Papillary Thyroid Cancer: Reasons to Seek Expert Care, Part I

The importance of experienced and proficient diagnosis and surgical management as they relate to outcomes and complications

Introduction

Since the 1970’s, the incidence of thyroid cancer has doubled. Until recently, thyroid cancer was the fastest growing cancer in the United States, mainly due to our ability to detect these cancers so well (Ultrasound, CT scan, MRI, etc.). Thyroid cancer is the 5th most common cancer in women. Overall, the 5-year survival rate for people with thyroid cancer is 98%, with long-term survival being 95% or higher.

Papillary thyroid cancer accounts for roughly 85% of all thyroid cancers. Papillary thyroid cancer typically arises as a solid, irregular, or cystic/solid mass that originates in otherwise normal thyroid tissue. This cancer is more common in women than men at a 3:1 ratio. Risks for developing papillary thyroid cancer are significant radiation exposure to the head/neck area or chest, typically from treatment of another cancer (lymphoma, breast cancer, etc.), smoking, obesity, and a strong family history of thyroid cancer. Overall cure rate approaches 100%, for most patients, particularly in the hands of expert surgeons at specialized, high-volume thyroid centers.

Below I will discuss the important reasons to seek expert care for papillary thyroid cancer diagnosis, thyroid surgery, and long term follow-up. Make sure to check out the second installment of this blog series where I will further discuss reasons to seek our expertise for papillary thyroid cancer treatment.

Learn more about thyroid cancer and expert thyroid care.

#1 Reason to Seek Expert Care for Papillary Thyroid Cancer: Thyroid Cancer Surgery is the Recommended Treatment

Thyroid surgery is the mainstay of treating thyroid cancer. There are 2 main types of thyroidectomy: thyroid lobectomy (removal of half of the thyroid) and total thyroidectomy (removal of the entire thyroid). Many cancerous thyroid nodules can be treated by removal of half the thyroid along with the lymph nodes that are located behind and around the thyroid. Numerous studies have shown that up to 30% of thyroid cancers have spread to lymph nodes at the time of diagnosis and surgery. Expert evaluation and complete removal of all cancer with the first surgery are extremely important to avoid complications and leaving cancer behind.

In other instances, total thyroidectomy is needed to treat papillary thyroid cancers that are large, located in both halves of the thyroid, or when cancer has spread to lymph nodes in the neck. Again, removal of the lymph nodes behind and around the thyroid in the middle of the neck, at a minimum, is important to ensure the cancer is completely cured. Complete thyroid removal is even riskier than thyroid surgery for half the thyroid. This is because both sides of the neck are worked on, exposing all 4 parathyroid glands (calcium control glands) as well as all the nerves to the voice box to potential damage. Thus, total thyroid removal should only be done by high-volume, experienced surgeons at busy centers such as ours.

Finally, papillary thyroid cancer that has spread to lymph nodes in the side of the neck is treated by removing the whole thyroid (total thyroidectomy) along with lymph node dissection (neck dissection). This thyroid surgery is done for thyroid cancers that have spread to lymph nodes in the side of the neck (on the left, right, or both) or to the lymph nodes in the center of the neck around and behind the thyroid. Thyroid cancer surgery must address the entirety of lymph node areas that are known to contain cancer as well as those that are at significant risk of having thyroid cancer.

Read more on thyroidectomy for thyroid cancer and the 3 best operations for thyroid cancer.

You need expert evaluation and surgery for papillary thyroid cancer. This is to ensure that the correct surgery is done, the cancer is cured with the 1^st operation, and that complications are minimized to almost zero. The wrong surgery in the wrong hands will lead to complications and further treatment or surgery.

#2 Reason to Seek Expert Care for Papillary Thyroid Cancer: Expert Thyroid Ultrasound is Key in Diagnosis and Staging

Thyroid ultrasound is the best imaging method to evaluate the thyroid and diagnose papillary thyroid cancer. Ultrasound is crucial in the work-up and diagnosis of thyroid nodules, cancer, and other thyroid disease. When someone is diagnosed with a thyroid condition, they should have a skilled, thorough ultrasound done if one has not been performed. If your doctor first orders a CT scan, MRI, or PET/CT scan to evaluate your thyroid problems, you need a second opinion from an expert.

All patients, particularly if they have papillary thyroid cancer or a suspicious mass in the thyroid, need their entire neck examined with a high-resolution ultrasound. If you do not get a skilled, expert ultrasound done with a high-resolution ultrasound machine, however, you run the risk that papillary thyroid cancer might be missed. Every thyroid ultrasound must include examination of the lymph nodes and the tissues that surround the thyroid. This should be done in the middle of the neck, and on both sides of the neck, from the jaw down to the sternum and collarbone. Otherwise, papillary thyroid cancer that has spread will be missed. 

Thus, the goal of the thyroid ultrasound is NOT just to look at the thyroid. A high-quality thyroid ultrasound also examines all the tissues on both sides of the neck to look for enlarged or abnormal- appearing lymph nodes. High- resolution ultrasound has a detection capability as small as 1-2 mm (the size of a tip of a ball point pen) for a papillary thyroid cancer or a papillary thyroid cancer that has spread to lymph nodes. An excellent, thorough ultrasound will determine if thyroid cancer is present or if a needle biopsy needs to be performed to diagnose papillary thyroid cancer or its spread to the lymph nodes. An inexperienced or incomplete thyroid ultrasound will lead to missed cancer and incorrect surgery.

Figure 1: Ultrasound image of a cancerous thyroid nodule

Figures 2-4: Ultrasound images of multiple enlarged, cancerous lymph nodes with a speckled, irregular appearance in the left side of the neck.

Learn more about thyroid ultrasound and the diagnosis of thyroid cancer.

#3 Reason to Seek Expert Care for Papillary Thyroid Cancer: Outcomes and Complications are Tied to Experience and Expertise

Knowledge, experience, and expertise are paramount in the diagnosis, surgical management, and follow-up for papillary thyroid cancer. Multiple studies have shown that complications are significantly reduced and outcomes are much better when papillary thyroid cancer surgery is handled by expert teams of medical professionals and staff. At our thyroid center and dedicated endocrine hospital, skill and competence permeate the entire team, from our surgeons to the nursing and operating room staff along with folks taking care of patients before and after surgery for papillary thyroid cancer.

Additionally, our radiology, anesthesia, and pathology colleagues have unmatched proficiency and expertise in thyroid cancer evaluation, diagnosis, and surgical management. Working with the same colleagues and staff day in and day out is a huge benefit for patient care and outcomes that cannot be understated.

Entrust only the best with the management of your papillary thyroid cancer! Learn more about how to choose a thyroid cancer surgeon.

Be sure to check out the second part of this blog series about the importance of experienced and proficient surgical management and how this affects further treatment, follow-up, and your quality of life.

The importance of experienced and proficient surgical management and how this affects further treatment, follow-up, and your quality of life.

Summary

Papillary thyroid cancer is the most common thyroid cancer by far. Fortunately, this cancer is very curable when managed skillfully and correctly. Expert thyroid cancer surgery done at a center like ours is the first and most important step in the cure of your papillary thyroid cancer. A skilled and thorough high- resolution ultrasound is crucial for diagnosis and determination of the extent of papillary thyroid cancer to ensure the appropriate surgery is done. An experienced, knowledgeable care team is critical throughout all phases of the pre-operative, post-operative, and surveillance periods to maximize outcomes and minimize complications

Our team of thyroid cancer experts is here to help and guide you every step along the way, and we will be there for you after your thyroid surgery for papillary thyroid cancer. Nothing is more important than your health! To learn more and become a patient, please see our resources below.

Additional Resources

• Become our patient by filling out the form at this link. 
• Learn more about The Clayman Thyroid Center here. 
• Learn more about our sister surgeons at the Scarless Thyroid Surgery Center, Norman Parathyroid Center, and Carling Adrenal Center
• Learn more about the Hospital for Endocrine Surgery.