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Confused about Thyroid Cancer

cmolina
Posts: 6
Joined: May 2005

During surgery to remove a lump on my thyroid, it was found to be thyroid cancer so they removed the whole tyroid. This was done in February this year. I have been reading about the different types of thyroid cancer, but am a little confused about my pathology report. It states Papillary Carcinoma Predominantly Follicular Variant. I thought papillary and follicular were two different types. I have been through one dose of I131 (200 millicures), but afterward the body scan still showed tissue there. My doctor says to wait and do another body scan in four months. He said that they have done all they can do at this point and we just have to wait and see. Is this normal to wait? I guess I am just really confused about the whole thing.

Rustifox's picture
Rustifox
Posts: 131
Joined: Mar 2005

It's very normal, unfortunately. When we take radioactive iodine, it continues over the next 6 months (and even longer sometimes!) to kill off any remaining thyroid cells, either benign or malignant. The post treatment scan after your treatment would be expected to show any remnant thyroid tissues anywhere in your body, so that is very normal, too. Even the best surgeons in the world aren't able to get all the thyroid cells - they need to leave a few behind to protect our laryngeal nerves, and other important neck structures.

What will be important is how your next scan compares to that first one! That, along with blood tests for a tumor marker called 'thyroglobulin' will become an important part of your long term follow up, as will ultrasounds for most of us. It takes a lot of patience on our part, that's for sure! Many people will only require one dose of radioactive iodine, but a certain percentage of us will require a second dose to get all the leftover tissues, or more difficult distant mets.

A follicular variant of papillary is a bit of a 'cross' over of cells, but considered to have as good of a prognosis as papillary (which is very good) - I have this variant, too.

Each type of thyroid cancer is simply a little different mutation of the cells. Papillary is the closest to thyroid cells in its' behaviours; follicular variant of papillary also behaves very much like a papillary cancer cell, in that it still uptakes radioactive iodine very well, making it highly treatable. As the cells mutate more, we see less thyroid-like behavior in important things like ability to absorb iodine, one of the best tools available to treat us.

If we thought of cancer in clothing terms, let's assume that cancer is a 'coat'. Most thyroid cancer is adenocarcinoma, meaning glandular cancer - this is like saying it is a 'winter coat'. A papillary adenocarcinoma is like saying it is a 'winter fur coat'; and a follicular variant of papillary is like saying it is a 'winter fur coat, with a rabbit collar' - it is just a further description of the cell types and their behaviours, but again, follicular variant of papillary is more easily treated, and less aggressive than a pure follicular carcinoma.

The only other important thing, and part of your treatment for now, is suppression of your TSH with a high level of thyroid hormones. Suppression works to keep any remaining tissues from growing, or at least growing as slowly as possible, until your next scan, and, if needed, next treatment with radioactive iodine. If you want more information about this, there are a bunch of links that you can find on my personal web page here - look to the column on the left, and you will see 'Personal Web Pages' - just enter my member name, and the page will come up.

I hope this helps. It can be very, very confusing in the first year, particularly when we are going through the hypothyroidism needed for treatments. It does help to talk it out with others who know just what you are going through - last year at this time, I was really confused, too, with the same questions you have!

Coloradodreams
Posts: 2
Joined: Jun 2005

Hi cmolina,

my name is coloradodreams, and i am 15 yrs old. A month ago i was feeling really sick, it started with the flu, then an ear infection, then a lump on the left side of my neck. I went to the doctor to check it out. He gave me some pink antibiotic pills, i think i made things worse when i missed a day. He said he didn't know what it was so i have to and take an X-ray 6/12/05. 3 weeks later my throat was starting to act up. The day is 6/8/05, and pray that it isn't cancer or mono. My throat is very painful when swallowing or sometimes talking. I get fever's here and there, swolleness in gland, very unactive and loss of appitite but still manage to eat. I am really worried about it because i just quite smoking, and i guess it could have caused it to be more painful. Please email me about your understanding of this disease!!! As soon as possible Thanks

brianjw
Posts: 9
Joined: Aug 2005

Had papillary thyroid cancer in 1979. Surgical removal of 1 lobe and 1/2 of the second lobe followed by I-131 ablation. Follow-ups every six months for 5 years then annually for 15 years. Then got kicked out of follow-up program. Now 26 years later. Be patient. Papillary is best kind to have if you have to have it, I recall. Talk to your doctor. Easy to get freaked out reading too much out of context.

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