Leyanys Santos visited her primary doctor for a regular physical after three years of not stepping into her office.
When the doctor detected a small lump on her throat — a thyroid nodule — she sent her to get an ultrasound and later, a biopsy.
Santos, a pharmacist, said she was initially calm after the doctor’s discovery in December of the nodule, as it was small and didn’t seem threatening. It was not until later, when she heard the word “cancer,” that the diagnosis sunk in.
“I went blank. The only thing I could think about was my children,” said Santos, 42, speaking in Spanish.
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The thyroid is a butterfly-shaped gland with two lobes in the lower front of the neck. It helps control body weight and regulates essential bodily functions such as breathing and pumping blood.
As a result of new, highly sensitive diagnostic tests, thyroid cancer is the most rapidly increasing cancer in the United States, tripling over the last 30 years, according to the American Cancer Society. Nearly 57,000 new cases are estimated for 2017, about 42,470 in women, and 14,400 in men.
The new tests mean that the cancer is being diagnosed at a much earlier stage, which helps considerably with survival. The five-year survival rate is 98 percent. The 10-year rate is 97 percent. By comparison, the five-year survival rate for lung cancer is 18 percent.
Treating the disease
Upon receiving her diagnosis, Santos was referred to Dr. Robert Udelsman, chief of endocrine surgery at the Miami Cancer Institute at Baptist Health South Florida. He extracted the right half of her thyroid in early March.
“I never thought the surgery would be so simple,” she said. “Nobody wants cancer, but if I had to choose, I would choose thyroid cancer.”
Udelsman said thyroid nodules are common and often undetectable through a physical exam. Highly sensitive ultrasounds, as well as fine needle aspiration biopsies, have made it easier to detect nodules that may not affect the health of a patient.
“If you were to live and die with your thyroid cancer, but you died at age 95 from cardiovascular disease, you would have rather not known that you had a thyroid cancer in the first place because it had no consequence on your quality or quantity of life,” he said.
Other causes behind the rise
Udelsman said doctors may be causing the rise in thyroid cancer by increasingly exposing patients to radiation through CT scans and X-rays. Exposure to radiation, especially during childhood, is a risk factor for the cancer.
“It’s not just that we’re picking up more, but we as a population in general might be increasing the exposure,” he said.
Dr. R. Mack Harrell, medical and imaging director at Memorial Center for Integrative Endocrine Surgery and president of the American College of Endocrinology, said it’s hard to settle the argument of whether the cancer is actually on the rise or if advanced technology is detecting what was always there.
“We’re trying to decrease the amount of surgery that is being done for little bitty tiny thyroid nodules that are probably never going to amount to anything, even if they are tiny papillary thyroid cancers,” he said.
While size is a common guideline to decide on whether surgery is necessary, Harrell said the location of the nodule is also important. If the nodule is located close to the vocal chords it may render the patient permanently hoarse and with difficulty swallowing.
The good news
Harrell recommends people keep their immune system healthy by exercising, eating a balanced diet and avoiding toxins like drugs and alcohol. A good immune system is likely to suppress small tumors in the thyroid, he said.
Dr. Josefina Farra, an endocrine surgeon at University of Miami Health System, said the most common subtype of thyroid cancer is papillary thyroid cancer, which is very treatable.
Farra said it is possible for thyroid cancer to metastasize, but when it does, it goes to the the lymph nodes in the neck, which can be treated surgically. It is rarer for it to spread to the lungs and the bones, and that’s usually more aggressive subtypes of the cancer, she said.
“I always tell my patients, ‘You’re not going to die of this cancer,’” she said. “It’s a nuisance, and we have to take care of it, but most patients live very fulfilling long lives with it.”