Tumors suspected of being Hürthle cell cancer are often treated like follicular neoplasms. Hürthle (Hurthle) cell cancer can also be hard to diagnose based on FNA biopsy. If there are signs the cancer has spread before surgery, the tumor must be a cancer and so a thyroidectomy will be done. Still, for most patients, this isn’t really needed. If the patient is only willing to have one operation, the doctor may just remove the whole thyroid gland in the first surgery. If the tumor turns out to be a follicular cancer, a second operation to remove the rest of the thyroid is usually needed (this is called a completion thyroidectomy). Only about 2 of every 10 follicular neoplasms will actually turn out to be cancer, so the next step is usually surgery to remove the half of the thyroid gland that has the tumor (a lobectomy). If the biopsy results are unclear, they might list “follicular neoplasm” as a diagnosis. Often, it isn’t clear that a tumor is a follicular cancer based on FNA biopsy. Because these cancers can be hard to treat, taking part in a clinical trial of newer treatments is another choice. Other targeted drugs might be helpful as well, especially if the cancer cells have changes in certain genes (such as the RET or NTRK genes). If these drugs are no longer working, cabozantinib (Cabometyx) might be an option. Targeted therapy drugs such as lenvatinib (Lenvima) or sorafenib (Nexavar) may be tried if the cancer has spread to several places and RAI and other treatments are not helpful. If the cancer does not show up on the radioiodine scan but is found by other imaging tests (such as an MRI or PET scan), external radiation may be used. If the cancer shows up on a radioiodine scan (meaning the cells are taking up iodine), radioactive iodine (RAI) therapy may be used, either alone or with surgery. If the tumor appears to be resectable (removable), surgery is often used. If cancer comes back in the neck, an ultrasound-guided biopsy is done to confirm that it is cancer. The recurrence might be found by either blood tests or imaging tests such as ultrasound or radioiodine scans. Recurrent cancer: Treatment of cancer that comes back after initial treatment depends mainly on where the cancer is growing, although other factors may be important as well. If RAI treatment is planned, the start of thyroid hormone therapy may be delayed until the treatment is finished (usually about 6 to 12 weeks after surgery). People who have had a thyroidectomy will need to take daily thyroid hormone (levothyroxine) pills. Areas of distant spread that do not respond to RAI might need to be treated with external beam radiation therapy, targeted therapy, or chemotherapy. The goal is to destroy any remaining thyroid tissue and to try to treat any cancer remaining in the body. RAI therapy is often given for more advanced cancers such as T3 or T4 tumors, or cancers that have spread to lymph nodes or distant areas.If the cancer does come back, radioiodine treatment can still be given. Radioactive iodine (RAI) treatment is sometimes used after thyroidectomy for early stage cancers (T1 or T2), but the cure rate with surgery alone is excellent.Treatment after surgery depends on the stage of the cancer: If cancer has spread to other neck lymph nodes, a modified radical neck dissection (a more extensive removal of lymph nodes from the neck) is often done. Because removing the lymph nodes allows them to be checked for cancer, this surgery also makes it easier to accurately stag e the cancer. Although this operation has not been shown to improve cancer survival, it might lower the risk of cancer coming back in the neck area. In addition, recent studies have suggested that people with micro-papillary cancers (very small thyroid cancers) may safely choose to be watched closely with routine ultrasounds rather than have immediate surgery.Įven if the lymph nodes aren’t enlarged, some doctors recommend central compartment neck dissection (surgical removal of lymph nodes next to the thyroid) along with removal of the thyroid. If lymph nodes are enlarged or show signs of cancer spread, they will be removed as well. Most cancers are treated with removal of the thyroid gland (thyroidectomy), although small tumors that have not spread outside the thyroid gland may be treated by just removing the side of the thyroid containing the tumor (lobectomy). Talk to your doctor if you have any questions about the treatment plan they recommend. The type of treatment your doctor will recommend depends on the type and stage of the cancer and on your overall health.
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