thyroid cancer

Thyroid Cancer 101: Symptoms, Causes, Stages, Types & Treatment

Find out more about thyroid cancer and its symptoms, survival rates, causes, stages, and treatment options.

by Nathasha Lee

Thyroid cancer is one of the top ten most common types of cancer in Singapore. It is the eighth most common cause of cancer among Singaporean women, with a study showing that there are 1100 new reported cases of thyroid cancer in Singapore every year. What is thyroid cancer, what causes thyroid cancer, and how can we treat and prevent it? We will find out in this article.

What is Thyroid Cancer?

Thyroid cancer affects a gland that produces hormones which control our heart rate, blood pressure, weight, and body temperature. These hormones are secreted into our bloodstream to control the activity of the cells and tissues in our body to make sure they can work properly. Sometimes our thyroid may secrete too much of the thyroid hormones, leading to hyperthyroidism that causes a faster heart rate and hyperactive bowel movement. Conversely, hypothyroidism happens when our thyroids don’t secrete enough hormone and causes our heart rate and the rate at which our intestines work to slow down. Thyroid cancer is caused by mutations in certain genes in the thyroid, though medical experts are not sure what exactly causes these mutations.

Some risk factors for thyroid cancer include:

  • Exposure to radiation repeatedly over time. Radiation is used in certain medical procedures like X-rays, CT scans, and radiation therapy for conditions like lymphoma. You are less likely to get cancer from repeated radiation exposure gained as an adult compared to when you were a child.
  • Being overweight.
  • Having a diet that is too high or too low in iodine. The body uses iodine to make thyroid hormones. Iodine is found in foods like dairy products like milk and yoghurt, seafood, seaweed, and table salt. A diet too high in iodine can increase one’s risk of papillary thyroid cancer but one that is too low in iodine can lead to follicular thyroid cancer. People who have a vegan diet, meaning they don’t consume any animal products, may be at risk of not getting enough iodine.
  • Having a first-degree relative, like a parent or a sibling, with thyroid cancer.

Types of Thyroid Cancer

There are main types of thyroid cancer: papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer.

Papillary Thyroid Cancer

The most common type of thyroid cancer, accounting for 38% of all thyroid cancer cases between 2007 and 2013. It is more common in younger people, especially women of childbearing age. A common sign of papillary thyroid cancer is a hard solid mass of abnormal tissue in the thyroid. There is a high chance of this type of cancer spreading to the lymph nodes in the neck. Papillary thyroid cancer is very frequently linked to radiation exposure.

Follicular Thyroid Cancer

The less common and is often found among older patients aged 40 to 60. There is also a variant of follicular papillary thyroid cancer. This type of cancer more frequently invades the blood vessels within the thyroid. The chance of follicular thyroid cancer spreading to other parts of the body like the lungs, brain and bladder is uncommon, though more common than it is with papillary thyroid cancer. Follicular thyroid cancer cure rate can be as high as 95% for younger adults but decreases with age.

Medullary Thyroid Cancer

The third most common cause of thyroid cancer and is likely to run in families, with 25% of cases being inherited. In medullary thyroid cancer, the cells that typically make thyroid hormone make a different hormone called calcitonin. This type of thyroid cancer typically presents itself as a lump in the throat that the patient may discover on his or her own or that may be discovered by the doctor during a medical examination. The lump may grow large enough to interfere with swallowing and speaking. Medullary thyroid cancer is more aggressive than papillary or follicular cancer. The chance of the patient being cured is highest if treatment occurs before the cancer spreads to other parts of the body.

Anaplastic Thyroid Cancer

The most aggressive type of thyroid cancer of the four main subtypes. It is found in less than 2% of all thyroid cancer patients and is most common in people over the age of 60. While the cause of anaplastic thyroid cancer is unknown, it can arise from other types of thyroid cancer like papillary or follicular thyroid cancer. The survival rate for anaplastic thyroid cancer is low, with an average survival rate of six months after diagnosis.

Stages of Thyroid Cancer

The stages of thyroid cancer are determined along three categories: by the size of the tumour (T), whether it has spread to the lymph nodes (N), and whether it has metastasised to other organs beyond the thyroid (M). Numbers or letters paced after T, N or M indicate the extent of one’s cancer that can be used to determine an overall stage in a process known as stage grouping. There are some systems that use the pathologic stage, which is the stage that is decided from examining tissue that is removed during an operation. If such an operation is not possible, clinical staging based on results from biopsies and tests may be used instead.

There are different staging systems that are used for anaplastic, medullar, and differentiated (papillary and follicular) thyroid cancer. The terminology used in these systems can be very complex so if you don’t understand them, you can ask your doctor to clarify the different stages for you.

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Thyroid Cancer Treatment

Thyroid cancer is often treatable, especially in younger patients. The five-year survival rate for thyroid cancer can be as high as 98%. However, the survival rate is dependent on other factors like age, the type of thyroid cancer, and the stage at which the cancer was discovered.

One of the main forms of treatment for thyroid cancer is a thyroidectomy, which is a surgery to remove all or part of the thyroid. Radioactive iodine treatment may also used where one ingests some iodine containing a radioactive substance which can travel through your bloodstream and kill cancerous cells. External radiotherapy is another option which uses a machine that kills cancer cells with beams of radiation, in addition to chemotherapy and other medicines.

Papillary thyroid cancer and follicular thyroid cancer are usually treated with surgery following radioactive iodine treatment. Medullary thyroid cancer is typically treated with surgery followed by radiotherapy. Anaplastic thyroid cancer cannot usually be treated using surgery, but radiotherapy and chemotherapy may help in controlling symptoms.

Thyroid Cancer Prevention

As many people with thyroid cancer have no known risk factors, it can be difficult to pinpoint an exact cause and address it to mitigate the risk of disease. Radiation exposure is a commonly known cause of papillary thyroid cancer, though radiation is used in less medical treatments today than it was in the past. If medical imaging needs to be performed on children to test for other conditions like bone fractures, try to ensure they receive the lowest possible dose of radiation exposure.

Genetic tests can also be done to evaluate the risk of gene mutations that could give rise to familial medullary thyroid cancer. Removal of the thyroid gland can help to prevent or treat this type of thyroid cancer. Discovering underlying risks early and taking swift action can help to prevent serious conditions like cancer in the future. If you know you have a family history of medullary thyroid cancer, you should consult a doctor who can help you with genetic testing for this condition.

Thyroid Cancer Support Groups and Resources in Singapore

Being diagnosed with thyroid cancer is a deeply upsetting event for patients and their loved ones. Struggling with treatment can feel like a lonely and tiring experience. However, thyroid cancer patients don’t have to struggle on their own. Here are some cancer support groups and programmes across Singapore that you can join to find others whom you can share your struggles and journey with.

Children’s Cancer Foundation

The Children’s Cancer Foundation provides social and recreational activities in hospitals for children who are going through cancer treatment. Child Life Specialists accompany young patients through the treatment process and teach children self-mastery techniques which can help them cope psychologically with the stress of going through treatment. Caregivers can join a parent support group to learn information they need to support their child’s condition and even receive massage sessions to support their well-being.

National Cancer Centre

The National Cancer Centre offers online programmes every month to help patients and caregivers develop resilience and equip attendees with other skills to support them in navigating the challenges caused by cancer diagnosis and treatment. You can also apply to join patient support programmes which help you discuss concerns in a safe environment and make informed decisions on how to cope with your illness. More information on how to contact the National Cancer Centre can be found on their website.

National Cancer Society (NCS) Rehabilitation Centre

The NCS Rehabilitation Centre focuses on providing community-based rehabilitative care for patients whose conditions do not require frequent visits to the hospital. People who have been recently diagnosed with cancer, those who are in a medically stable condition and have completed follow-ups at the hospital and are all welcome to apply. Patients will work with SCS personnel to create a personalised recovery plan. Elements of a patient’s recovery plan may include therapy to relieve chronic pain, counselling to help with emotional challenges and a Return-to-Work programme to help people with cancer return to the workforce. To join a rehabilitation programme you require a doctor, nurse, medical social worker, or therapist to submit a referral on your behalf.

Singapore Cancer Society (SCS) Bishana Ladies’ Group

This group is for women who have been affected by any type of cancer, regardless of whether they are undergoing treatment or have survived cancer. The group gathers for recreational activities like baking workshops, yoga and Zumba sessions, and ukulele classes. Older members also share advice with newer members on how to cope with the lifestyle changes brought about by cancer. The Bishana Ladies’ Group meets every third Friday from 6.30p.m. to 9.00p.m. and third Saturday from 10.00a.m. to 12p.m.

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References
  1. American Thyroid Association. (2020, June 8). Medullary Thyroid Cancer. https://www.thyroid.org/medullary-thyroid-cancer/
  2. Bishana Ladies Group. (n.d.). Singapore Cancer Society. Retrieved May 8, 2021, from https://www.singaporecancersociety.org.sg/get-help/cancer-survivor/join-a-support-group/bishana-ladies-group.html
  3. Can Thyroid Cancer Be Prevented? (n.d.). American Cancer Society. Retrieved May 8, 2021, from https://www.cancer.org/cancer/thyroid-cancer/causes-risks-prevention/prevention.html#:%7E:text=Most%20people%20with%20thyroid%20cancer,to%20treat%20less%20serious%20diseases.
  4. Clayman, G. (2018, October 7). Papillary Thyroid Cancer. EndocrineWeb. https://www.endocrineweb.com/conditions/thyroid-cancer/papillary-cancer#:%7E:text=Papillary%20thyroid%20cancer%20(also%20sometimes,spread%20beyond%20your%20thyroid%20gland).
  5. Follicular Thyroid Cancer. (n.d.). Clayman Thyroid Center. Retrieved May 6, 2021, from https://www.thyroidcancer.com/thyroid-cancer/follicular
  6. Hospital Facilities. (n.d.). Children’s Cancer Foundation. Retrieved May 8, 2021, from https://www.ccf.org.sg/programmes-and-services/in-the-hospitals/hospital-facilities/
  7. Join a Cancer Rehabilitation Programme. (n.d.). National Cancer Society. Retrieved May 8, 2021, from https://www.singaporecancersociety.org.sg/get-help/cancer-patient/join-a-cancer-rehabilitation-programme.html
  8. NHS website. (2019, August 29). Treatment. NHS. https://www.nhs.uk/conditions/thyroid-cancer/treatment/#:%7E:text=The%20main%20treatments%20are%3A,cancer%20cells%20to%20kill%20them
  9. Office of Dietary Supplements – Iodine. (2021, March 22). National Institutes of Health. https://ods.od.nih.gov/factsheets/Iodine-Consumer/
  10. Shulin, J. H., Aizhen, J., Kuo, S. M., Tan, W. B., Ngiam, K. Y., & Parameswaran, R. (2018). Rising incidence of thyroid cancer in Singapore not solely due to micropapillary subtype. Annals of the Royal College of Surgeons of England, 100(4), 295–300. https://doi.org/10.1308/rcsann.2018.0004
  11. Support Groups. (n.d.). National Cancer Centre Singapore. Retrieved May 8, 2021, from https://www.nccs.com.sg/patient-care/specialties-services/support-groups
  12. Thyroid Cancer Facts, Symptoms, Diagnosis & Treatment | Gleneagles Hospital, Singapore. (n.d.). Gleneagles Hospital. Retrieved May 4, 2021, from https://www.gleneagles.com.sg/facilities-services/centre-excellence/cancer-care/thyroid-cancer
  13. Thyroid Cancer Stages. (n.d.). American Cancer Society. Retrieved May 8, 2021, from https://www.cancer.org/cancer/thyroid-cancer/detection-diagnosis-staging/staging.html
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About the Writer
Nathasha Lee
Nathasha Lee is a final-year Anthropology major at Yale-NUS College. She hopes her writing can make a positive difference in the lives of readers, no matter how small. In her spare time, she enjoys making art, listening to podcasts, and drinking lots of tea.
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