Stage 4 Thyroid Cancer

By Kathryn E. Vinson, MS, CCRC

Stage 4 Thyroid Cancer and Early Stage Diagnosis – the cancer that some people just love to call the “good cancer.”  Let’s be perfectly honest – there is no good cancer.  For more on my feelings about this, check out “The Good, The Bad, and The Ugly: Thyroid Cancer.” Despite being pregnant when I was diagnosed, I was fairly lucky – we caught it fairly early, with no distant spread and only a couple of lymph nodes with suspected spread.  Why was my cancer caught so early?  Well, I’ve had thyroid disease for almost my entire life, so frequent checks on my neck are a thing for me. But not everyone has those checkups.  Heck, until I was diagnosed with hypothyroidism at 11, I didn’t even know I had a thyroid.  With that being said, let’s take some time today to talk about late stage thyroid cancer, its symptoms, outlook, and treatment options.

What are the symptoms of stage 4 thyroid cancer?

The most common symptoms of thyroid cancer are typically painless swelling in the front of the neck, below the Adam’s apple and difficulty swallowing. Lymph nodes may also swell if the disease has spread to them.  Its important to understand that there are four different types of thyroid cancer – papillary, follicular, medullary, and anaplastic.  Papillary thyroid cancer likes to spread to the lymph node, lungs and bones, while follicular thyroid cancer spreads more easily to blood vessels. Anaplastic thyroid cancer, due to its highly aggressive nature, is considered metastatic from the moment it is diagnosed. With that being said, the symptoms of metastatic disease, in any of these four types, will depend upon the type of thyroid cancer, due to the differing locations of spread.  As such, symptoms of distant spread could be difficulty breathing, poor circulation, bone pain, and many others.

What is the prognosis for stage 4 thyroid cancer?

Again, this varies based upon the type of thyroid cancer, but the five-year survival rates are as follows:

  • Stage 4 Papillary thyroid cancer: 78%
  • Stage 4 Follicular thyroid cancer: 56%
  • Stage 4 Anaplastic thyroid cancer: 3%
  • Stage 4 Medullary thyroid cancer: 37%

How is stage 4 thyroid cancer treated?

I’m about to sound like a broken record, but this again depends on the type of cancer. For almost all types the first step in treatment is a total thyroidectomy.  For patients diagnosed at earlier stages, whose disease has progressed, any remaining thyroid tissue and involved lymph nodes will likely be removed.  This is known as a radical neck dissection.  Further treatment for papillary and follicular carcinomas involves radioactive iodine treatment. Sadly, these two types of thyroid cancer can become resistant to radioactive iodine, and thus may require radiation and/or chemotherapy.

Medullary and ananplastic diseases, however, are not sensitive to radioactive iodine at all, and must begin with surgery, followed by radiation/chemotherapy.  Further targeted treatments are possible utilizing biomarkers and genetic traits of the tumor.

Surgical removal of metastases has been utilized in some patients, but it should be understood that the primary outcome with these surgeries is to improve quality of life.

New findings on familial thyroid cancers

For those of us that have been diagnosed with any type of cancer, we often worry about our family members, and for me, especially my babies. Wonderful new research out of Penn State University has revealed a mutation in the DUOX2 gene may be at least partly responsible for many non-medullary thyroid cancers. This gene is responsible for producing hydrogen peroxide within the thyroid, which is a needed compound in the production of thyroid hormones. When the mutation is present in this gene, the production of hydrogen peroxide does not turn off at the right time, which can cause further genetic damage to the thyroid – which as we have learned – is a precursor to cancer. What a blessing it could be to discover a genetic marker that could enable early identification of many thyroid cancers!

As always, much love, many prayers, and abundant blessings to all of the warriors out there!!

Sources:
https://www.texasoncology.com/types-of-cancer/thyroid-cancer/stage-iv-thyroid-cancer
https://www.cancer.net/cancer-types/thyroid-cancer/statistics
https://www.sciencedaily.com/releases/2019/11/191120121201.htm

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