Surgery is the best treatment for medullary thyroid cancer. The full treatment depends on whether the lymph nodes are affected and if the cancer has spread to distant organs. At the least, a total thyroidectomy with central lymph node removal (dissection) is recommended. This form of treatment involves removing the entire thyroid and all of the lymph nodes between the carotid arteries on each side from the bone just above the Adam’s apple to the innominate vessels located just below the top of the breastbone.
More extensive surgery may be necessary if the cancer has spread to additional lymph nodes and other areas of the body.
After surgery, blood levels for calcitonin and CEA should be monitored regularly (every six months to a year). If calcitonin and CEA levels rise above the immediate postoperative level, imaging tests may be necessary to determine if the cancer has recurred.
Tumors of the Parathyroid: Removal of affected parathyroid glands through parathyroidectomy is generally recommended. This surgery is performed under local anesthesia with a small incision to remove the enlarged parathyroid gland. After removal of the gland, and while the patient is still under anesthesia, the surgeon performs a blood assay to check the patient's parathyroid hormone level in the operating room. This blood test will allow the surgeon to confirm that all enlarged parathyroid glands have been removed before the patient leaves the operating room. Most patients go home the same day of surgery.
Pheochromocytomas: In the majority of cases, surgery to remove the affected adrenal gland, known as an adrenalectomy, is the preferred treatment option for pheochromocytomas. Removing the affected adrenal gland generally reverses any symptoms caused by the tumor. If both adrenal glands need to be removed, then patients will need to take medications to replace the hormones that would normally be excreted by the adrenal glands.