Experienced team combats increase in thyroid cancer
The incidence of thyroid cancer has more than doubled since 1990 and it is now the fifth most common cancer in women. The MetroHealth System has developed a multi-disciplinary approach to treat thyroid cancer that includes a team of experienced physicians who specialize in diagnosis, treatment and follow-up.
“We perform a large volume of thyroid surgery at MetroHealth and manage all aspects of the care of patients with thyroid cancer,” says Christopher R. McHenry, MD, Vice Chair of MetroHealth’s Department of Surgery and a past president of the American Association of Endocrine Surgeons.
Thomas A. Murphy, MD, in the Division of Endocrinology, is involved in the diagnosis, management and follow-up of patients with thyroid cancer.
Stephen W. Tamarkin, MD, Chief, Body Imaging, has led the effort in ultrasound guided fine-needle aspiration biopsy for diagnosis of thyroid cancer and ultrasound evaluation for nodal metastases.
Amer Khiyami, MD, in the Department of Pathology, is well recognized for his expertise in cytology and pathology of thyroid cancer.
Erol Martin Beytas, MD, in nuclear medicine, is responsible for Iodine-131 whole body scanning and Iodine-131 treatment of metastatic thyroid cancer.
Dr. McHenry says that no one is certain why the incidence of thyroid cancer has risen so dramatically, although it may, in part, be related to increased detection as a result of the increased use of office-based ultrasound.
A study published in Clinical Thyroidology in August 2011 indicated that environmental factors may play a role in the increase of thyroid cancer. One of those factors may be related to nitrate in the diet, although the authors said more studies are needed to confirm this finding.
Another factor that has been implicated is increased environmental radiation exposure including radiation from excessive X-ray and CT imaging.
“There’s a very good cure rate for this cancer,” says Dr. McHenry. “Most thyroid cancer patients have a 10-year survival rate that is 93 percent or better.”
Dr. Tamarkin uses ultrasound to help determine whether a patient with a thyroid nodule has cancer and for follow up of patients with thyroid cancer to evaluate for recurrence. Ultrasound-guided biopsies are done with local anesthetic, and there’s very little discomfort to the patient.
“We commonly get at least three samples, and those samples are immediately evaluated by our cytopathologists with microscopes right outside of biopsy procedure rooms,” he says.
Dr. Tamarkin adds that this decreases the chance of having an inadequate sample and having to do a second biopsy.
“And because of the high volume of patients we see, we have an expertise in pathology and interpreting the ultrasound studies related to thyroid cancer,’’ says Dr. Murphy.
The majority of thyroid cancers are papillary or follicular, both of which can be treated with radioiodine. MetroHealth also has extensive experience and an excellent safety record working with nuclear medicine.
Radioactive iodine treatment is used to ablate any thyroid tissue which remains following surgery and involves swallowing a capsule or capsules with radioactive I-131 iodine.
“It is rare that there isn’t some little piece or pieces of thyroid tissue left in the neck after surgery. In order to use the blood to evaluate if there is any tumor persistence or recurrence in the future or to use I-131 iodine whole-body scans to visualize tumors, we have to get rid of any remaining thyroid tissue left behind by the surgery,” says Dr. Beytas.
Typically, one full dose of radio I-131 iodine is needed. The patient follows isolation guidelines for up to five days after the treatment is given as an outpatient.
MetroHealth thyroid cancer team members make a point of working with referring physicians and keeping them up to date on their patients’ condition and progress.
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