Moves in Medicine: De-escalating thyroid cancer treatment

PHILADELPHIA (WPVI) -- Treatment for thyroid cancer used to be a "one size fits all". But new guidelines have allowed doctors to take a more individualized approach and include the patient in the decision-making.

That's the way Fox Chase Cancer Center does it.

Traditionally, a diagnosis of thyroid cancer meant removing the entire thyroid, but that's no longer the case.

"The pendulum has swung from that one treatment protocol to very individualized treatment that not only depends on the type of thyroid cancer but also depends on the size of thyroid cancer and if it has any other aggressive features," explained Dr. Pankaj Sharda, an endocrinologist.

The thyroid gland produces hormones that regulate the body.

One path of cancer treatment is active surveillance.

"Even if we watch it for five years, ten years about 90-percent of them they don't grow and even if they grow, they grow very, very slowly and the prognosis are as good as taking it out today," said Dr. Sharda.

Another option is surgery, either whole or half removal of the thyroid.

"You don't want to be cutting into the gland because it has a tendency to bleed," said Dr. Jeffrey Liu, an associate professor of Otolaryngology and head and neck surgery. "We generally want to remove the entire one half or the whole gland in its entirety."

No matter what course you choose experts said make sure you are addressing all of the care you will need.

"One of the benefits here at Fox Chase Cancer Center is that we work as part of teams," said Dr. Liu. "Both the surgeon and endocrinologist have a detailed discussion, we discuss all of these patients and tumor board to really figure out what is the best recommendation because sometimes these decisions are not straightforward."

They also said to make sure you get information about all eventual outcomes.

"It's nice to have that conversation with patients before surgery; sometimes we find things we didn't expect. If this happens this is what we can expect to happen," said Dr. Liu.

Another thing to remember is that you can have nodules in your thyroid but that doesn't mean you have cancer.

Doctors say about 70- to 80-percent of nodules are benign. Also the survival rate of most thyroid cancers is in excess of 90-percent.
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