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Thyroid Cancer

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What is thyroid cancer?

Thyroid cancer originates from the thyroid gland, a butterfly-shaped organ in your neck, just below the Adam’s apple. The thyroid gland produces hormones that help regulate various bodily functions, including metabolism. 

Thyroid cancer is typically characterised by a lump or nodule in the neck. It is a relatively rare form of cancer but is often highly treatable, with a high survival rate. The main types of thyroid cancer include:

  • Papillary thyroid cancer: the most common type of thyroid cancer, with approximately 80% of all thyroid cancers being papillary. It grows slowly and often spreads to the lymph nodes in the neck. It is highly treatable and rarely fatal.
  • Follicular thyroid cancer: accounting for approximately 15% of thyroid cancer, follicular thyroid cancer commonly spreads to other parts of the body, including the lungs and bones.
  • Medullary thyroid cancer: typically linked to a family history of this disease, medullary thyroid cancer accounts for approximately 2% of all thyroid cancer, with ¼ of affected individuals having a genetic link.
  • Anaplastic thyroid cancer: the most aggressive and challenging to treat thyroid cancer, it grows quickly and spreads easily to other parts of the body. It is rare and affects approximately 2% of individuals with thyroid cancer.

What causes thyroid cancer?

Thyroid cancer occurs when genetic changes occur in the thyroid cells, causing them to multiply uncontrollably, resulting in a growth or tumour. These genetic changes can turn on oncogenes – genes that help cells grow and divide or live longer, and turn off tumour suppressor genes – genes that reduce cell growth and tell cells when to die. Thus resulting in the overgrowth of cells.

However, it is still unclear as to what causes the DNA or genes of cells to malfunction. Several risk factors may contribute to this occurrence; these include exposure to radiation, genetics, etc.

What are the symptoms of thyroid cancer?

Symptoms of thyroid cancer include:

  • Neck lump
  • Change in voice
  • Difficulty swallowing
  • Neck pain
  • Enlarged lymph nodes
  • Throat or neck discomfort
  • Breathing difficulty
  • Coughing or wheezing
  • Fatigue

If you suspect you have symptoms of thyroid cancer or are concerned about your thyroid health, consult with an endocrinologist for a proper evaluation and diagnosis.

thyroid pain
The pain level for thyroid cancer is typically mild to moderate.

Is thyroid cancer painful?

In its early stages, thyroid cancer is not typically associated with pain and is not a highly painful cancer (when compared to other forms of cancer). Most thyroid nodules or early tumours are painless and only often discovered incidentally – known as thyroid incidentalomas during routine physical examination(s), ultrasound, or imaging tests. 

These thyroid nodules or tumours usually do not cause discomfort or pain. However, as the thyroid cancer advances or grows, it can lead to symptoms such as difficulty swallowing, a sensation of a lump or pressure in your neck, and/or changes in your voice, which can cause some level of discomfort or pain (depending on your tolerance to pain). In such cases, the discomfort or pain is usually on the mild to moderate side, with severe pain being relatively rare.

Who is at risk of thyroid cancer in Singapore?

In Singapore, thyroid cancer can affect individuals of various backgrounds and ages. However, certain risk factors may increase the likelihood of developing thyroid cancer. These risk factors are:

  • Gender: thyroid cancer is more common in women than men, with research showing that women are about 3 times more likely to experience thyroid cancer than men.
  • Age: thyroid cancer risk increases with age, particularly between 25 to 65 years.
  • Genetics: your risk increases if you have a family history of thyroid cancer or hereditary conditions, such as multiple endocrine neoplasia type 2 (MEN2) or familial medullary thyroid cancer. Specific gene mutations, such as RET and BRAF mutations, have also been associated with a higher risk of thyroid cancer.
  • Radiation exposure: exposure to high levels of radiation, especially during childhood, can increase your risk of thyroid cancer. This may result from medical treatments such as radiation therapy or environmental exposures.
  • Certain genetic syndromes: if you have inherited genetic syndromes such as multiple endocrine neoplasia (MEN) type 2A and 2B and familial adenomatous polyposis (FAP), you have an increased risk of thyroid cancer.
thyroid cancer female
Thyroid cancer is more prevalent in women than men.

How is thyroid cancer diagnosed?

Generally, diagnosing thyroid cancer involves a series of medical tests, such as:

  • Clinical evaluation: your endocrinologist will start by discussing your medical history and any symptoms you may be experiencing. They will perform a physical examination, paying close attention to your neck and thyroid gland.
  • Imaging tests: to get a better look at your thyroid and any potential abnormalities, imaging tests such as ultrasounds, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may be ordered.
  • Biopsy: a biopsy is the most definitive way to diagnose thyroid cancer. Your endocrinologist may perform a fine-needle aspiration (FNA) biopsy, where a small sample of thyroid tissue or cells is extracted using a thin needle. This sample is then examined to check for the presence of cancer. Occasionally, surgical biopsies may be needed for a more comprehensive examination.
  • Blood tests: blood tests such as thyroid function tests and measuring the levels of specific thyroid hormones may be conducted to provide additional information.
  • Lymph node examination: a lymph node biopsy may be performed if there is a concern that the cancer has spread to nearby lymph nodes.

Once your diagnosis is confirmed, the specific type and stage of thyroid cancer will be determined. This information is essential for developing an appropriate treatment plan. Early detection and prompt treatment can significantly improve your chances of preventing it from spreading.

thyroid exam
Seeking medical attention early is important to address thyroid cancer before it develops further.

What are the treatment options for thyroid cancer in Singapore?

Treatment for thyroid cancer ultimately depends on the symptoms and stage of the cancer. Treatment options for thyroid cancer include: 

  • Thyroid surgery: this is often the primary treatment for thyroid cancer. Examples of thyroid surgery include transaxillary endoscopic thyroidectomy (link to service page), minimally invasive video-assisted thyroidectomy (MIVAT) (link to service page), conventional open hemithyroidectomy (link to service page), near-total thyroidectomy (link to service page), and total thyroidectomy +/- neck lymph node dissection (link to service page). The choice of surgery depends on the stage and severity of thyroid cancer.
  • Radioactive iodine (RAI) therapy: after surgery, RAI therapy may be used to destroy any remaining thyroid tissue or cancer cells.
  • Thyroid hormone replacement: once the thyroid gland is removed, thyroid hormone replacement medication must be taken for life to help maintain your body’s normal functions.
  • External beam radiation: in some cases, external beam radiation therapy may be used, particularly for more advanced or aggressive thyroid cancers.
  • Targeted drug therapies: if your case is advanced or recurrent, targeted drug therapies may be used to slow the growth of the cancer.

If you are suffering from a thyroid disorder, have a family history of thyroid disorders, or are concerned about developing thyroid cancer, schedule an appointment with ACE Surgery and Endoscopy for a detailed examination and individualised treatment plan. 

Frequently Asked Questions

Is thyroid cancer curable?

Thyroid cancer is often curable, especially when detected early and with the appropriate treatment. Many thyroid cancer patients have a favourable prognosis and go on to lead normal, healthy lives.

Are there risks of recurrence with thyroid cancer?

Yes, there is a risk of recurrence with thyroid cancer, depending on the type and stage. Regular follow-up care and monitoring are crucial to detect and manage any potential recurrences effectively.

Are there risks of recurrence with thyroid cancer?

Yes, with appropriate treatment and follow-up care, many individuals with thyroid cancer can lead normal lives. The outcome depends on the cancer type and stage.

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Reyaz Moiz

Dr Reyaz Singaporewalla
Senior Consultant Endocrine and General Surgeon

MBBS (Bom), MS (Surg), DNB (Surg), FRCS (Edin), MMed (Singapore), FRCSEd.