Guest post by Ilya Likhterov, MD, Assistant Professor of Otolaryngology – Head and Neck Surgery and member of the Division of Head and Neck Oncology at Mount Sinai Beth Israel. To make an appointment with Dr. Likhterov, call 212-844-8775.
Thyroid cancer diagnosis is becoming more and more common among patients of all ages, but in the vast majority of cases, thyroid cancer is slow growing and rarely causes symptoms while it is small. Although there is potential for thyroid cancer to spread to the lymph nodes in the neck, overall prognosis is excellent even in the high risk, advanced stages of disease.
The increase in the frequency of the diagnosis is in part related to imaging of the neck in patients without symptoms. CT and MRI scans performed for unrelated reasons can detect small thyroid masses that would otherwise go undiagnosed. Ultrasound of the thyroid to “screen” for cancer can also identify small tumors that cannot be felt during an examination of the neck.
Unlike patients of many other cancer types, where early diagnosis of a tumor improves effectiveness of treatment, thyroid cancer patients do not necessarily benefit from early identification of small cancers. The American Thyroid Association, a national organization dedicated to treatment of thyroid disease, does not recommend biopsying thyroid nodules smaller than 1 centimeter (about the size of a penny) even if they look like cancer on ultrasound. Many of these tumors will not grow and will not cause any problems; thus, performing a biopsy may not be necessary.
Even when diagnosis of cancer is made with a biopsy of a small thyroid tumor, there is still an option to monitor rather than to operate right away. “Active surveillance” is a monitoring plan through which the physician “keeps an eye” on the tumor with repeat ultrasounds. If growth of the tumor is noted at any checkup, half of or the entire thyroid can be removed at a later date without added risk to the patient.
The potential of avoiding surgery is an attractive option for many. On the other hand, the uncertainly of living with a diagnosis of cancer can be a source of tremendous anxiety for those who do not choose up front surgery. A thorough discussion of all treatment options and recommendations with a doctor is paramount.