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Papillary Thyroid Cancer

Last updated Dec. 16, 2018

Approved by: Krish Tangella MD, MBA, FCAP

DoveMed.com

Fine Needle Aspiration (FNA) of thyroid showing papillary carcinoma of thyroid. H&E stain.


What are the other Names for this Condition? (Also known as/Symptoms)

  • Papillary Cancer of Thyroid Gland
  • Papillary Carcinoma of Thyroid Gland
  • Papillary Thyroid Carcinoma

What is Papillary Thyroid Cancer? (Definition/Background Information)

  • Papillary Thyroid Cancer or Carcinoma is the most common type of thyroid cancer. It is more commonly seen in middle-aged adults
  • It starts developing as a small lump or nodule in the thyroid gland. Some symptoms might include swelling, trouble swallowing, pain, change in voice, and difficulty in breathing
  • The exact cause of Papillary Thyroid Cancer is not known. However, it is generally believed that a genetic defect might be involved in an individual’s susceptibility to the condition
  • Exposure to radiation (such as during radiation therapy for some cancers, exposure from nuclear plant disasters, etc.), a family history of thyroid cancer, and insufficient or excess iodine in diet are considered to be some risk factors of Papillary Thyroid Carcinoma
  • Some complications that could arise either from the cancer itself or as a result of treatment for Papillary Thyroid Cancer are metastasis of the cancer to other body parts, accidental removal of parathyroid gland during surgery, pressure on the vocal cord, nerve damage, etc.
  • The treatment may include a complete surgical removal of the tumor with adequate margins. Also, radioactive iodine (to kill any remaining cancer cells) and medication (to replace thyroid hormone whose synthesis by the body might be lost because of cancer treatments) may be considered
  • The prognosis for Papillary Thyroid Cancer is considered excellent, if detected and treated early. However, it is also dependent on various factors including whether the tumor can be completely removed through surgery or not

Who gets Papillary Thyroid Cancer? (Age and Sex Distribution)

  • The majority of cases of Papillary Thyroid Cancer are seen in adults between 30-50 years of age. It could affect children too
  • Although both genders are affected, women are 3 times more likely to be affected when compared to men
  • Papillary Thyroid Carcinoma affects individuals from all races and ethnicities

What are the Risk Factors for Papillary Thyroid Cancer? (Predisposing Factors)

The risk factors associated with Papillary Thyroid Cancer include:

  • Female gender
  • A family history of the cancer
  • Radiation exposure - either for treatment of a disease or as a result of a nuclear plant accident
  • Insufficient or excess iodine content in diet

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your health care provider.

What are the Causes of Papillary Thyroid Cancer? (Etiology)

The exact cause for the development of Papillary Thyroid Cancer is not clearly understood. However, the following factors may contribute significantly to its development:

  • A genetic defect - some genes have been found to be mutated in this type of cancer (for example: RET/PTC genes, have been found in about 10-30% of patients)
  • Exposure to radiation

What are the Signs and Symptoms of Papillary Thyroid Cancer?

Papillary Thyroid Cancer starts developing as a small lump or nodule in the thyroid gland. Small tumors usually do not cause any symptoms; but, occasionally they may become painful, if they compress the surrounding structure.

The signs and symptoms observed in Papillary Thyroid Carcinoma include:

  • Signs and symptoms depend on the size of the tumor
  • Swelling of the neck
  • Change in voice, hoarseness
  • Difficulty swallowing
  • Trouble breathing
  • Pain along neck region

How is Papillary Thyroid Cancer Diagnosed?

A physician might employ one or more of the following methods to arrive at an accurate diagnosis of Papillary Thyroid Cancer:

  • Physical examination - the physician might palpate the neck and throat and check for bumps or swollen areas
  • Blood tests to check for thyroid stimulating hormone
  • Genetic testing to check for mutations in the RET/PTC genes
  • An ultrasound to get a detailed image of the thyroid gland
  • CT scans, chest x-rays, and whole body PET scan to enable the physician to understand if the cancer is contained or has metastasized

Although the above modalities can be used to make the initial diagnosis, a tissue biopsy of the tumor is required to make a definitive diagnosis to begin treatment.

  • The tissue for diagnosis can be procured in multiple different ways, and they include:
    • Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
    • Core biopsy of the tumor
    • Open biopsy of the tumor
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely electron microscopic studies to assist in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Papillary Thyroid Cancer?

The complications from Papillary Thyroid Cancer could arise either directly as a result of the cancer or due to the treatments performed to combat the condition. The possible complications include:

  • Metastasis of the cancer to the lymph nodes and other body parts
  • Accidental removal of parathyroid gland during surgery to remove affected tissue
  • Nerve damage in the vocal cords
  • Excess pressure on the vocal cords

How is Papillary Thyroid Cancer Treated?

There are 3 sequential methods that are currently available to cure Papillary Cancer of the Thyroid.

  • Surgery to remove the affected thyroid tissue: The amount of thyroid tissue removed would depend on how big the cancerous mass is
  • Radioactive iodine therapy (oral) to kill the remaining cancer cells, if any. The radioactivity might also provide a clear image of the gland post-surgery
  • Medication may be given to replace the thyroid hormone whose synthesis in the body might be lost due to the carcinoma. The medication would need to be taken life-long
  • Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals

In addition to this, these individuals would need to regularly visit their physician once every 6-12 months to measure their thyroid levels.

How can Papillary Thyroid Cancer be Prevented?

  • Current medical research has not established a way of preventing Papillary Thyroid Cancer formation
  • Regular medical screening at periodic intervals with blood tests, radiological scans, and physical examinations for those who have already endured the tumor are helpful

What is the Prognosis of Papillary Thyroid Cancer? (Outcomes/Resolutions)

  • The most reliable prognostic factor of Papillary Thyroid Cancer is dependent on whether the tumor can be completely removed through surgery with free margins (no traces of the tumor in adjoining tissue) or not
  • Individuals have an overall excellent survival rate following first complete surgical resection
  • Papillary Thyroid Cancer that behave malignantly can lead to death
  • As with any tumor, it is important to have follow-up appointments with a physician to monitor for any returning tumors
  • Prognosis of Papillary Cancer of Thyroid also depends upon a set of several factors, which include:
    • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
    • The surgical respectability of the tumor (meaning, if the tumor can be removed completely) 
    • Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
    • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
    • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur
    • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment

If diagnosed early and treated promptly, the prognosis for Papillary Thyroid Carcinoma is considered to be very good.

Additional and Relevant Useful Information for Papillary Thyroid Cancer:

A tumor is an abnormal growth of tissue arising due to uncontrolled and rapid multiplication of cells that serve no function. They are also called neoplasms. Tumors can be benign or cancerous. A benign tumor may generally indicate no threat to one’s health; it also means that it is not “cancerous”

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Nov. 30, 2015
Last updated: Dec. 16, 2018