Thyroid cancer- Hurthle cell

Overview

A rare form of cancer that originates in the thyroid gland. This cancer is characterized by the abnormal presence of Hurthle cells which may signify benign or malignant thyroid cancer. The cancer usually responds well to treatment if detected in the earlier stages.

Symptoms

* Asymptomatic in early stages * Neck lump * Difficulty breathing * Difficulty swallowing * Hoarseness

Causes

Predisposing factors to thyroid cancer include radiation exposure (especially childhood radiation therapy), prolonged thyroid-stimulating hormone (TSH) stimulation (through radiation or heredity), familial predisposition, or chronic goiter. Thyroid cancer occurs in all age-groups, especially in people who have had radiation treatment of the neck area. It affects 1 in 1,000 people.

Diagnosis

The first clue to thyroid cancer is usually an enlarged, palpable node in the thyroid gland, neck, lymph nodes of the neck, or vocal cords. A patient history of radiation therapy or a family history of thyroid cancer supports the diagnosis. However, tests must rule out nonmalignant thyroid enlargements, which are much more common. Thyroid scan differentiates between functional nodes (rarely malignant) and hypofunctional nodes (commonly malignant) by measuring how readily nodules trap isotopes compared with the rest of the thyroid gland. In thyroid cancer, the scinti-scan shows a “cold,” nonfunctioning nodule. Other tests include needle biopsy, computed tomography scan, ultrasonic scan, chest X-ray, serum alkaline phosphatase, and serum calcitonin assay to diagnose medullary cancer. Calcitonin assay is a reliable clue to silent medullary carcinoma

Treatment

*Total or subtotal thyroidectomy, with modified node dissection (bilateral or unilateral) on the side of the primary cancer (papillary or follicular cancer) *Total thyroidectomy and radical neck excision (for medullary, giant, or spindle cell cancer) *Radiation with external radiation (for inoperable cancer and sometimes postoperatively in lieu of radical neck excision) or alone (for metastasis) *Adjunctive thyroid suppression, with exogenous thyroid hormones suppressing TSH production, and simultaneous administration of an adrenergic blocking agent such as propranolol, increasing tolerance to surgery and radiation *Chemotherapy for symptom-producing, widespread metastasis is limited, but doxorubicin is sometimes beneficial.