Definition and Overview

A papillary thyroid carcinoma is the most common type of thyroid cancer. It accounts for about 80% of all cases of thyroid cancer. It is characterised by a tumour or cystic mass that develops from normal thyroid tissue. Papillary thyroid carcinoma survival rates are quite high at 80 to 90 percent because most of these tumours are slow-growing and are easy to detect due to the presence of unusual lumps in the neck.

Causes of Condition

The common known cause of papillary carcinoma of the thyroid is radiation exposure, as is true with other types of thyroid cancer. In fact, this factor is said to cause up to 85% of all thyroid cancers, especially when exposure is focused mostly on the head, neck, or chest area. Exposure to radiation has a tendency to cause genetic mutations that may cause abnormal malignant cells to develop on otherwise healthy tissues.

Papillary thyroid carcinoma most commonly affects people between the ages of 30 and 50 years old. They are more common in women than men with a ratio of 3:1.

Key Symptoms

A papillary carcinoma thyroid presents itself as a tumour or mass in the thyroid area, usually in the multinodular goiter area. The tumour or mass can be either big or small, depending on the stage and aggressiveness of cancer. The size of the tumour has a direct effect on a patient’s long-term prognosis. Patients whose tumours are less than ½ inch or 1.5cm in size generally have a good prognosis and a great chance of complete cure. If the tumour is very small and the patient is relatively young and is in good health, the cure rate is almost 100%. Patients with papillary cancer of the thyroid may also develop enlarged cervical lymph nodes.

However, more than half of patients with thyroid papillary carcinoma develop metastatic cancer. The first to be affected is usually the lymph nodes in the neck area. Although metastases to distant sites are quite rare, they can also occur. Metastatic papillary carcinoma can cause lesions in parts of the body where cancer has spread.

It is important to note that not all unusual lumps in the neck are papillary thyroid carcinoma symptoms. In fact, most of them are harmless or benign masses. But to be certain, patients with such lumps are advised to see a doctor to undergo diagnostic tests. If the lump turns out to be a malignant tumour and the patient is able to receive early treatment, papillary thyroid carcinoma prognosis significantly improves.

Tests for diagnosing papillary cancer of the thyroid include:

  • Blood tests to check for thyroid-stimulating hormone (TSH)

  • Ultrasound, which can detect even small cancerous tumours that are less than 1cm in size (known as microcarcinomas)

  • Thyroid scan

  • Biopsy, such as a fine needle aspiration biopsy

Once a patient has been diagnosed with thyroid carcinoma, more tests are performed to determine the stage (or severity) of the disease. The staging of the disease is based on the size of the tumour, its location, and whether or not it has spread to nearby tissues.

Who to See and Types of Treatments Available

Patients with unusual lumps in the neck should go to a general physician, family doctor, or primary care physician for the initial diagnosis and tests. These healthcare providers also make necessary referrals in case specialists are needed. Patients who are diagnosed with the condition are then placed under the care of a medical oncologist (a doctor that specialises in cancer treatment) and an endocrinologist (a doctor that specialises in treating diseases that involve the thyroid and the rest of the endocrine system). The medical care team will also include a radiation oncologist and a surgeon.

For small tumours that have not spread to other tissues, the primary treatment for papillary carcinoma of the thyroid is the removal of the thyroid lobe where the tumour is located. This usually includes the isthmus, or the small central portion of the thyroid’s lobes. Conservative surgical procedure, such as isthmusectomy and hemithyroidectomy are generally advised for papillary carcinomas that are isolated, well circumscribed, and less than 1.5cm in size, as well as for patients who are relatively young or aged between 20 and 40 years old without a history of severe radiation exposure.

However, for more severe cases, such as tumours that are larger than 1.5cm, more aggressive surgery such as a total thyroidectomy may be necessary. Although total thyroidectomy comes with certain risks, such as laryngeal nerve injury, their rates of occurrence are quite low, and do not outweigh the procedure’s potential benefits.

A total thyroidectomy is usually followed by radioiodine and thyroid suppression therapies. Studies show that these follow-up thyroid papillary carcinoma treatments help reduce the recurrence rate of papillary thyroid carcinoma as well as its mortality rate. They also have a low risk of side effects, especially when compared with chemotherapy. There is no hair or weight loss, or nausea involved. However, they do tend to be more effective in early stage cancers, but may not be as effective in more advanced cases.

Conventional cancer treatments, such as chemotherapy, targeted therapy, internal radiation therapy, and external radiation therapy, may also be used. Moreover, if some lymph nodes have been affected and have become enlarged, they also need to be removed.

Patients who have had a part of their thyroid or the entire thyroid gland removed as treatment for papillary thyroid carcinoma also have to undergo thyroid hormone replacement therapy for the rest of their lives. In addition, they also need to undergo periodic cancer screening and annual chest x-rays to check for recurrences.

References:

  • Norman J. “Papillary cancer.” EndocrineWeb. https://www.endocrineweb.com/conditions/thyroid-cancer/papillary-cancer

  • Gonzales-Gonzales R, Bologna-Molina R, et al. “Papillary thyroid carcinoma: Differential diagnosis and prognostic values of its different variants: Review of the Literature.” ISRN Oncol. 2011; 2011: 915925. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302055/

  • Guerrero MA, Clark OH. “Controversies in the management of papillary thyroid cancer revisited.” ISRN Oncol. 2011; 2011:303128. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197013/

  • Roti E, degli Uberti EC, Bondanelli M, Braverman LE. “Thyroid papillary microcarcinoma: a descriptive and meta-analysis study.” European Journal of Endocrinology. 2008. 159:659-673. http://www.eje-online.org/content/159/6/659.full.pdf

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