The thyroid is a gland at the base of the throat near the trachea (windpipe). It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus is a thin piece of tissue that connects the two lobes. It usually cannot be felt through the skin.
The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:
There are two types of thyroid nodules:
Papillary and follicular thyroid cancer are sometimes called differentiated thyroid cancer. Medullary and anaplastic thyroid cancer are sometimes called poorly differentiated or undifferentiated thyroid cancer. Anaplastic thyroid cancer is very rare in children and not discussed in this summary.
Your child's doctor may find a lump (nodule) in your child's thyroid during a routine medical exam. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. Nodules may be solid or fluid-filled.
When a thyroid nodule is found, an ultrasound of the thyroid and a fine-needle aspiration biopsy are often done to check for signs of cancer. Blood tests to check thyroid hormone levels and for anti-thyroid antibodies in the blood may also be done. This is to check for other types of thyroid disease.
Thyroid nodules usually don't cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only one in five thyroid nodules become cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think your child may be at risk.
Risk factors for childhood thyroid cancer include the following:
The genes in cells carry hereditary information from parent to child. A certain change in the RET gene that is passed from parent to child (inherited) may cause medullary thyroid cancer.
There is a genetic test that is used to check for the changed gene. The patient is tested first to see if he or she has the changed gene. If the patient has it, other family members may also be tested to find out if they have an increased risk of medullary thyroid cancer. Family members, including young children, who have the changed gene may have a thyroidectomy (surgery to remove the thyroid). This can decrease the chance of developing medullary thyroid cancer.
Sometimes thyroid tumors do not cause any signs or symptoms. These and other signs and symptoms may be caused by papillary or follicular thyroid cancer or by other conditions.
Check with your child's doctor if your child has any of the following:
These and other signs and symptoms may be caused by medullary thyroid cancer or by other conditions.
The following tests and procedures may be used:
The prognosis (chance of recovery) depends on the following:
To plan treatment, it is important to know whether cancer cells have spread within the thyroid, to the area around the thyroid, or to other parts of the body.
The following tests and procedures may be done to find out if cancer cells have spread:
Cancer can spread through tissue, the lymph system, and the blood:
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.
Recurrent thyroid cancer is cancer that has recurred (come back) after it has been treated. Thyroid cancer may come back in the thyroid or in other parts of the body.
Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:
Surgery is the most common treatment for thyroid cancer. One of the following procedures may be used:
Follicular and papillary thyroid cancers are sometimes treated with radioactive iodine (RAI) therapy. RAI therapy may be given to children after surgery to kill any thyroid cancer cells that were not removed or to children whose tumor cannot be removed by surgery. RAI is taken by mouth and collects in any remaining thyroid tissue, including thyroid cancer cells that have spread to other places in the body. Because only thyroid tissue takes up iodine, the RAI destroys thyroid tissue and thyroid cancer cells without harming other tissue. Before a full treatment dose of RAI is given, a small test dose is given to see if the tumor takes up the iodine.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Tyrosine kinase inhibitor therapy (TKI) is a type of targeted therapy that blocks signals needed for tumors to grow. Vandetanib is a TKI used to treat children with advanced medullary thyroid cancer.
Targeted therapy is being studied for the treatment of childhood thyroid cancer that has recurred (come back).
Hormones are substances made by glands in the body and circulated in the bloodstream. After treatment for thyroid cancer, the thyroid is not able to make enough thyroid hormone. Patients are given thyroid hormone replacement pills for the rest of their lives.
Information about clinical trials is available from the NCI website.
For information about side effects that begin during treatment for cancer, see our Side Effects page.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
It is common for thyroid cancer to recur (come back), especially in children younger than 10 years and those with cancer in the lymph nodes. Ultrasound and thyroglobulin tests may be done from time to time to check if the cancer has recurred. Lifelong follow-up of thyroid hormone levels in the blood is needed to make sure the right amount of hormone replacement therapy (HRT) is being given. Talk with your child's doctor to find out how often these tests need to be done.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of papillary and follicular thyroid carcinoma in children may include the following:
Within 12 weeks of surgery, tests are done to find out if thyroid cancer remains in the body. These may include thyroglobulin tests and RAI scans. A radioactive iodine scan (RAI scan) is done to find areas in the body where thyroid cancer cells that were not removed during surgery may be dividing quickly. RAI is used because only thyroid cells take up iodine. A very small amount of RAI is swallowed, travels through the blood, and collects in thyroid tissue and thyroid cancer cells anywhere in the body. Further treatment depends on whether cancer cells remain in the body:
See the Multiple Endocrine Neoplasia Syndromes section of the Unusual Cancers of Childhood Treatment summary for more information.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of medullary thyroid carcinoma in children may include the following:
Treatment of progressive or recurrent papillary and follicular thyroid carcinoma in children may include the following:
Treatment of progressive or recurrent medullary thyroid carcinoma in children may include the following:
For more information from the National Cancer Institute about thyroid cancer, see the following:
For more childhood cancer information and other general cancer resources, see the following:
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