There are few statements that can light a fire under me as much as someone telling me that " Oh, you have ( or had) thyroid cancer! That's the good cancer, right? Aren't you lucky? It is so easily treatable and the prognosis is great! " I had thyroid cancer in 2010, and have dealt with these comments for years. It was not too long before I put my Southern manners aside, and tried to educate others on thyroid cancer- specifically why it is not the " good cancer".
First the obvious. the words "Cancer " and "good " usually do not belong in the same sentence! Who in the world thinks having ANY type of cancer is a good thing? And I do not put too much faith in statistics, either. I have been told that 95% of thyroid nodules are benign. I guess that puts me in the unlucky 5%, then.
Before discussing the types of thyroid cancer, it is important to note that the thyroid gland has two main types of cells. Follicular cells get iodine from our blood and make thyroid hormones that regulate metabolism. The other cells are called C-cells or parafollicular cells, and these make calcitonin which helps with how our bodies use calcium.
It matters what type of thyroid cancer one has insofar as diagnosis and treatment. That is another eye opener for some people. There are at least five types of thyroid cancer ( Papillary, Follicular, Medullary, Hurthle, and Anaplastic). A person can have one or more of these types. I had both Papillary and Follicular thyroid cancer. Papillary cancer accounts for about 80% of diagnosed thyroid cancer. Follicular comes in at about 10%, while Hurthle accounts for around 3%, Medullary around 2-4% of thyroid cancer cases, and lastly, the rarest of all- Anaplastic thyroid cancer- accounts for about 2% of all cases.
Papillary and Follicular are classified as differentiated thyroid cancer. Simply put, this means that the thyroid cancer cells retain important features of normal thyroid cells. ( before malignancy). These two types are the easiest to treat of the above five mentioned, with Follicular being a little more challenging than Papillary. Papillary, Follicular and Hurthle thyroid cancer develop from thyroid follicular cells. Medullary thyroid cancer develops from the C-cells. Anaplastic thyroid cancer is called undifferentiated thyroid cancer. It is rare, difficult to treat, and the cancer cells do not look anything like normal thyroid gland cells. The scary thing to me is that sometimes Anaplastic thyroid cancer develops from existing papillary or follicular cancer. Maybe because this is such a rare cancer, but there is not a lot of information about this type of thyroid cancer. I am hoping that more research will be conducted on this type.
Treatment for differentiated thyroid cancer can include surgical removal of the thyroid gland- full or partial- possibly along with treatment with the radioactive I-131. To simplify, these follicular cells are involved with iodine uptake. So when one gets the I-131 after surgical removal of the thyroid gland, the only thyroid gland cells remaining will be the cancerous ones. The rogue ones, as I like to say. They gobble up the radioactive iodine, after being deprived from the patient being on an iodine free diet, and the remaining cancer cells die. Medullary comes from the C-cells, so the I-131 is not an effective treatment for this type. Anaplastic is undifferentiated, so treatment is also challenging.
Thyroid cancer is not a " one size fits all" kind of cancer- either in type or treatment options. After surgical removal of the cancerous thyroid, full or partial removal, thyroid supplement is necessary for the patient to feel " more normal". Herein lies the problem! Many factors influence the type of thyroid hormone that works best for the individual patient. This means many dosage adjustments as well as perhaps types of thyroid hormone. Synthetic or naturally sourced? Does a patient need T3 supplement or not? We thyroid patients are used to rolling up our sleeves constantly for blood work, as well as enduring at least yearly ultrasounds and exams. Recurrence is always a possibility- albeit not an extremely common occurrence.
Also, after having thyroid cancer, the American Cancer Society states that thyroid cancer patients have a slightly increased risk for having a SECOND PRIMARY cancer. These are not recurrences of the thyroid cancer, but are new, unrelated cancers. The types the ACS says that thyroid cancer patients are somewhat more at risk for are: Breast cancer ( in women), Prostate cancer, Kidney cancer and Adrenal cancer. The risk of adrenal cancer is higher in those who had medullary thyroid cancer. As a side note, I had breast cancer in 2015. I had stage 2B invasive lobular breast cancer. I had bilateral mastectomies and three months of chemotherapy. I am in remission now, thankfully.
As I said at the first of this blog: there is no cancer that qualifies as the good cancer. There are certainly some that are more easily treatable and have a better survival rate. Personally, I am hoping for a time when all cancers can be survivable and easily treated.
