Sunday, April 29, 2018

Medullary and Anaplastic thyroid cancer

these two types are the serious and more difficult to treat thyroid cancers as compared to the differentiated thyroid cancers that  i just mentioned. this will be a basic overview of these two rare cancers. it is extremely important, if you have one of these types,  to see a physician who specializes in these cancers. there are also support groups on the thyca.org website that offer information and support for those patients dealing with either of these types of thyroid cancer. 

medullary thyroid cancer begins in the "C" cells of the thyroid gland. these "C" cells produce the hormone calcitonin . it is very important to note that elevated levels of the hormone calcitonin in the blood stream can possibly be an early indicator of medullary cancer. there can be a genetic link associated with this cancer. medullary cancer accounts for about 3 to 5 percent of all thyroid cancers.

i will mention treatment of medullary cancer ( MTC)  here because it is a little different than treatment of the differentiated thyroid cancers. surgery to remove the thyroid gland is indicated, as with differentiated thyroid cancers.  unfortunately, medullary thyroid cancer does not respond to the radioactive iodine treatment. early detection is key to survival. there is an aproximately 90% survival rate after 15 years if detected early, surgery is performed, and the disease has not spread to distant sites. if there is some involvement in the neck area, the survival rate is reduced to 76%. if however, there are distant metastases( the disease has spread, in other words)  the survival rate drops to only 3%. there have been two new drugs approved for the treatment of MTC within the past couple of years. . the names of these chemotherapy drugs are: vandetanib and cabozantinib. there are side effects that one might expect with traditional chemotherapy drugs. careful monitoring of patients with MTC is crucial- to determine the staging and if chemotherapy or radiation is indicated. quality of life is also a consideration.

anaplastic thyroid cancer (ATC) is " one of the most aggressive solid tumors to affect humans." according to the Journal of Oncology, vol. 2011, article ID# 542358. this type of cancer is not present in children. it occurs in adults over 65 or  70 years of age. in one study, cited by the Journal of Oncology, 67% of patients were over 70; females comprised 70% of those patients, while
 males comprised 30%. thankfully, ATC makes up only 1 to 2% of all thyroid cancers. the median survival rate of ATC is only 3 to 5 MONTHS.

treatment for ATC is surgery, and can include the chemotherapy drug doxorubicin. only 22% of patients respond to this chemotherapy drug, however. newer drugs are being studied, and hopefully there will be a better treatment on the horizon. ATC is a rapidly growing, aggressive, " get your affairs in order" type of cancer. the very best thing that can be said about ATC is that while differentiated thyroid cancers are on the rise, and are the fastest growing( in numbers) cancers in the US, according to the American Cancer Society, ATC cases are actually decreasing.

so, i have provided a quick overview of the main types of thyroid cancer. i sincerely hope that this information has been of some help. perhaps those reading this are thyroid cancer patients, or have a loved one or family member who is a thyroid cancer patient. with better education, comes better understanding. i began these blogs when one of my physicians called my thyroid cancer the " good cancer". i wonder what he would say after reading my blogs...

Follicular thyroid cancer, 101

Follicular thyroid cancer comes from the follicular cells of the thyroid. as i said, i hope, in my last blog, these follicular cells produce and store thyroid hormone. this type of thyroid cancer usually occurs in older adults- aged 50 and older. this type of cancer accounts for about 10 to 15 percent of all thyroid cancers. hurthle cell cancer is a rare, thankfully, and usually more aggressive form of follicular cancer. hurthle cell cancer is less likely to respond to the RAI, than say " regular" papillary or " regular" follicular." it is more likely to spread into the neck via the blood vessels, generally not the lymph nodes, thus spreading the cancer to other parts of the body. those parts usually  being the lungs and bones.

a term that one might come in contact with is " differentiated thyroid cancer" which includes both papillary and follicular types of cancer. this just means that they are somewhat similar to a non-cancerous, or normal, thyroid cell. differentiated thyroid cancers have a higher survival rate because of the iodine link to normal thyroid cells. normal and cancerous thyroid cells of differentiated thyroid cancers will both take in iodine. if you feed the differentiated thyroid cancer cells radioactive iodine, they will eat it up like a normal, non-cancerous thyroid cell. but it will hopefully kill them and their buddies,too. in this situation, it is better to have a differentiated thyroid cancer than a non-differentiated one. but of course, there are many other factors to consider- staging just being one.

the survival rate for both papillary and follicular thyroid cancers is around 90% if diagnosed early. the rate of recurrence is still around 30% for follicular as well as papillary, and recurrences of follicular can occur decades later after the initial diagnosis and treatment. as with all types of thyroid cancer, tests, blood work and monitoring will need to be done for the rest of a patient's life. the good cancer? i think not.

now on to the next blog... it is a combo of two very serious thyroid cancers: medullary and anaplastic. 

Wednesday, April 25, 2018

Papillary thyroid cancer, 101

Papillary thyroid cancer is the most common type of thyroid cancer. about 80% of all thyroid cancers fall into this category. papillary ( as well as its buddy, follicular) form in the follicular cells of the thyroid gland. these are the cells that make and store thyroid hormone. as a side note, it is important to mention  here that this hormone contains iodine. this explains why RAI works in the treatment of these cancers.  the variants of papillary thyroid cancer, which i will mention, but not go into detail about, are as follows: columnar, diffuse sclerosing, follicular variant of papillary( i had this,too), hurthle cell, and tall cell. while papillary cancer is considered slow growing, the variants of papillary thyroid cancer can grow and spread quicker than " just plain" papillary thyroid cancer. this is where it gets a little confusing. the follicular variant of papillary thyroid cancer is different than " just plain" follicular cancer. it is considered to be slower growing than the other papillary thyroid cancer variants. HOWEVER, papillary cancer can certainly spread to the lymph nodes in the neck, as well as to other parts of the body. i have been told by my radiologist, that when thyroid cancer spreads, two of the favored locations in the body are the lungs and bones. this may explain some tests you may receive if you have this type. examples:  chest x-rays, cat scans, etc.

people in their twenties to sixties tend to get this type of thyroid cancer. but a person of any age, even a small child, can get thyroid cancer. according to the American Academy of Otolaryngology- head and Neck Surgery,  " thyroid cancer is the third most common solid tumor malignancy and the most common endocrine malignancy in children. it occurs four times more in females than in males. " papillary thyroid cancer is the most common kind of thyroid cancer in children, as well as in  adults. the signs and characteristics of papillary cancer in children are pretty much the same as in adults.

it is not clear what causes thyroid cancer. some sources state possible  exposure to radiation. two things that i have heard mentioned as possible links are :  dental x-rays without the proper precautions and x-rays of children's feet for easier  shoe fitting ( this was done in the 1950's i think. i did not have that done, by the way). there are several theories, but no one knows of a definitive cause as yet. a FORMER endocrinologist of mine, kept asking me " why do you think you got thyroid cancer?" she made me feel like it was my fault somehow. i only saw this doctor briefly. my current endocrinologist has never asked me this question. since no one can be sure what causes thyroid cancer, all that we can do is to make wise decisions when it comes to our testing and health care.

treatment for papillary thyroid cancer is generally surgery, and possibly RAI ( radioactive iodine) dosing. my treatment was a total thyroidectomy, removal of eleven lymph nodes, removal of two parathyroids, which were also cancerous, and a large dose of the RAI ( 155 milicuries). i received the RAI  a couple of months after my surgery. the decision to have RAI therapy or not  is generally decided by the radiologist or oncologist after the surgery. my tumors had ruptured and spilled out into my neck area. i had three tumors, two of which were fairly large. some patients do not want the RAI, due to side effects. it is an individual decision, with no " one size fits all" solution. my endocrinologist told me that even the most brilliant surgeon can not get all of the tiny bits of the thyroid cancer cells that have made it out of the tumor into the neck area. i decided to have the RAI since it made the most sense for me. i would make that decision again, by the way, even with the salivary stones issues that i have had. traditional chemotherapy drugs do not work for this cancer, which is another fact to consider when coming up with an individual treatment plan.

papillary cancer is slow growing, yes, but it can spread. depending on the staging, papillary cancer can have an excellent survival rate.( about 90% if diagnosed early ).  but, the rate of recurrence is about 30%. and recurrences can occur decades after an initial diagnosis. monitoring- ultrasounds and blood work,usually- will continue for a lifetime. changes in doses of thyroid hormone replacement drugs will also occur. it is not easy to suppress TSH, therefore hopefully preventing recurrence, and at the same time, finding the dose that the patient feels good on.  it is a slippery slope, and one that i can attest to.

next blog: follicular thyroid cancer, 101


Tuesday, April 24, 2018

What are the different types of thyroid cancer? And yes, there are more than just one...

as i mentioned in my last blog, i told my gynecologist that someone who had anaplastic thyroid cancer would certainly not think that thyroid cancer was " the good cancer". the fact that he seemed confused, and seem not to know that there are several different types of thyroid cancer, was the inspiration for this blog. i know that most thyroid cancer patients know that there are different types, but i thought that it might be a good idea to discuss each particular type of thyroid cancer. this will be another mini series of blogs relating to the same issue. each type of thyroid cancer will have it's own blog, and i will provide the information that i have on each type of thyroid cancer. details on  new treatments for and research on treating the different types of thyroid cancer may not be available to me now, so please do not think that what i have to say about the different types is the definitive last word, so to speak. and i probably do not have all of the information, but i will give you what i have.

and, it depends on what sources you are consulting, as to how many types of thyroid cancer are defined. some sources say four, some say five. some cancers, such as papillary, have different variants, but are grouped under the umbrella of just papillary. i will mention these variants briefly. staging is very tricky and a little complicated. i am not going to go into this, as it would take several blogs to cover it. if you are interested in staging, or if your physician has not told you your stage( i would advise that you ask your physician, first, of course) there is a detailed breakdown of staging on the thyca. website. every thyroid cancer patient should make thyca.org their friend.

i have decided to discuss four of the various types of thyroid cancer. and i will briefly mention any variants of these main groups. the groups are as follows: papillary, follicular, medullary, and anaplastic. some people have just one, and some, like me, have a combination of the above mentioned types.

at this point in my introduction, i can not stress enough the importance of being your best own patient advocate. be informed by reputable websites, books, and knowledgeable health care professionals. know your type of thyroid cancer, stage, and best treatment options. keep all of your test results, and overviews of office visits in a notebook for easy reference. i mentioned this in a blog that i wrote some time ago, but one time  my endocrinologist was missing some test results in my folder that she needed to see. it seems that her office had switched computer program systems, and the test result that she needed to see had been deleted. i happened to have my " thyroid book" with me, and poof, there was the test that she needed! your doctor has many other patients- you are not the only one she/he has to take care of. take care of yourself by being informed. it is the best piece of medical advice that i can give to anyone.

one thing holds true for any patient who has/had thyroid cancer. it is a life long condition. it requires constant testing and monitoring  for recurrences. ( which can occur decades after the initial thyroid cancer diagnosis.)  there is also regular blood work done  to make sure that patients' TSH is suppressed, if need be, for example. T3, free T4 and other tests also are important and certainly affect the quality of life. it is a roller coaster ride for almost everyone, with frequent dosage changes being the aggravating norm.  thank goodness for thyroid hormone supplements, but nothing can compare to  the thyroid hormone made by a healthy thyroid gland.

enough of the introduction. my next blog will discuss papillary thyroid cancer.

Thursday, April 19, 2018

a thank you to those who follow my blog...i was surprised and honored by this.

Anuj Agarwal anujsagarwal@feedspot.com

7:47 AM (11 hours ago)
to me
Hi Bea Young-Smith,

My name is Anuj Agarwal. I'm the Founder of Feedspot.

I would like to personally congratulate you as your blog Losing the Butterfly has been selected by our panelist as one of the Top 15 Thyroid Cancer Blogs on the web.


I personally give you a high-five and want to thank you for your contribution to this world. This is the most comprehensive list of Top 15 Thyroid Cancer Blogs on the internet and I’m honored to have you as part of this!

We'd be grateful if you can help us spread the word by briefly mentioning about the Top 15 Thyroid Cancer Blogs list in any of your upcoming post.

Please let me know.

Best,
Anuj

" ...sometimes i feel a little mad...but i'm just a soul whose intentions are good, oh Lord, please don't let me be misunderstood." " don't let me be misunderstood" lyrics by the animals

i had my yearly check up with my gynecologist this week. things were fine- just routine stuff. he gave me sort of a "mini- physical". the doctor listened  to my chest, blood pressure check,etc. and  all was fine until he said, " well, now, let me check your thyroid." as his hands encircled my neck, i said, " oh, well, i had thyroid cancer, remember?, so i do not have a thyroid." and then he said those awful words. those words that make every thyroid cancer patient's ( well almost every) blood boil. " well, if you have to have cancer, that is the good one to have! easily treatable, high cure rate,etc." at this point, i sort of tuned him out. i wish that i had said more, but what i did say was, " well, i would not say that to someone who has anaplastic thyroid cancer." FYI,  there are at least five different types of thyroid cancer, with anaplastic being the most serious. a person can have one, or a combo like i had.

i had stage three papillary, with an aggressive area  of follicular variant. two of my parathyroids were also cancerous and had to be removed. i had 11 lymph nodes removed. because of the stage and aggressive nature of one of the types of thyroid cancer that i had, i have to still be monitored with blood tests, ultrasounds, and office visits every six months. and it will be 8 years on may 19th. it is a real challenge to keep my thyroid levels at the point where my TSH is suppressed enough to hopefully prevent a recurrence of the disease, while still maintaining a good quality of life.

i am a member of several thyroid cancer websites. i am constantly reading posts that state that someone has told a thyroid cancer patient they have the " good cancer". good and cancer do not belong in the same sentence, in my opinion. i used to say nothing when someone said this to me. i know people are trying to be nice, but i had hoped that this misconception about the " good cancer"was going away. the symptoms of a hypothyroid patient, with a thyroid that functions somewhat, are many. the thyroid is the " master gland" in the body and controls just about everything. being hypo after having the thyroid removed puts patients into a whole new level of hypo. thank goodness for thyroid hormone supplements, but they are no where near as good as the hormones produced by a happy, healthy thyroid gland.

and we should not forget that if you have had thyroid cancer, you are at about  a 30% risk of having another primary cancer. i know all about that,too. that is why this is a 2Fer blog. so, although my gynecologist meant well, i believe, i expected more understanding from a health care professional. i do feel like thyroid cancer patients are very misunderstood. it is not a five year and you are done kind of cancer. thyroid cancer requires lifelong monitoring and testing. thyroid cancer is the fastest growing cancer now in the country. perhaps as more people have to deal with this, there will be more understanding of the challenges facing those with thyroid cancer. i sure hope so...