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- Thyroid Cancer Diagnosis
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View Clinical TrialsThyroid Cancer Diagnosis
Getting an accurate diagnosis can be very important to the treatment of thyroid cancer. At MD Anderson’s Endocrine Center, our experts are among the most experienced and skilled in recognizing, staging and treating thyroid cancer.
If you have signs or symptoms of thyroid cancer, your doctor will examine your neck and throat, feeling for lumps or swelling. Your doctor will also complete a medical history. This involves asking questions about your symptoms, other health problems and health problems in other members of your family. If anyone in your family has had thyroid cancer, parathyroid disease or adrenal tumors, be sure to tell your doctor.
One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests may also be used to find out if treatment is working.
Imaging exams: After a physical exam by your physician, most evaluations will start with an imaging exam of the thyroid, typically an ultrasound. Other imaging techniques, such as CT and PET scans, may be used after a diagnosis of thyroid cancer in order to determine the extent of the disease. This is most commonly needed when an aggressive form of thyroid cancer has been found.
Biopsy: Removing a small number of cells and looking at them under a microscope is the best way to diagnose thyroid cancer without surgically removing the thyroid gland. This procedure is called a biopsy. If the initial imaging shows a potential cancer, a fine needle aspiration (FNA) biopsy is usually recommended. During this procedure doctors use an ultrasound to help them guide a thin needle into the nodule. The needle retrieves the suspected cancer cells for examination.
Radioactive iodine thyroid scan: In the case of well differentiated thyroid cancer, a radioactive iodine thyroid scan may be used after thyroid surgery. This helps determine if any cancer remains or has spread to other parts of the body. During this procedure the patient takes a liquid form of radioactive iodine (usually contained in several capsules). Since thyroid cells absorb iodine, they can then be identified using a scanner similar to a Geiger counter. Neither medullary thyroid cancer nor anaplastic thyroid cancer absorb iodine, so this test is not useful for those diseases.
Blood tests: When thyroid cancer is suspected, doctors typically test the hormones related to thyroid function. This can help them understand the nature of the suspected cancer, the health of the thyroid gland itself and the effects of future treatment. The thyroid gland’s ability to function properly is not necessarily impacted by the presence of thyroid cancer, though. People with thyroid cancer usually have a normally functioning thyroid. On the other hand, the majority of people with abnormally functioning thyroid glands do not have thyroid cancer.
Genetic testing: People with medullary thyroid cancer, should undergo a blood test to determine if they carry a genetic mutation that causes the hereditary form of the disease. If the test is positive, the patient’s children, siblings and parents should be tested to see if they also have the genetic mutation. In some cases, family members have been diagnosed with a previously unknown thyroid cancer thanks to this process. More than 90% of people who have the genetic mutation will eventually develop the hereditary form of medullary thyroid cancer.
If a child has the gene, the doctor will most likely suggest removal of the thyroid. Although children rarely develop MTC before age five, one type of hereditary MTC can occur within the first year of life. Doctors will help determine the best time for surgery. If the thyroid is removed, that person will need to take thyroid medication daily for the rest of his or her life.
Genetic testing of the tumor and blood can also be used to identify treatment options for patients with aggressive thyroid cancers such as medullary thyroid cancer, poorly-differentiated thyroid cancer, and/or anaplastic thyroid cancer, including participation in clinical trials.
Some cases of thyroid cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Thyroid Cancer Staging
If you are diagnosed with thyroid cancer, your doctor may do more tests to determine how big the tumor is and whether the cancer has spread to more places in the body.
This process is called staging, and it helps your doctor plan your treatment. It also provides information about the expected outcome, or prognosis, of your cancer.
Once the staging classification is determined, the stage stays the same even if treatment is successful or the cancer spreads.
Health Tip
Thyroid Cancer Stages
(source: National Cancer Institute)
Papillary and follicular thyroid cancer in patients younger than 55 years
People who are less than 55years old have only Stage I or Stage II papillary or follicular thyroid cancer.
Stage I: In stage I papillary and follicular thyroid cancer, the tumor is any size and may have spread to nearby tissues and lymph nodes. Cancer has not spread to other parts of the body.
Stage II: In stage II papillary and follicular thyroid cancer, the tumor is any size and cancer may have spread to nearby tissues and lymph nodes. Cancer has spread from the thyroid to other parts of the body, such as the lungs or bones.
Papillary and follicular thyroid cancer in patients 55 years and older
Stage I: In stage I papillary and follicular thyroid cancer, cancer is found in the thyroid only and the tumor is 4 centimeters or smaller.
Stage II: In stage II papillary and follicular thyroid cancer, one of the following is found:
- cancer is found in the thyroid and the tumor is 4 centimeters or smaller; cancer has spread to nearby lymph nodes; or
- cancer is found in the thyroid, the tumor is larger than 4 centimeters, and cancer may have spread to nearby lymph nodes; or
- the tumor is any size and cancer has spread from the thyroid to nearby muscles in the neck and may have spread to nearby lymph nodes.
Stage III: In stage III papillary and follicular thyroid cancer, the tumor is any size and cancer has spread from the thyroid to soft tissue under the skin, the esophagus, the trachea, the larynx, or the recurrent laryngeal nerve (a nerve that goes to the larynx). Cancer may have spread to lymph nodes.
Stage IV: Stage IV papillary and follicular thyroid cancer is divided into stages IVA and IVB.
In stage IVA, the tumor is any size and cancer has spread to tissue in front of the spine or has surrounded the carotid artery or the blood vessels in the area between the lungs. Cancer may have spread to lymph nodes.
In stage IVB, the tumor is any size and cancer has spread to other parts of the body, such as the lungs or bones. Cancer may have spread to lymph nodes.
Anaplastic thyroid cancer in patients of all ages
Anaplastic thyroid cancer grows quickly and usually has spread within the neck when it is found. Anaplastic thyroid cancer is considered stage IV thyroid cancer. Stage IV anaplastic thyroid cancer is divided into stages IVA, IVB, and IVC.
In stage IVA, cancer is found in the thyroid only and the tumor may be any size.
In stage IVB, one of the following is found:
- cancer is found in the thyroid and the tumor may be any size; cancer has spread to nearby lymph nodes; or
- the tumor is any size and cancer has spread from the thyroid to nearby muscles in the neck and may have spread to nearby lymph nodes; or
- the tumor is any size and cancer has spread from the thyroid to soft tissue under the skin, the esophagus, the trachea, the larynx, the recurrent laryngeal nerve (a nerve that goes to the larynx), or tissue in front of the spine, or has surrounded the carotid artery or the blood vessels in the area between the lungs; cancer may have spread to lymph nodes.
In stage IVC, the tumor is any size and cancer has spread to other parts of the body, such as the lungs or bones. Cancer may have spread to lymph nodes.
Medullary thyroid cancer in patients of all ages
Stage I: In stage I medullary thyroid cancer, cancer is found in the thyroid only and the tumor is 2 centimeters or smaller.
Stage II: In stage II medullary thyroid cancer, one of the following is found:
- cancer is in the thyroid only and the tumor is larger than 2 centimeters; or
- the tumor is any size and cancer has spread from the thyroid to nearby muscles in the neck.
Stage III: In stage III medullary thyroid cancer, the tumor is any size and cancer may have spread from the thyroid to nearby muscles in the neck. Cancer has spread to lymph nodes on one or both sides of the trachea or larynx.
Stage IV: Stage IV medullary thyroid cancer is divided into stages IVA, IVB, and IVC.
- In stage IVA, either of the following is found:
- the tumor is any size and cancer has spread from the thyroid to soft tissue under the skin, the esophagus, the trachea, the larynx, or the recurrent laryngeal nerve (a nerve that goes to the larynx); cancer may have spread to lymph nodes on one or both sides of the neck; or
- the tumor is any size and cancer may have spread from the thyroid to nearby muscles in the neck; cancer has spread to lymph nodes on one or both sides of the neck.
- In stage IVB, the tumor is any size and cancer has spread to tissue in front of the spine or to the spine or has surrounded the carotid artery or the blood vessels in the area between the lungs. Cancer may have spread to lymph nodes.
- In stage IVC, the tumor is any size and cancer has spread to other parts of the body, such as the lungs or liver. Cancer may have spread to lymph nodes.
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