Papillary thyroid cancer arises from the hormone-producing follicular cells of the thyroid gland and is the most common type of thyroid cancer. It usually grows slowly, may cause no symptoms for a long time, and in most patients presents as a nodule found on ultrasound. With appropriate treatment its course is usually favourable.
What is papillary thyroid cancer?
It takes its name from the finger-like (papillary) arrangements of cells seen under the microscope. It can occur at any age but is more common in young and middle-aged adults, particularly women. It may be a single focus within the thyroid, or there may be several foci in both lobes of the gland (multifocal). Its most characteristic feature is a tendency to spread first to the lymph nodes of the neck; even when lymph nodes are involved, the disease can usually be brought under control. Besides the classic type, there are subtypes such as the follicular variant and the tall-cell variant; some subtypes may behave a little more persistently and can affect the treatment plan. Very small tumours are called “papillary microcarcinoma” and usually have a very good course.
Symptoms
- A painless, firm swelling at the front of the neck
- An enlarged lymph node at the side of the neck; sometimes this is the first and only finding
- In advanced cases, hoarseness and difficulty swallowing
- Incidental detection without any symptoms is the most common form of presentation
Diagnosis
Ultrasound assesses the suspicious features of the nodule (such as irregular margins, tiny calcifications, or being taller than it is wide) and the lymph nodes of the neck. The definitive diagnosis is made by fine-needle aspiration biopsy; papillary cancer cells have a fairly typical appearance under the microscope. Scanning the whole neck with ultrasound before surgery is important so that any lymph node involvement is included in the planning.
Treatment
Treatment is surgical. For small, single-focus tumours confined to the gland, removing only the affected lobe (lobectomy) may be enough; for larger, multifocal tumours or those with lymph node involvement, the whole gland is removed (total thyroidectomy) and the lymph nodes of the neck are cleared when necessary. After surgery, radioactive iodine treatment may be given to patients at risk of recurrence; in low-risk patients it may not be needed. When the whole gland is removed, thyroid hormone medication is started. For very small microcarcinomas without suspicious features, active monitoring with ultrasound instead of surgery may also be an option in selected patients.
After surgery and follow-up
Follow-up uses neck ultrasound and the thyroglobulin level in the blood; because thyroglobulin is a protein produced by thyroid tissue, it is monitored as a marker of disease in patients whose whole gland has been removed. Follow-up continues for years but becomes less frequent over time. If a recurrence is found, treatment with further surgery or radioactive iodine is usually possible.
When should you see a doctor?
If you notice a new swelling or lymph node in your neck, if a known nodule is growing, or if your hoarseness has not gone away for a few weeks, it is advisable to see a doctor.
Frequently asked questions
Is papillary thyroid cancer dangerous?
It is one of the thyroid cancers with the most favourable course. It grows slowly, and surgery-based treatment gives most patients a long disease-free life.
Does treatment change if it has spread to the lymph nodes?
Yes. In that case removal of the whole thyroid together with the involved lymph nodes, followed by radioactive iodine treatment, may be planned.
Is the whole thyroid removed in every papillary cancer?
No. For small, single-focus tumours confined to the gland, removing only the affected lobe may be enough; the decision depends on the features of the tumour.
This page is general information. Decisions about diagnosis and treatment are made for you personally, and only after an examination. If you have symptoms, see a doctor.