Thyroid cancer: ask an expert

Written by: Mr Jonathan Bernstein
Published:
Edited by: Cal Murphy

In this article, top thyroid cancer surgeon Mr Bernstein explains the basics of thyroid cancer.

What is the thyroid?

The thyroid is a butterfly-shaped endocrine gland located in the middle of the neck. It is responsible for making thyroid hormone, which is essential for regulating the body’s metabolism.

Most thyroid nodules are benign and not of concern, but cancer of the thyroid gland has been getting more common, probably because of increased detection with imaging. The majority of this increase is accounted for by small, low-risk papillary thyroid carcinomas. Thyroid cancer can also occur in more advanced forms, with a firm mass in the neck or with spread to lymph nodes.

 

Thyroid cancer: 4 top facts

  1. Thyroid cancer is three times more common in women than men.
  2. There are four main types of thyroid cancer: papillary (most frequent), follicular, medullary and anaplastic (least frequent). Lymphoma can also occur in the thyroid but this is very rare.
  3. Thyroid cancer can be more aggressive over the age of 55.
  4. Thyroid cancer accounts for over 3% of all new cancer diagnoses each year.

 

Four types

  1. Papillary thyroid carcinoma – 8 out of 10 thyroid malignancies are papillary thyroid carcinoma. Most papillary thyroid carcinoma is low-risk. When solitary and under 4 cm, this form of thyroid cancer can sometimes be treated by only removing the affected half of the thyroid gland. It is important to tailor the treatment to the individual.
  2. Follicular thyroid carcinoma – 1 out of 10 thyroid cancers are follicular carcinoma. This and the Hurthle cell carcinoma variant can be higher risk.
  3. Medullary thyroid carcinoma – This type of thyroid cancer usually occurs sporadically, but medullary carcinoma can run in families and can be part of a condition called MEN type II.
  4. Anaplastic thyroid carcinoma – This is a fast-growing and very aggressive form of thyroid cancer, accounting for less than 1% of thyroid cancers.

All of the above forms of thyroid cancer are seen very frequently at the Thyroid Unit at The Royal Marsden.

Lymphoma can also be found in the thyroid. Lymphoma is a cancer that develops in the lymph system (part of the immune system).

 

What are the causes of thyroid cancer?

Usually there is no cause to be found for thyroid cancer; thyroid cancer is usually spontaneous. The incidence is much higher in women than in men. The risk factors associated with thyroid cancers include radiation exposure, a family history of thyroid cancer in a first-degree relative, and certain rare syndromes, such as Cowden syndrome.

 

What are the symptoms of thyroid cancer?

Most thyroid cancer, and low-risk papillary thyroid carcinoma in particular, cause no symptoms. Thyroid cancer symptoms can include:

  • A firm lump around the middle of the neck which moves upwards on swallowing
  • Firm lumps in the outer neck
  • Weakness of the voice lasting more than several weeks

The keys to diagnosis are ultrasound and fine needle aspiration cytology (biopsy). Sometimes a contrast-enhanced CT scan is needed because CT can show more extensive disease very clearly. Radioactive iodine therapy is frequently an essential part of treatment, and radiotherapy can be needed in certain more advanced cases.

Where can I go for thyroid cancer treatment?

The Royal Marsden’s Thyroid Unit at its central London and Surrey hospitals has particular expertise in all aspects of treatment of all stages and forms of thyroid cancer. The Unit deals with all patients with early to advanced disease, diagnostics, second opinions, and helping patients and their families to the highest of international standards.

If you would like to see Mr Jonathan Bernstein at the Royal Marsden as a private patient, you can arrange to be seen by calling the contact numbers given on his Top Doctors profile page. For NHS referrals, please arrange a referral to Mr Bernstein at the Royal Marsden with your general practitioner and then an appointment can be booked immediately.

By Mr Jonathan Bernstein
Otolaryngology / ENT

Mr Jonathan Bernstein is a consultant in otolaryngology specialising in head and neck surgery, thyroid surgery and ear, nose and throat conditions (ENT). From London originally, Jonathan qualified at Bristol University in 2002 and trained in Bristol, Manchester and Toronto. After completing UK training, Mr Bernstein undertook a three-year comprehensive fellowship programme in head and neck surgical oncology, reconstructive microsurgery and thyroid/ parathyroid surgery at the Department of Otolaryngology - Head & Neck Surgery, University of Toronto.

Mr Bernstein is Honorary Clinical Senior Lecturer at Imperial College London. He completed a two-year period of translational research and was granted a doctorate in cancer biology by the University of Manchester. He has undertaken research in clinical outcomes in thyroid cancer, surgical technology, head and neck cancer biomarkers, and functional MRI.

His surgical interests include salivary gland surgery (parotid/ submandibular), head and neck cancers (neck, mouth, throat), thyroid surgery and reconstructive techniques.

In your consultation with Mr Bernstein, he will discuss with you your opinion and preference, your health and medical history, and current best options for treatment.

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