About the Department
There is a gland that is located in front of the neck and right below the voice box, otherwise known as larynx. This gland is called the thyroid gland which is part of the endocrine system. Additionally, iodine from the bloodstream is absorbed by the thyroid glands that in turn produces thyroid hormones. The body’s metabolism is also regulated by this. The thyroid gland releases and regulates hormones that also directs other body functions such as using energy, producing heat and how the body consumes oxygen.
There are two lobes in a normal thyroid gland, one on either side of the windpipe that is joined by the isthmus, which is a narrow strip of tissue. If the thyroid gland is healthy, it is barely palpable and that means that it is even difficult to locate it by touch. If a growth begins developing in the thyroid, it appears in a lump like form in the neck. If the thyroid glands become swollen or enlarged, it is called a goitre which may be the result of the individual not having adequate access to iodine.
Thyroid cancer starts in these thyroid glands when the cells begin to mutate or transform. A tumour is formed, if the abnormal cells begin to indiscriminately multiply in the thyroid.
Women are more at risk of developing thyroid cancer at a ration of 3:1. While thyroid can may occur at any age, it is most common post crossing 30. Over time, it seems to aggressively increase in older patients significantly.
The Department of Thyroid Cancer at Fortis Hospitals, Bannerghatta Road combines top-notch patient care with cutting-edge medical technology that has been highly effective with proven results in individualised treatment alternatives for patients diagnosed with nodular and thyroid cancer. Committed towards progressively researching advanced options of diagnosing and treating thyroid cancer, Fortis Hospitals at Bannerghatta Road had a leading clinical team that offers timely, compassionate and comprehensive multidisciplinary care, covering a range of cancer services.
Fortis Hospitals at Bannerghatta Road’s multidisciplinary Endocrine Oncology Department has developed a unique model of patient centric care. It is the only one of its kind in Bangalore that aims to transform and modernise treatment of patients diagnosed with thyroid nodules, thyroid cancer and hyperthyroidism. The Department of Thyroid Cancer has a team of renowned and established specialists in endocrinology, surgery, nuclear medicine, medical and radiation oncology, and pathology who come together in order to combine their respective fields of expertise to offer the patient the treatment and support that he or she needs to advance towards the road to recovery.
Areas of Care
If the cells in your thyroid undergoes genetic mutations, it may lead to thyroid cancer. The transformation in the cells permits them to rapidly expand and multiply in numbers. In due course of time, this exponential growth in cells makes them lose their ability to die, as is the case with normal cells. Therefore, the accumulation of these abnormal thyroid cells over a significant period of time results in a tumorous growth. The tissues nearby may be invaded by the abnormal cells which may lead to the cancer spreading throughout the body.
Thyroid cancer and its treatment and prognosis are determined by its type which may include the following:
- Papillary thyroid cancer:
This is the most common type of thyroid cancer that constitutes approximately 70% to 80% of all know types of thyroid cancers. While this type of cancer may impact at any age, it is mostly seen developing in people between the ages of 30 and 50. The follicular cells that produces and stores thyroid hormones is the starting point of papillary thyroid cancer. The growth of this type of thyroid cancer is slow and over time may penetrate in to the lymph nodes in the neck region.
- Follicular thyroid cancer:
Making up about 10% to 15% of all thyroid cancers, follicular thyroid cancer, also initiates from the follicular cells of the thyroid. People older than 50 years are mostly affected by this particular cancer type. While follicular cancer is rarer in comparison to papillary cancer, it still can spread to the lymph nodes in the neck area and is more likely to penetrate other organs in the body too, specially the lungs and the bones.
Hurthle cell cancer: This is a rare type of follicular thyroid cancer and potentially more aggressive. They too can penetrate into the lymph nodes in comparison to other sub-types of follicular thyroid cancers.
- Medullary thyroid cancer:
The C cells within the thyroid cells is where medullary thyroid cancer starts from. These C cells generate the hormone known as calcitonin. If the levels of this hormone – calcitonin, in the blood is elevated, it may possibly indicate towards an early stage of medullary thyroid cancer.
Medullary thyroid cancer may also be the result of a genetic syndrome known as multiple endocrine neoplasia type 2 (MEN2). The cancerous growth in this case has limited likeness to a normal thyroid tissue.
While this type of cancer accounts for only 3% of all thyroid cancers out of which 25% is due to genetic reasons. This basically implies that all family members may be at risk of a similar diagnosis. If diagnosed and treated at an early stage, medullary thyroid cancer can be controlled from spreading to other organs in the body.
- Anaplastic thyroid cancer:
This is difficult to treat type of thyroid cancer and has the characteristic of spreading in the body very quickly. The starting point of anaplastic thyroid cancer is from a rapidly- growing, poorly differentiated thyroid cancer or even a benign thyroid tumour. This type of cancer mostly affects adults over the age of 60 years and be further sub-types into giant cell classifications. Due to its distinctive fast-growing nature, it is extremely difficult to successfully treat anaplastic thyroid cancer.
- Thyroid lymphoma:
A rare form of cancer, thyroid lymphoma typically starts developing in the immune system cells, specifically in the lymph tissue, which is a part of the body’s lymphatic system. In a short period of time, the cancerous cells exponentially multiply. Mostly, older adults are affected by this type of cancer. The common form of thyroid lymphoma are types of non-Hodgkin lymphoma or also referred to as NHLs.
The Department of Thyroid Cancer at Fortis Hospitals, Bannerghatta Road, exceptionally patient centric. Multiple specialists who are highly skilled and experienced in managing and treating all types of thyroid cancers are available at a single location. Diagnostic screenings and tests can also be performed within the same facility which is convenient for the patient and their families too. We ensure that outcomes are made available as quickly as possible so that the care team is able to make timely treatment decisions.
Symptoms & Diagnosis
Signs and Symptoms of Thyroid Cancers
There are little or no symptoms for those developing thyroid cancers. It is only during routine examinations of the neck or during x-rays and other imagine tests that thyroid cancers tend to get detected. People with thyroid cancers may experience none, one or more than one of the following symptoms:
- If you observe a lump in front of the neck, probably closer to the Adam’s apple
- If you experience hoarseness
- If you notice glands in the neck that are swollen
- If you find it difficulty swallowing
- If you have a hard time breathing
- If you experience pain in the neck or throat
- If you have persisting cough which is not the result of a cold
It is prudent to seek medical help if you have been experiencing one of more of these symptoms immediately. It is possible that some of these symptoms may be the result of other, non-cancerous conditions too. It may also be due to other forms of neck cancers. It is common to have lumps in the thyroid which tend to benign in nature. However, getting advice from your healthcare provider is the right decision to take as cause of these symptoms can be correctly diagnosed and treatment may begin, if required.
Our Diagnostic Services
The symptoms are one of the first reasons that may help detect thyroid cancers. It may possibly be found also during routine physical examinations and tests. If your healthcare provider suspects thyroid cancer, additional screenings and diagnostic tests may be prescribed in order to confirm the diagnosis.
Some of these tests include:
- Physical Examination:
During the physical examination, the doctor may try and get information on the overall general health of patient, medical history of the family and if the patient has experienced any medical issues in the past. A thorough physical examination will be performed during this consultation.
- Blood Tests:
The doctor may prescribe several blood tests that may be aimed at diagnosing and monitoring the patient during and after treatment. One of the blood tests recommended may be the tumour marker test where it can detect higher than normal levels of substances or markers in the patient’s blood stream, urine or body tissue, if cancer cells indeed present in the body.
Medullary type-specific tests: This screening looks for high levels of calcitonin and carcinoembryonic antigen (CEA) which can be done with the help of a tumour marker test. If the doctor suspects the presence of RET proto-oncogenes, he or she prescribe additional blood tests.
- Thyroid hormone levels:
This diagnostic test is aimed at finding out the current levels of thyroid hormones - triiodothyronine (T3) and thyroxine (T4) in the patient’s body.
- Thyroid-stimulating hormone (TSH):
The TSH or Thyroid-stimulating hormone is generated by the pituitary gland near the brain. This diagnostic screening is able to measures the levels of TSH in the body.
- Tg and TgAb:
This diagnostic screening checks for Thyroglobulin or the Tg protein which is a natural product generated by the thyroid as well as the differentiated thyroid cancer. Post treatment, the presence of this protein in the body should be of very low levels as the intention of the therapy is to be able to remove all thyroid cells. However, if the levels after surgery or radioactive therapy is seen to be higher, it may indicate that the cancers cells are actually increasing.
The objective of the test for thyroglobulin antibodies (TgAb) is to check for proteins being made by the body to attack the thyroglobulin which are developing in the patient. If there are traces of thyroglobulin, it may interfere with the outcome of the Tg level screening.
- Ultrasound thyroid scan:
Using sound waves, an ultrasound scan is able to generate detailed visuals of the inside of the neck and the thyroid gland. The doctor is also able to look at the lymph nodes in the neck area to check for presence of any abnormalities.
- Molecular testing of the tumour:
In order to identify any particular genes, proteins, and other key aspects to the tumour, the doctor may recommend further laboratory tests on the tumour sample.
- Radionuclide scanning:
A scan of the entire body, the radionuclide scan is done using a I-131 or I-123 that is mostly used to gather more information on the thyroid nodule. The patient is required to swallow a radioactive iodine which is harmless and small. This iodine gets absorbed by the thyroid cells that makes it more clearly visible on the scan image. This permits the doctor to be able to make an accurate distinction between the cells and the body structures.
- Fine needle aspiration:
During this procedure, the doctor passes a tiny needle in the neck where the swelling has developed. Local anaesthetic may be applied in order to numb the area. In addition to this, the doctor may possibly make use of an ultrasound scanner that will assist him or her to direct the needle in the correct region. A small sample is then collected which is later examined under microscopic conditions for the presence of cancerous cells.
- Core biopsy:
Local anaesthesia is used to numb the area when the patient is undergoing a core biopsy. A slightly bigger needle is used to collect the sample of tissue. The doctor uses an ultrasound scanner to guide the needle to the affected area for sample collection. A core biopsy is only recommended if fine needle aspiration is not possible, the fine needle procedure was not successful in collecting adequate cells for later examination and if the pathologist examining the sample collected from the fine needle aspiration is unable to arrive at a conclusive decision on the presence of cancerous cells in the thyroid.
If the diagnosis of thyroid cancer is confirmed, the doctor at Fortis Hospitals, Bannerghatta Road may recommend some additional screenings to check for the size and position of the cancer. The tests will be aimed at also detecting if the cancer has penetrated to other organs in the body. Some of these diagnostic tests may include:
- MRI (magnetic resonance imaging) scan
- CT (computerised tomography) scan
- PET/CT (positron emission tomography) scan
- Vocal cord check
It may be difficult for anyone to wait for the outcome of these diagnostic tests. At Fortis Hospitals, Bannerghatta Road, we assure our patients that we use the most modern instruments available to ensure that the test outcomes are accurate and quick. Once the results are available, we encourage the patients and their families to have a detailed consultation with the specialist and their dedicated care team.
A panel of experts in consultation with the patient and their families formulate possible treatment plans for cancer. Thyroid cancer is curable; however, there is difference of opinion on the combination of therapies to use and the times when they should be performed.
Having said that, most thyroid cancer patients will undergo one or a combination of these therapies as part of their treatment plan.
Surgical therapy, also called a resection, involves removing the tumorous growth and some of the surrounding healthy tissue during the procedure. For those diagnosed with thyroid cancer, the main form of treatment is surgery which is performed under the expert skills of a surgical oncologist .Surgical options will depend on the size of the nodule. The options are:
- Lobectomy is a procedure where the lobe of the thyroid gland that has the malignant nodule is surgically removed.
- Near – total Thyroidectomy or Subtotal Thyroidectomy is a process where the thyroid gland is removed partially.
- Total Thyroidectomy is a surgery where the entire thyroid gland is removed during the procedure.
There are three different surgical methods of performing a thyroidectomy, namely,
- Standard Thyroidectomy is a process where the operating surgeon makes a tiny incision or cut close to the base or middle of the neck which gives the surgeon direct access to the patient’s thyroid gland.
- Endoscopic Thyroidectomy includes making a single and small incision which is similar to that of a standard thyroidectomy. However, a video monitor and a scope guides the surgeon during the operation as opposed to a surgical loupe magnification, which is a special eyewear in this procedure.
- Robotic thyroidectomy is a surgery where the surgeon makes the cut either in the armpit or the hairline of the neck, possibly the chest and uses a robotic instrument to perform the operation.
Hormone Treatment is usually recommended to patients who have already undergone surgical therapy. By applying the thyroid hormone therapy, it aims to reduce the growth of the cancerous cells in the body and attempts to replace it with the hormone that the patient’s body requires.
The dosage of the hormone varies from patient to patient, depending on the type of tumour, patient’s age and weight. The treating oncologist at Fortis, Bannerghatta Road will regularly monitor the levels of the thyroid hormone through periodic blood tests.
Radioactive iodine (radioiodine) therapy is where the iodine, I-131 or RAI, is inserted into the patient’s body and the thyroid absorbs it. This specific iodine type is able to kill the thyroid cells that cannot be removed via a surgical procedure and has penetrated beyond the thyroid to other organs in the body.
Those patients diagnosed with papillary and follicular thyroid cancer are generally recommended to undergo radioactive iodine treatment. The iodine is administered either in liquid or pill form. Patients undergoing this form of therapy may possibly require a hospital downtime of 2 – 3 days. However, that will depend on other key factors and how the patient responds to iodine dose that has bee administered.
External-beam radiation therapy is an alternative type of radiation therapy that makes use of high energy x-ray beams which are targeted on the patient’s body to kill the malignant cells via a machine from outside. The patient is required to undergo a series of similar radiation sessions over a period of 5 – 6 weeks, around 5 days a week.
External beam radiation therapy is only used for particular cases of thyroid cancer, generally when the cancer has reached an advanced stage and the malignant cells have spread to other parts of the body, such as the trachea, voice box in the neck area. Radiation is given in combination with surgical therapy and is focussed towards a distinct area that has been affected by the cancer cells.
Chemotherapy is a form of treatment that destroys the malignant cells vis the usage of medication administered through and intravenous or IV tube or in a pill or capsule form. The objective of chemotherapy is combination with surgery is to kill the remaining cancerous cells and minimise the growth of the tumour and reduce the effect of the symptoms on the patient.
Chemotherapy, too, is given in a series of sessions over a period of time. The patient may be given a single or a combination of different medications at the same time.
Targeted therapy is aimed at some of cancer’s specific genes, proteins or the tissue surrounding that promotes the growth of the malignant cells and aids in their survival. Targeted therapy provides a blockage to this growth and restricts the cancer cells from spreading, thereby limiting further damage to the normal body cells.
Prior to starting the full-fledged treatment, it is suggested that the care team along with the consulting specialist at Fortis Hospitals, Bannerghatta Road, the patient and the immediate family have detailed conversation to understand the pros and cons of the suggested treatment routes. During this consultation, the possibility of side effects should also be covered so that both patient and the care team know what to expect. If the patient is experiencing any additionall health issues, then this is time to bring it forward.
Our Team that cares
Staffed with a expert, highly skilled, multi-disciplinary team of leading medical oncologists, surgical oncologists, endocrinologists, endocrine surgeons, cytopathologists, radiologists, and other specialists, the Department of Thyroid Cancer at Fortis Hospitals, Bannerghatta Road is committed towards producing the best possible outcomes for their thyroid cancer patients. Nationally renowned and extremely experienced in their respective medical fields, the team constantly endeavours to have a comprehensive understanding of more modern methods of treating thyroid and nodular conditions – right from diagnosis, to treatment and outpatient services.
The key to our success lies on the fact that our services and treatments are individualised according to the patient’s health requirements. In order to achieve that, we start with having one-on-one, detailed consultations with specialists and the care team, with through diagnostic screenings that builds the foundation of the therapy. Other factors that are also taken into consideration are the patient’s lifestyle, personal preferences and the family’s consent. With an approach that is personalised, Fortis Hospitals, Bannerghatta Road is focussed to reach the best possible outcome of their patients and nudge them towards the road to recovery.