason. “These thyroid nodules are very common, and most are not cancerous” says Bryan McIver, M.D., Ph.D., leader of the Endocrine Oncology Program at Moffitt. “For that reason, it is very important that we evaluate these nodules rapidly, efficiently and accurately, while causing a minimum of pain, worry and expense to our patients”.
At Moffitt, McIver and his team have developed a highly efficient diagnostic clinic for patients with thyroid nodules. Based conveniently at our Moffitt Cancer Center at International Plaza outpatient facility, Moffitt’s Thyroid Clinic is one of only a handful of places in the country that offers same-day evaluation of thyroid nodules, permitting clinical assessment, ultrasound imaging, biopsy procedures, and result reporting all within just a few hours, as well as access to state-of-the-art molecular testing for nodules that cannot be diagnosed on biopsy alone. And Moffitt is almost the only location in the country in which the patient can also be seen – on the same day – by a highly specialized thyroid surgeon, if surgery proves necessary.
“Most thyroid nodules are benign and do not need any treatment.” comments McIver, “But if the nodule turns out to be cancer, it’s really important to offer the patient rapid access to an entire team of specialists and to move ahead with the treatment as soon as possible ”. Fortunately, the survivorship for thyroid cancer is very high—more than 99 percent in stage 1 cases. “Thyroid cancer is often called a ‘good’ cancer,” McIver says. “But there is no such thing as a ‘good’ cancer. What is true is that Thyroid cancer is slow-growing and responds very well to treatment, at least when it is found early. The problem is that, even then, the impact on a patient’s quality of life can be huge, and we as physicians need to be aware of that.”
Fortunately, most cases of thyroid cancer are caught in early stages, because the thyroid nodule can often be seen or felt in the front of the neck. The best way to detect the disease early is to know about the common symptoms of thyroid cancer, “check your neck” and see a physician right away if you notice anything that looks (or feels) like a lump or swelling in the front of your neck.
Treatment of thyroid cancer involves surgery to remove the thyroid gland. “Although there are risks of Thyroid surgery, those risks are low in expert hands” says Kristen Otto, M.D., assistant member of the Head and Neck, and Endocrine Oncology Program at Moffitt. “At the cancer center, our surgeons are highly specialized and use advanced techniques, including nerve monitoring, to maximize safety. Plastic surgical techniques also ensure the scar heals well – usually, it becomes almost invisible in just a few months.”
Beyond surgery, treatment includes thyroid hormone – which acts as a form of chemotherapy in thyroid cancer – and sometimes radioactive iodine, a form of internal radiation therapy. “In the past, we have used far too much radioactive iodine in this country.” says McIver, “Our studies have clearly shown that most patients do not need that treatment and that careful, selective use provides the right balance between controlling the cancer, controlling the complications, and controlling the cost.”
Long-term follow-up is necessary to ensure thyroid cancer is driven into remission, but “doing this well means being thoughtful and careful about what tests we choose and how often we use them” says McIver. After effective treatment, most patients need to be seen in the cancer center only once a year, though often for 10 years or more, before they can be considered cured of their disease. “’Cure’ is a hard word” notes McIver, “I prefer the term remission, stable remission, and long-term stable remission, because we have to remember that our testing can never be perfect”.
For those patients with more advanced disease, disease that has spread into other parts of the body, and for whom the standard treatments prove ineffective, Moffitt offers patients the latest diagnostic techniques, and a wide range of treatment options, including the newest tyrosine kinase inhibitor drugs – a targeted, technologically advanced chemotherapy approach for thyroid cancer. “We are also deeply involved in research in thyroid cancer, looking at outcomes, improving treatment options, and developing clinical trials.” says Jeffery Russell, M.D., Ph.D., a medical oncologist in Moffitt’s Endocrine Tumor Program. “Our clinical research programs at Moffitt have been recognized by the National Cancer Institute, which has designated Moffitt a Comprehensive Cancer Center— the only one based in Florida. Our cancer survival rates consistently outrank national averages, and our ultimate goal is to provide our patients with better outcomes and higher-quality lives.”
“Fortunately, most of our patients do well with treatment” McIver says. “Using the skills of our endocrinologists, surgeons, medical oncologists, radiologists and pathologists – offering multidisciplinary care in one of the best cancer centers in the country - we quickly develop and institute a comprehensive treatment plan, ensure the patient is free of the disease, and then use minimal check-ins so the patient can enjoy her quality of life for years and decades to come.”
About Moffitt Cancer Center
Located in Tampa, Moffitt is one of only 45 National Cancer Institute-designated Comprehensive Cancer Centers, a distinction that recognizes Moffitt’s excellence in research, its contributions to clinical trials, prevention and cancer control. Moffitt is the top-ranked cancer hospital in Florida and has been listed in U.S. News & World Report as one of the “Best Hospitals” for cancer care since 1999. With more than 4,600 team members, Moffitt has an economic impact in the state of $1.9 billion. For more information, visit MOFFITT.org, and follow the Moffitt momentum on Facebook, Twitter and YouTube.