You've probably heard of the butterfly-shaped thyroid gland at the front of your neck. Sometimes you can feel a small lump in this gland. Or a doctor may see it when you're examining you. While this lump is usually not dangerous, it can, in rare cases, be a sign of cancer. Today, we're going to talk about a special, but somewhat rare, type of cancer that occurs in the thyroid gland.
What is medullary thyroid cancer (MTC)?
Simply put, Medullary Thyroid Cancer (MTC) is a cancer that develops inside your thyroid gland. The inner part of this gland is called the 'medulla' . There is a special type of cell in this medulla, called 'parafollicular C cells' . These C cells produce the hormone 'calcitonin' . So, when these C cells start to grow uncontrollably, MTC occurs. Think of it like unwanted plants in a garden spreading everywhere without control.
It's normal to have a lot of questions and fears when you hear about cancer, especially if it's a rare type. But remember, your medical team is with you on this journey. There are many different ways to treat MTC.
How common is medullary thyroid cancer (MTC)?
Now you might be thinking, "Oh, is this a disease that everyone gets?" Don't worry. Thyroid cancer is fairly common. However, the type we're talking about , medullary thyroid cancer (MTC) , is very rare . Even in a country like the United States, only 4% to 10% of all thyroid cancers reported are diagnosed as MTC. That means that only about 1,000 people are diagnosed with MTC there every year. So, in Sri Lanka, this number may be even lower.
What are the symptoms of medullary thyroid cancer (MTC)?
Okay, so what are the symptoms of MTC? Not everyone experiences the same symptoms. However, there are some common ones:
- A lump (nodule) on the top of your thyroid gland is palpable. This is the main symptom that occurs in 75% to 95% of people when they are diagnosed. It can feel like a small lump, and can sometimes be seen when you look at the front of your neck.
- Swollen lymph nodes in the neck . This is also seen in about 70% of people at diagnosis. These can be felt as small lumps on either side of the neck.
However, very rarely, if the thyroid nodule becomes large, the following symptoms may occur:
- Voice changes, hoarseness.
- Difficulty swallowing food.
- Difficulty breathing.
The important thing is that some people with MTC may not have any symptoms for a long time. This is because the cancerous tumor is very small. Therefore, it is very important to pay attention to anything unusual in the neck.
Why does medullary thyroid cancer (MTC) develop?
Now let's look at why this MTC occurs. There are several reasons for this. Mainly, there are two ways in which MTC occurs.
Sporadic MTC
About 75% (about three out of four) of MTC patients develop the condition sporadically . This means that no one in their family has had MTC before. It occurs without a family history. Scientists have not yet found the exact cause of this sporadic MTC. However, between 40% and 50% of people who develop MTC in this way have mutations in a gene called ``(RET)`` . This is not something they are born with, but a genetic abnormality that develops later in life.
MTC from generation to generation
On the other hand, about 25% of MTC patients (about one in four) may have an inherited condition called 'Multiple Endocrine Neoplasia type 2' (MEN2) . There are several subtypes of 'MEN2':
- `(MEN2A)`: People with this condition have a very high risk of developing MTC (about 90%) .
- `(MEN2B)`: Some cases of `(MEN2B)` are hereditary. However, in most cases this is not the case. People with `(MEN2B)` have a 100% chance of developing MTC at a very young age .
There is another subtype of this `(MEN2B)`, called `Familial Medullary Thyroid Cancer (FMTC) . People with `(FMTC)` have a `(RET)` gene mutation, but they only develop MTC (and not other types of cancer).
Imagine, if someone in your family is found to have this ``(RET)`` gene mutation, you may be able to avoid a major risk by having the thyroid gland removed through preventive surgery before cancer develops.
How is medullary thyroid cancer (MTC) diagnosed?
MTC often first appears as a lump in the thyroid gland. You may feel it yourself, or your doctor may find it when you feel your neck during a routine exam. Sometimes, the lump is found incidentally during an imaging test done for another reason.
If your doctor suspects you have MTC, they will likely order these tests:
- Imaging tests: These can help to clearly see the thyroid gland. For example , a thyroid ultrasound , CT scan, and/or MRI can be done. Think of it like taking a picture with a camera, these machines can clearly see what's inside the body.
- Fine needle aspiration (needle biopsy): Your doctor will likely recommend taking a small sample of tissue (biopsy) from your thyroid nodule. This involves using a very fine needle. It feels like a tiny needle prick. This tissue sample is then examined under a microscope to see if there are any cancer cells.
- Blood tests: These may include tests that measure the levels of substances in your blood called calcitonin and carcinoembryonic antigen (CEA) . These levels are usually elevated in people with MTC.
Your doctor may also recommend genetic testing to see if you have a genetic condition called ``MEN2''. If so, they may recommend genetic testing for other blood relatives, as this can help determine if they are at risk.
What are the treatments for medullary thyroid cancer (MTC)?
Okay, now let's see what treatments are available for MTC.
The main treatment for MTC is surgery to remove your entire thyroid gland (total thyroidectomy) . Although this may seem like a major operation, it is the best way to cure this cancer.
- Lymph node removal: If thyroid cancer has spread (metastasized) to the lymph nodes in your neck, the surgeon will likely remove them as well.
- Hormone therapy: After surgery, you will need to take thyroid hormone replacement medications for the rest of your life. Because the hormones produced by the thyroid gland are essential for the body, they need to be given externally in the form of pills.
In addition to surgery, your doctor may recommend other treatments, including:
- Radiation therapy: A method of destroying cancer cells using high-energy rays.
- Chemotherapy: A method of using drugs to kill cancer cells.
- Targeted therapies: In some cases of MTC, specific drugs that target only the changes in DNA are used. Examples include vandetanib and cabozantinib .
After treatment for MTC, your doctor will regularly check your CEA and Calcitonin levels through blood tests. This will help them know how effective the treatment is and whether the cancer has come back.
MTC is a cancer that can be a little more aggressive than other, more common types of thyroid cancer. However, if it is found before it spreads to the lymph nodes in the neck or other parts of the body, it is much easier to treat, cure, and control.
What is the prognosis for someone with medullary thyroid cancer (MTC)?
The prognosis, or outlook, for someone with MTC depends on several factors.
- The stage of the cancer (that is, how far the cancer has spread).
- Whether the cancer has spread (metastasized) to other parts of the body.
- How much of the cancerous lump was removed during surgery.
- Your age and overall health.
The prognosis for MTC is generally not as good as for papillary thyroid cancer and follicular thyroid cancer . However, if you and your doctor catch MTC early, it can be completely cured with surgery . Even if the diagnosis is late, MTC often spreads (gets worse) relatively slowly .
The chances of recovery may be slightly lower for people like these:
- People over 65 years of age.
- People in the advanced stages of cancer.
- Those whose cancer could not be completely removed during surgery.
What is the life expectancy of medullary thyroid cancer (MTC)?
When it comes to the survival rate of someone with MTC, current research shows that the five-year survival rate for stages one, two, and three of MTC is about 93%. However, for stage four, this rate drops to 28%.
However, the important thing here is that because so few new cases of MTC are reported each year, these survival rates may not be very accurate. Your medical team will give you a better idea of what to expect.
What is the difference between papillary and medullary thyroid cancer?
Now you're probably wondering, 'What's the difference between this MTC and those other types of thyroid cancer?'
Papillary thyroid cancer is the most common type of thyroid cancer . It accounts for 80% of thyroid cancer diagnoses. However, medullary thyroid cancer (MTC) is rare .
The main difference lies in the cells from which these two types of cancer begin.
- Papillary thyroid cancer starts in the follicular cells in your thyroid gland that produce thyroglobulin, a protein.
- MTC develops from C cells in the thyroid gland that produce calcitonin, a hormone.
Another thing is that papillary thyroid cancer is often associated with radiation exposure, but there is no such clear link with MTC.
Finally, remember this.
Hearing that you have cancer, no matter what type, is a very scary thing. We all know that. But when it comes to medullary thyroid cancer (MTC) , remember that it responds well to treatment if it is detected early .
Although the exact cause of most cases of MTC is unknown, there is a strong link to some hereditary conditions. Therefore, if you or a close family member (first-degree relative - parents, siblings, children) has been diagnosed with MTC, it is very important to get genetic testing. This can be very helpful for you and your family.
If you have any questions about your risk of developing MTC, don't be afraid to talk to your doctor. They are always there to help you and answer your questions. The most important thing is to stay informed, stay informed, and take the necessary steps.
` Medullary thyroid cancer, MTC, thyroid gland, cancer symptoms, genetic testing, MEN2, thyroid surgery
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