Timely detection key to cure thyroid cancer

Thyroid cancer has shown an increasing incidence in the west and it is likely that India will follow the same trend. While thyroid cancer carries a good outcome, there are many challenges along the way in diagnosing and treating it. The big question is whether we as a nation are geared up to handle this problem effectively.

The thyroid glandis, a butterfly-shaped organ located in the base of the neck, is responsible for thyroid hormones. These hormones are important in the normal regulation of the metabolism of the body. Although the exact cause of thyroid cancer remains unknown, the disease is identified via a lump or nodule in the thyroid gland or enlarged lymph nodes in the neck.

Pain or weight loss is exceedingly rare but in later stages it can interfere with swallowing, persistent cough and may result in voice change. This type of cancer is much more common in women than in men. About three women are diagnosed for every man and can happen at any stage of adult life. Surgery and radioactive iodine remain the mainstay for the treatment of thyroid cancer.

The management of thyroid cancer over the years has evolved. Previously, it used to be a one treatment for all types of thyroid cancers. Today, every thyroid cancer is treated based on the risk stratification in the form of low, high and intermediate risk.

Low risk cancer gets treated with a limited operation and often no additional therapy. Surgery for thyroid cancer is in general exceedingly safe with very few complications. The cure rates for the most common varieties of thyroid cancer are very good. Most patients are cured with therapy and can lead a normal life.

Despite these positive developments, there are multiple challenges with regard to its screening and management. Firstly, most patients with thyroid cancer present to the doctor with a lump or nodule in the thyroid gland without any other symptoms.

Today, a key challenge in thyroid cancer research lies in distinguishing benign thyroid nodules from malignant tumours in order to avoid unnecessary surgery.

Many a times, surgeons get to know only post-surgery that a patient has cancer based on the histopathology report. In the current scenario, even a standardised test like Fine Needle Aspiration Cytology (FNAC) test sometimes is not able to indicate clearly whether a lump is cancerous or not. It leads to subjectivity in interpreting the FNAC results and different recommendations from different doctors confuse the patient.

Secondly, there are inadequate number of trained thyroid surgeons in the community to help the patients. Lack of high-end radioactive iodine treatment facility also poses a great concern for patients as this is a very important component of the treatment of thyroid cancer.

National guidelines
Thirdly, the comprehensive management of thyroid cancer is not widely available. Developed countries like USA, UK and Japan have a set of national guidelines on the management of thyroid cancer, which is still not present in India.

Last but not least, thyroid cancer patients already face numerous difficulties in diagnosis and treatment as they have to travel great distances. Follow-ups can be a tedious process and many patients may have to be under observation, in some cases up to 20 years or lifelong.

According to official statistics, the number of thyroid patients in India is one-tenth of 80,000 Americans who are suffering from thyroid cancer. The US is expected to have the highest number of thyroid cases by 2020 in the world, closely followed by India at the third position.

Therefore, the need of the hour is to build specialised dedicated units in larger cities to provide care to complicated cases, promote excellence, conduct research, impart education to trainee doctors and ensure follow-up therapy.

We have to develop tests that can accurately distinguish cancerous from non-cancerous nodules so that the number of surgeries for non-cancerous nodules can be minimised. Additionally, there is a need for creating a centralised database for tracking the outcomes of the treatment.

A disease like thyroid cancer can have profound social and economic consequences for people, often leading to family impoverishment and societal inequity. Stronger determination to cancer management is much required to accelerate and what must be a continuous, sustainable campaign. The time to act is now. As the saying goes, the best preparation for tomorrow is doing your best today.

(The writer is Director, Head and Neck Oncology Surgery, Medanta, The Medicity)