Papillary Thyroid Cancer: An Expert Overview for a Newly Diagnosed Patient

Overview of Papillary Thyroid Cancer

Papillary thyroid cancer is the most common form of thyroid cancer, accounting for about 80% of all thyroid cancer diagnoses. It originates from the follicular cells in the thyroid gland, a butterfly-shaped endocrine organ located at the base of your neck. The thyroid produces hormones that regulate metabolism, heart rate, and body temperature.

Papillary thyroid cancer is generally considered a "well-differentiated" cancer, meaning the cells resemble normal thyroid tissue. This characteristic is a key reason why the prognosis is typically very good. The disease tends to grow slowly and, in most cases, it remains confined to the thyroid gland. Even when it spreads, it's usually to nearby lymph nodes in the neck, which is often effectively managed with treatment.

How is Papillary Thyroid Cancer Diagnosed?

A diagnosis of papillary thyroid cancer typically begins with a physical exam of your neck. If a doctor feels a lump or nodule, further tests are needed. The primary diagnostic tool is an ultrasound of the thyroid and neck, which creates detailed images of the gland and any suspicious nodules. If a nodule appears concerning, a fine needle aspiration (FNA)biopsy is performed. During this procedure, a thin needle is inserted into the nodule to collect a small tissue sample. The sample is then examined under a microscope by a pathologist to determine if cancer cells are present. In some cases, a molecular analysis of the biopsy sample may also be done to help confirm the diagnosis and determine the best course of treatment. Additional assays, such as blood tests to check thyroid hormone levels, may also be part of the diagnostic process.

What is the Prognosis for Patients With Papillary Thyroid Cancer?

The prognosis for papillary thyroid cancer is excellent, particularly for patients with smaller tumors that have not spread beyond the thyroid. The five-year survival rate for papillary thyroid cancer is over 99%, and the 10-year survival rate is also very high. The prognosis is generally determined by several factors, including the patient's age, the size of the tumor, and whether the cancer has spread to lymph nodes or other parts of the body. Cancers that are confined to the thyroid gland have the most favorable prognosis. Even when the cancer has spread to lymph nodes, the prognosis remains very good because it is often successfully treated. Your doctor will use this information to determine your "risk stratification" — deemed as low, intermediate, or high risk — which helps guide treatment decisions and follow-up care.

What Are the Treatment Options for Papillary Thyroid Cancer?

The primary treatment for patients with papillary thyroid cancer is surgery. The extent of the surgery depends on the size and location of the tumor. It may involve a lobectomy, which removes the half of the thyroid with the tumor, or a total thyroidectomy, which removes the entire gland. In some cases, nearby lymph nodes may also be removed.

Following surgery, radioactive iodine (RAI) therapy may be recommended for patients with larger tumors, or if the cancer has spread to lymph nodes or other parts of the body. RAI targets and destroys any remaining thyroid tissue or cancer cells.

Dr. Noah S. Kalman, a radiation oncologist at Miami Cancer Institute at Baptist Health South Florida explained during an interview with CURE that managing quality of life during and after RAI treatment for patients with thyroid cancer may be challenging.

“If patients do have some issues with treatment, whether it’s dry mouth from the radioactive iodine, some patients can have occasionally some swallowing issues after their thyroid surgery, [but] there are some resources available,” Kalman said. There are speech therapies, there are medications to help with dry mouth — there are things we can do to help manage some of these patients’ symptoms going forward.”

After a total thyroidectomy, patients will need to take thyroid hormone replacement medication for the rest of their lives. This medication, typically a single pill taken daily, replaces the hormones the thyroid would normally produce.

External beam radiation therapy and chemotherapy are rarely used in patients with papillary thyroid cancer but may be considered in very specific, rare situations.

Overall, personalized therapy is key for a patient with thyroid cancer, including those with papillary disease.

“When a patient with iodine-refractory papillary thyroid cancer walks through the door of the clinic, they may have a very different disease from the earlier patient who had the same diagnosis,” Dr. Lori J Wirth, professor of medicine and medical director, Center for Head and Neck Cancers, of Massachusetts General Hospital, said during a CURE Connections program. “Personalized therapy is crucial because the disease from patient to patient can differ a lot.”

How Do Patients Live With Papillary Thyroid Cancer?

After treatment, living with papillary thyroid cancer often involves a lifelong commitment to follow-up care. Regular visits to your oncologist and endocrinologist are essential. These appointments usually include physical exams, blood tests to monitor thyroid hormone levels and check for markers of cancer recurrence, and periodic ultrasounds of the neck. It's crucial to take your thyroid hormone replacement medication as prescribed and to be vigilant about any new or returning symptoms.

Most patients can return to their normal daily activities and maintain a high quality of life. Many cancer centers also offer support groups or counseling services to help patients and their families cope with the emotional and psychological aspects of a cancer diagnosis.

Your Journey With Papillary Thyroid Cancer

A diagnosis of papillary thyroid cancer can be unsettling, but it's important to remember that this is a highly treatable form of cancer with an excellent prognosis. The treatment journey typically involves surgery, and sometimes radioactive iodine therapy, followed by long-term monitoring and hormone replacement. This information is intended to be a starting point for discussion with your medical team. Your oncologist will provide a personalized treatment plan based on your specific case. Open and honest communication with your doctor is key to a successful cancer journey and recovery.

This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

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