What is Thyroid cancer

Diagnosis and treatment of thyroid cancer

The thyroid gland is a butterfly shaped endocrine organ located just below the Adam’s apple. This important gland secretes hormones that are involved in numerous major physiological processes including metabolism and regulation of heart rate and body temperature. Over the last 30 years, there has been a marked increase in the incidence of thyroid cancer cases worldwide, partly due to improvements in the techniques used for the early identification and detection of these diseases. Thyroid cancers occur more frequently in females than males, and as any other cancer, result when cells lose their ability to regulate their division and growth. Indeed, thyroid cancer is the most common endocrine malignancy, with an estimated 37,200 cases diagnosed in the United States in 2009.

There are four major subtypes of thyroid cancer: papillary, follicular, medullary and anaplastic. The most common forms (papillary and follicular) are usually less aggressive and less commonly fatal. The medullary subtype can be cured, if detected early – before it extends out of the neck, but has a poorer prognosis if it has spread to other sites. The anaplastic subtype is the most aggressive, but fortunately also the rarest type of thyroid cancer. It has a very poor prognosis with a low chance of survival.

Early detection of thyroid cancer has been facilitated in North America by our centre’s (Mount Sinai Hospital) pioneering introduction of neck/thyroid ultrasound and the use of fine needle aspiration biopsy of any suspicious lumps (nodules) or abnormal neck lymph nodes. This has permitted the improved selection of those nodules at risk for cancer, and avoided unnecessary surgery for those nodules which are benign.

Subsequent to surgical removal of the thyroid cancer, further management is undertaken to determine the degree of aggressiveness, and the need for supplementary radiation therapy or repeat surgical interventions.

Your support of the Da Vinci Gala Fundraiser has assisted our thyroid research and patient care programs at Mount Sinai Hospital’s Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases in providing these services to patients with thyroid nodules who require appropriate investigation, and in the improved post-surgical management of patients proven to have thyroid cancer.

With your help we have been able to:

  1. Reduce the need for unnecessary surgery on benign thyroid nodules,
  2. Improve the selection among those thyroid nodules which do represent early cancer and will require appropriate surgical treatment,
  3. Avoid unnecessary radioactive iodine treatment in low-risk well differentiated papillary/follicular thyroid cancers by the use of serial follow up measurements of serum thyroglobulin biomarker and neck ultrasound monitoring, to avoid unnecessary radiation exposure, patient inconvenience, and conserve healthcare costs,
  4. Administer appropriate radioactive iodine treatment to high-risk well differentiated papillary/follicular thyroid cancers,
  5. Explore new strategies on the application of additional novel biomarkers which could distinguish between aggressive and non-aggressive forms of thyroid cancer by testing the surgical pathology and thereby predict which affected thyroid cancer patients will require earlier and more aggressive follow up investigation and treatment,
  6. Discover new strategies which may be similarly applied to not only thyroid cancers but also other aggressive epithelial cancers such as breast, prostate, lung, and oral cancers,
  7. Maintain a thyroid cancer database which catalogs responses to treatment on serial follow up for the various subtypes of thyroid cancer and maps the clinical course in response to treatment, as a valuable tool for understanding the future management of thyroid cancer,
  8. Acquire technologists, and research assistants to maintain these clinical care and research activities,
  9. Implement new potentially innovative and clinically applicable strategies which may improve the management of patients with aggressive thyroid cancer problems,
  10. Sponsor suitable applicants for Fellowship training in clinical or basic thyroid oncology.

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Shown below are a series of recent publications over the last several years which acknowledge your support:

Immunohistochemical Subcellular Localization of Protein Biomarkers Distinguishes Benign from Malignant Thyroid Nodules: Potential for Fine-Needle Aspiration Biopsy Clinical Application.
Ralhan R, Veyhl J, Chaker S, Assi J, Alyass A, Jeganathan A, Somasundaram RT, MacMillan C, Freeman J, Vescan AD, Witterick IJ, Walfish PG. Thyroid. 2015 Nov;25(11):1224-34. doi: 10.1089/thy.2015.0114. Epub 2015 Aug 6. Click here
Post-operative stimulated thyroglobulin and neck ultrasound as personalized criteria for risk stratification and radioactive iodine selection in low- and intermediate-risk papillary thyroid cancer.
Orlov S, Salari F, Kashat L, Freeman JL, Vescan A, Witterick IJ, Walfish PG. Endocrine. 2015 Sep;50(1):130-7. doi: 10.1007/s12020-015-0575-0. Epub 2015 Mar 20. Click here
Induction of painless thyroiditis in patients receiving programmed death 1 receptor immunotherapy for metastatic malignancies.
Orlov S, Salari F, Kashat L, Walfish PG. J Clin Endocrinol Metab. 2015 May;100(5):1738-41. doi: 10.1210/jc.2014-4560. Epub 2015 Mar 9. Click here
PD-1 Immunotherapies Induce Painless Thyroiditis in Patients With Metastatic Malignancies
Click here
S100A7 overexpression is a predictive marker for high risk of malignant transformation in oral dysplasia.
Kaur J, Matta A, Kak I, Srivastava G, Assi J, Leong I, Witterick I, Colgan TJ, Macmillan C, Siu KW, Walfish PG, Ralhan R. Int J Cancer. 2014 Mar 15;134(6):1379-88. doi: 10.1002/ijc.28473. Epub 2013 Oct 8.
Click here
Prognostic significance of cytoplasmic S100A2 overexpression in oral cancer patients.
Kumar M, Srivastava G, Kaur J, Assi J, Alyass A, Leong I, MacMillan C, Witterick I, Shukla N, Thakar A, Duggal R, Roychoudhury A, Sharma M, Walfish PG, Chauhan S, Ralhan R. J Transl Med. 2015 Jan 16;13(1):8. [Epub ahead of print]
Click here
Immunohistochemical analysis based Ep-ICD subcellular localization index (ESLI) is a novel marker for metastatic papillary thyroid microcarcinoma.
Kunavisarut T, Kak I, Macmillan C, Ralhan R, Walfish PG.
BMC Cancer. 2012 Nov 15;12(1):523.
Activated leukocyte cell adhesion molecule (ALCAM/CD166) is a marker for thyroid cancer aggressiveness and disease-free survival.
Chaker S, Kak I, Macmillan C, Ralhan R, Walfish PG.
Thyroid. 2012 Nov 13.
An Ep-ICD based index is a marker of aggressiveness and poor prognosis in thyroid carcinoma.
He HC, Kashat L, Kak I, Kunavisarut T, Gundelach R, Kim D, So AK, MacMillan C, Freeman JL, Ralhan R, Walfish PG.
PLoS One. 2012;7(9):e42893.
Biotinidase is a novel marker for papillary thyroid cancer aggressiveness.
So AK, Kaur J, Kak I, Assi J, MacMillan C, Ralhan R, Walfish PG.
PLoS One. 2012;7(7):e40956.
Radioiodine ablation in low-risk thyroid cancer.
Orlov S, Freeman JL, Walfish PG.
N Engl J Med. 2012 Aug 16;367(7):672; author reply 673-5.
Predictive value of metastatic cervical lymph node ratio in papillary thyroid carcinoma recurrence.
Yip J, Orlov S, Orlov D, Vaisman A, Hernández KG, Etarsky D, Kak I, Parvinnejad N, Freeman JL, Walfish PG.
Head Neck. 2012 Jun 23.
Stimulated thyroglobulin and neck ultrasonography facilitates postsurgical radioactive iodine remnant ablation selection in patients with low-risk well-differentiated thyroid carcinoma.
Gomez Hernandez K, Etarsky D, Orlov S, Walfish PG.
Thyroid. 2012 Jul;22(7):760-1.
Nuclear and cytoplasmic accumulation of Ep-ICD is frequently detected in human epithelial cancers.
Ralhan R, He HC, So AK, Tripathi SC, Kumar M, Hasan MR, Kaur J, Kashat L, MacMillan C, Chauhan SS, Freeman JL, Walfish PG.
PLoS One. 2010 Nov 30;5(11):e14130.
Thyroid pathophysiology: reflections on physician-scientist careers in thyroidology.
Walfish PG.
Thyroid. 2010 Nov;20(11):1201-4.
Secretome-based identification and characterization of potential biomarkers in thyroid cancer.
Kashat L, So AK, Masui O, Wang XS, Cao J, Meng X, Macmillan C, Ailles LE, Siu KW, Ralhan R, Walfish PG.
J Proteome Res. 2010 Nov 5;9(11):5757-69.