Papillary Thyroid Cancer

Papillary thyroid cancer is the most common type of thyroid cancer making up to 70 to 80 percent of all thyroid cancer cases. Papillary thyroid cancer can occur at any age, and its incidence has been increasing over the last few decades. There are about 20,000 new cases of papillary thyroid cancer in the United States each year. It is now ranked as the 8th most common cancer in women in the United States, and the most common cancer in women under the age of 25 years. 

Being diagnosed with papillary thyroid cancer can be very scary at first; however, papillary thyroid cancers are most often slow-growing tumors, and most can be removed surgically. Although slow growing, papillary thyroid cancer can sometimes spread to the lymph nodes in the neck. Unlike some other tumors, positive lymph nodes do not usually worsen the generally excellent prognosis for. The involved lymph nodes can be surgically removed along with the thyroid.

Risk Factors

A risk factor is anything that increases a person's chance of getting a disease. Different diseases have different risk factors. Some risk factors can be controlled with lifestyle changes. Other risk factors cannot be changed.

For most patients, the specific reason why they develop thyroid cancer is not known. It is important to note that some patients with multiple risk factors never develop thyroid cancer. In fact, most people who have thyroid cancer have no obvious known risk factor. 

Known risk factors for papillary thyroid cancer include: 

Radiation exposure: Papillary thyroid cancer is more common in people who have a history of exposure to significant ionizing radiation. Radiation-induced thyroid cancer can happen at any time between a few years after exposure to as long as 30 to 50 years later. Radiation exposure is broken down into three major categories: 
  • Childhood exposure: X-ray treatments were widely used in the 1940s and 1950s. This radiation was used to treat acne, enlarged tonsils, lymphomas, ringworm, enlarged thymus glands, and other ailments. X-rays were also used to measure foot sizes in shoe stores, and many people fondly remember seeing their "glowing green feet" and playing in these shoe fluoroscopes for hours while siblings were fitted for shoes. Children, younger than 15 years old, are most sensitive to radioactive damage to their thyroids.
  • Medical Therapy: Radiation therapy to the head, neck, and upper chest are an increasingly common cause of radiation-induced thyroid cancer. Lymphoma, head and neck cancers, lung cancer, and breast cancer are some of the more common cancers that are associated with radiation exposure to the thyroid.
  • Environmental exposure: Thyroid cancer can be caused by radioactivity released from nuclear incidents such as the 1986 nuclear accident at the Chernobyl power plant in Russia. Many of the children in areas of Russia and the Eastern Bloc countries were inadvertently exposed to radiation and went on to develop thyroid cancer. Some people may also be exposed to radiation at work. However, routine X-ray exposure (for example dental X-rays, chest X-rays, mammograms) have NOT been shown to cause thyroid cancer.
Genetics: Papillary thyroid cancer can run in the family and may be associated with genetic syndromes. Although rare, it can also be associated with goiters or colonic tumors. Therefore, patients should ask their relatives for a family history of papillary thyroid cancer, goiter, colon/rectal tumors, or breast cancer. Patients with a positive family history are more at risk for thyroid cancer than those with no family history.

Having one or more of the above risk factors does not mean that you will develop papillary thyroid cancer. Understanding your risk factors will help you determine, what, if any, precautions and special screening you should consider.

Symptoms

Most patients with thyroid cancer do not have any symptoms. Typically, patients present with a thyroid nodule that is found to be cancer on further evaluation. 

Symptoms may include: 
  • Swelling in the neck 
  • Difficulty with swallowing 
  • Shortness of breath 
  • Difficulty with breathing or changes in the voice 
If the nodule is large, it may cause: 
  • Difficulty swallowing
  • Choking sensations 
  • A large mass in the neck 
Rarely, the cancer can grow into the nerves (i.e. the recurrent laryngeal nerves) that control the voice box and cause hoarseness. 

If you have one or more of the above symptoms, it does not mean that you have papillary thyroid cancer. If you think you have this cancer, please call your doctor.