Thyroid Cancer

Many people who learn they have thyroid cancer are surprised. They may have gone in for a  routine checkup or for another reason. This is called an “incidental” diagnosis because the cancer symptoms weren’t why the person went to the doctor. Lab work can be the first sign that something is wrong.

What is the first step in a thyroid cancer diagnosis?

A thyroid cancer diagnosis can be a shock to patients. They may have felt just fine and didn’t suspect anything at all. A routine checkup is often the first step in a thyroid cancer diagnosis. An annual exam in lab work often includes a blood test called a thyroid function test.

A thyroid function test is a blood test that measures thyroid-stimulating hormone (TSH). The thyroid-stimulating hormone shows how well the pituitary gland and the thyroid are working together. The pituitary gland tells the thyroid how much TSH to make. When hormones are too high or too low, there is an issue.

Just because TSH hormones are abnormal does not mean you have thyroid cancer. There are many common thyroid problems. That is why TSH hormones are checked frequently at exams.

Remember that any cancer diagnosis needs multiple tests. If your levels are off, your doctor will order more testing to learn what is going on.   

Common Symptoms of Patients Have

There are very few early symptoms of thyroid cancer. Sometimes a patient doesn’t have any signs that something is wrong. Even more advanced thyroid cancer symptoms can be easy to ignore. Those can seem like a cold or another common illness.

The amount of time you don’t feel well is an important detail to pay attention to. Make an appointment if you have symptoms for two weeks and they don’t go away.

Common thyroid cancer symptoms include:

• A voice change like hoarseness, lost voice (laryngitis) 
• Difficulty swallowing 
• Neck pain 
• A swelling in the neck 
• Throat pain
• A lump in the throat you can feel with your hands

Why Patients Choose Siteman for Their Cancer Diagnosis

Our patients often pick Siteman Cancer Center because we have earned their trust through our reputation. They know we will provide them with expert, cutting-edge care.

Siteman is the only NCI-designated cancer center in Missouri. That means our physicians and experts have the experience, technology, and research focus that you can’t find at other cancer centers.

Our physicians use specialized testing techniques and technology for a precise diagnosis that may include:

• Lab work and blood tests 
• Invasive tests, such as a biopsy
• Imaging and scans like ultrasound, PET, CT, and MRI 

An accurate diagnosis is the foundation for any cancer treatment. Here, our WashU Medicine physicians can learn exactly what kind of thyroid cancer you have and create a unique treatment plan for you.

What to Expect During a Diagnosis

Siteman Cancer Center patients can expect to be an important part of their own diagnosis. This starts at your first appointment as part of a physical exam. 

1) Share your symptoms and history
Your physician will ask about your lifestyle and symptoms to learn how your cancer impacts you. We want to know about your family history and your past health history. This information can help experts understand what kind of treatments and support you need to help you feel your best.

2) Lab work and blood tests
If you’ve been to the doctor before, you are probably familiar with having your blood taken.  A nurse or other technician uses a needle to remove a few tubes of blood from a vein. This quick test can say a lot about your overall health.

An expert, called a pathologist, looks at your blood under a microscope. They can see the cells that are and are not there, how many there are, their shape, and more. What they see tells a lot about how well your cells, hormones, and whole body are working. A pathologist is trained to identify anything that is out of the ordinary.

Your doctor may order one or more of these blood tests:

• Carcinoembryonic antigen (CEA): Carcinoembryonic antigen is a protein in the body. It is common for people with MTC to have high levels of CEA in their blood.
• Calcitonin: Calcitonin is a hormone that the thyroid makes that helps control how the body uses calcium. These cells can develop into medullary thyroid cancer (MTC).
• Thyroid hormone test for T3 and T4: T3 and T4 are the main hormones made by the  thyroid gland. These hormone levels can show how well the thyroid gland is functioning. 
• Thyroid-stimulating hormone (TSH): Testing blood levels of thyroid-stimulating hormone can check the overall activity of your thyroid gland, or if thyroid hormone replacement therapy after surgery is working for you. 
• Thyroglobulin: Thyroglobulin is a protein that the thyroid gland makes. This test helps track how much of the protein is in the body, showing how effective surgery was.  

Advanced and Invasive tests 

Doctors may send you to get a lymph node biopsy. A biopsy is a procedure where an expert takes a small sample of tissue to be studied under a microscope. For a lymph node biopsy, you will have local anesthesia to numb the area. Then, a needle is put into the lymph node. A pathologist will look at the tissue under a microscope to check for cancer cells.

Imaging Tests

CT Scan (CAT Scan): A CT scan takes detailed X-ray pictures of your body from different angles. Sometimes a special dye is injected to make organs show clearly in the images.  But if your doctor thinks you might have cancer, they won’t use the dye. It could interfere with treatment you might need later.

MRI (Magnetic Resonance Imaging): An MRI uses magnets and radio waves to create detailed pictures inside of your body. This imaging doesn’t use radiation or needles.

PET-CT Scan: A PET-CT scan uses a small amount of radioactive sugar to make cancer cells visible. An imaging specialist injects the sugar into your vein and then a CT scan is done at the same time. Because cancer cells use more sugar than normal cells, they light up brighter on the scan. This test is only used in very specific situations for thyroid cancer. 

Thyroid Radioiodine Scan: A thyroid radioiodine scan has a few different steps. First, you swallow a small amount of radioactive iodine, which your thyroid naturally absorbs. Then,  an imaging specialist places a special camera near your neck to see where the iodine goes. This test can find thyroid cancer and check if any cancer remains after treatment.

Ultrasound: An ultrasound uses sound waves to create pictures of your thyroid. An imaging specialist takes a small wand-like device and gently presses it over your neck. The sound waves bounce back to create images on a screen. This test can show if a thyroid lump is solid or filled with fluid, how many lumps you have, their sizes, and whether nearby lymph  nodes are swollen

Staging Thyroid Cancer

Staging is an important part of a cancer diagnosis. It tells us how much cancer has spread in the body. There are four stages for thyroid cancer: 1 (I), 2 (II), 3 (III), and 4 (IV). Stage 1 is the earliest. Stage 4 is the most advanced.

Siteman experts look at all of your testing and your overall health to decide what stage your thyroid cancer is. Staging helps decide what kind of treatment is best for your situation.

Papillary, follicular, and medullary thyroid cancers can each be Stages 1-4. Depending on how widespread the disease is. Your age can also become a factor in staging.

Anaplastic thyroid cancer is always considered Stage 4 because of its aggressiveness, and because it has usually spread when it is discovered.  

Chance of Recovery (Prognosis)

Many kinds of thyroid cancer are treatable. Even cancers at an advanced stage can be cured. Your chance of recovery (prognosis) is something your physician will discuss with you. It depends on different factors like:

• Tumor size 
• Tumor growth and whether it has spread 
• The type of thyroid cancer (based on how the cancer cells look under a microscope)
• If your cancer has come back (recurred) after treatment