BY AMBER SMITH
The man was in his mid-50s in 2011 when he sought care for enlarged lymph nodes in the back of his neck. It was thyroid cancer.
Surgeons in Binghamton removed his thyroid gland, and the man received radioactive iodine therapy afterward.
That typically is all the treatment that’s required.
Abirami Sivapiragasam, MD
But when the man returned six months later for a follow-up scan, more cancer showed up. That’s when he was referred to doctors at Upstate. He had more tissue removed from the left side of his neck. Then six months after that, cancer appeared again, and more tissue had to be removed from the right side.
As a patient at Syracuse’s only academic medical center, the man received expert care — while his physicians simultaneously learned and taught others about his unique type of thyroid cancer. They wrote about his case in the journal Case Reports in Oncological Medicine to educate other physicians.
The patient had an uncommon type of thyroid cancer, a “tall cell variant,” which grows and spreads rapidly, along with a genetic mutation that seems to make cancer more likely to grow and spread to other parts of the body.
It was 2014 when one of the man’s routine follow-up scans revealed cancer where his thyroid used to be. “At that time, he was symptomatic, with more fatigue and weight loss,” Abirami Sivapiragasam, MD, wrote in the journal. She’s an assistant professor of medicine at Upstate, specializing in hematology and oncology.
Joseph Fullmer, MD, PhD
The man underwent surgery to remove additional lymph nodes and tissue. From the medical laboratory, Upstate pathologist Joseph Fullmer, MD, PhD, discovered recurrent papillary thyroid carcinoma, the same cancer the man had before, but also another type of cancer called squamous cell carcinoma.
At this point, things were not adding up. The man had been treated successfully, but cancer kept coming back.
Fullmer sent samples and conferred with pathologists from Memorial Sloan Kettering Cancer Center in New York City for a second opinion.
The physicians believe the man’s papillary cancer transformed into squamous cell cancer. His papillary cancer was particularly aggressive, and although it’s rare, “it can evolve into different types,” explained Alina Basnet, MBBS, one of the man’s Upstate doctors.
Alina Basnet, MBBS
They decided the best treatment for the man would be six weeks of radiation therapy, during which time he would receive weekly chemotherapy. Because he lived in the Binghamton area, he received treatment close to his home.
Three months after he was done, another scan showed “near-complete resolution of metabolic activity in the thyroid bed and regional lymph node areas,” according to the journal article.
The patient continues to be closely monitored.
His case is a good example of the benefit of collaboration when a patient has a complicated diagnosis or signs and symptoms that don’t add up. Bringing experts together produces a novel treatment plan.
About thyroid cancer
- The butterfly-shaped thyroid gland is below the Adam’s apple in the front of the neck. It has two main types of cells: follicular, which use iodine from the blood to make hormones that help regulate metabolism, and C cells, which make a hormone that helps the body use calcium.
- Nearly three out of four cases are in women.
- About 80 percent of thyroid cancers are papillary carcinomas, which tend to grow slowly and to develop in only one lobe of the thyroid. Fewer than 10 percent of thyroid cancers are follicular. Medullary thyroid cancer, arising from the C cells, is the third most common, making up about 3 percent of thyroid cancers.
- The most common subtypes of papillary cancer have a good prognosis for treatment and outcome when found early. Some of the less common — including one called “tall cell variant” — grow and spread more quickly.
- Treatment often includes two or more of these options: surgery, radioactive iodine treatment, thyroid hormone therapy, external beam radiation, chemotherapy or targeted therapy.
- Most thyroid cancers can be cured, especially if they have not spread to distant parts of the body.
- In rare cases, a papillary thyroid cancer may be aggressive and could possibly transform into another type of cancer, such as squamous cell carcinoma.
Cancer Care magazine winter 2018 issue
This article appears in the winter 2018 issue of Cancer Care magazine.