Menu

Q & A: Thyroid Cancer

U.S. Chief Justice William H. Rehnquist has thyroid cancer, the Supreme Court announced Monday.

Rehnquist, who turned 80 on Oct. 1, entered Bethesda Naval Hospital last Friday to undergo a tracheotomy related to thyroid cancer, a court spokesman says. The tracheotomy, a surgical procedure to create an airway through the neck, appears to have been required due to complications arising from treatment.

Thyroid cancer is considered very treatable. Unless the disease is very advanced, it is rarely fatal. News reports say Rehnquist is expected to be released from the hospital later this week. He is expected to return to the bench for arguments scheduled on Nov. 1.

Rehnquist becomes the fourth cancer survivor sitting on the Supreme Court:

—In 1988, Justice Sandra Day O'Connor was diagnosed with breast cancer.

—In 1992, Justice John Paul Stevens underwent radiation treatment for prostate cancer.

—In 1999, Justice Ruth Bader Ginsburg underwent surgery for colon cancer previously treated with radiation and chemotherapy.

What Is Thyroid Cancer?

Thyroid cancer is a disease in which cancerous (malignant) cells are found in the tissues of the thyroid gland. (search)The thyroid gland is in the lower front of the neck at the base of the throat. It has two lobes, one on the right side and one on the left. The two lobes are connected with a smaller lobe called the isthmus. The thyroid gland makes important hormones that help the body function.

There are four main types of thyroid cancer:

Papillary Follicular Medullary Anaplastic

Thyroid cancers are usually found when a bump is seen in the neck. A biopsy will determine whether the nodule (bump) contains cancer. Only about 5-10 percent of nodules are cancerous.

The majority of thyroid cancers are either papillary (search) or follicular cancers (search). These are commonly called well-differentiated cancers.

There are about 18,000 cases of thyroid cancer annually in the U.S. (13,000 women and 4,600 men), accounting for about 1.1 percent of all cancer cases and about 1,200 deaths a year.

What Are the Symptoms of Thyroid Cancer?

Often, thyroid cancer has no symptoms and is found by chance at a doctor's visit. When symptoms are present, the cancer can appear as a gradually enlarging lump on the front part of the neck that moves when swallowing. Any lump in the neck should be brought to the attention of your health-care provider.

What Are the Causes of Thyroid Cancer?

No one knows what causes thyroid cancer, but experts have identified many risk factors:

—Exposure to large amounts of radiation (either from the environment or in those who have had radiation treatment for medical problems in the head and neck, such as acne or fungal infections of the face). The cancer may not occur until 20 years or longer after radiation treatment.

—Heredity (particularly for medullary thyroid cancer).

—Sex. Cancer of the thyroid is more common in women than in men.

How Is Thyroid Cancer Diagnosed?

A doctor's exam is the first step. After taking a careful medical history, the doctor will feel the neck for lumps or other abnormalities.

If a lump is found, further testing may be warranted. Testing may include:

—Blood tests to look for any abnormalities in the production of thyroid hormones.

—An ultrasound to see the structure of the mass or lump within the thyroid.

—A thyroid scan to see if the thyroid lump is making too many hormones.

—Biopsy. Using ultrasound to see the lump, the doctor can take a small amount of tissue from the lump for laboratory analysis. Also, if there is fluid within the lump, the doctor can take a sample to look for cancer cells.

What Is the Treatment for Thyroid Cancer?

Four types of treatment are used:

—Surgery (removing the cancer)

—Radiation therapy (usually in the form of radioactive iodine pills, but high-dose X-rays or other high-energy rays are also used)

—Hormone therapy (using hormones to stop cancer cells from growing)

—Chemotherapy (using drugs to kill cancer cells)

Surgery is the most common treatment of cancer of the thyroid. A doctor may remove the cancer using one of the following operations:

Lobectomy (search) removes only the side of the thyroid where the cancer is found. Lymph nodes (search) in the area may be taken out (biopsied) to see if they contain cancer. Near-total thyroidectomy (search) removes all of the thyroid except for a small part. Total thyroidectomy removes the entire thyroid. Lymph node dissection removes lymph nodes in the neck that contain cancer.

Radiation therapy uses X-rays to kill cancer cells and shrink tumors. Radiation for cancer of the thyroid may come from a machine (external beam radiation therapy) or from drinking a liquid that contains radioactive iodine. Because the thyroid takes up iodine (search), the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells.

Hormone therapy (search) uses hormones to stop cancer cells from growing. In treating thyroid cancer, hormones can be used to stop the body from making other hormones that might make cancer cells grow. Hormones are usually given as pills.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be injected in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the thyroid.

By Daniel J. DeNoon, reviewed by Brunilda Nazario, MD

SOURCES: The Cleveland Clinic. News reports. News release, U.S. Supreme Court.