The Age of No Surgery is HERE Even for Some Thyroid Cancers: Active Surveillance AS.
1.5 classic papillary thyroid cancers in idea locations in the thyroid lobes away from the capsule and recurrent nerve and isthmus are candidates for AS. Yes this cancer rarely grows or kills you. 50 year registry follow up with ultrasound yearly size evaluation is needed instead of total thyroidectomy and radiation therapy. If there is 3 mm growth anytime during follow up, a rescue surgery can be done as safely an original surgery done years before.
AS centers include Cedar Sinai in Los Angeles under Allen HO MD, MD Anderson, Mayo Clinic, and UCLA. A private center is Santa Monica Thyroid Center AS program directed by Dr.Richard Guttler. Private center with no long waits in university waiting rooms to get the yearly ultrasound evaluations. Call Matt at 310-393-8860 for AS program details.
The candidate criteria for “no thyroid surgery” active surveillance and about the programs are listed below.When you find you have a thyroid cancer,usually you have surgery and maybe radiation therapy.However, a papillary thyroid micro-cancer are small and very slow growing and unlikely to spread or kill you. An alternative treatment is to closely monitor your nodule with yearly neck ultrasounds. This is called ACTIVE SURVEILLANCE AS.
Why Active Surveillance?
It is acceptable alternative to surgery for patients with low low risk cancers.Recent
studies on 600 patients show few PTMC’s grow. They also have the same survival rates as the one that had surgery.If there is the slightest growth 3 mm during surveillance surgery can be done safely with no difference in outcomes.
What are the AS procedures?
You need to have to have routine standard of care visits for 5 years or longer.
The cancer nodule will be closely monitored by blood cancer marker,ultrasounds of thyroid and neck lymph nodes.
Annual evaluations to determine if the nodule has grown.
You can withdraw at any time and have surgery.
What are the benefits and risks of AS?
Major benefit is avoiding the major surgery with all the loss of work hospital stay and pain and suffering of surgery. Routine thyroid cancer treatment with surgery,radioiodine,follow up studies end in bankruptcy for many thyroid patients.
Risk includes the rare chance the the tumor grows needing rescue surgery, and the cancer spreads to neck lymph nodes.
Surgery is safer now than in the 14 th century, but if you can use AS instead you are ahead of the game and may never need surgery or in a few cases only need rescue surgery years later if it grows even 3 mm! Most thyroid surgery is done by low volume surgeons with high complication rates compared to high volume surgeons.
Richard B.Guttler MD,FACE,ECNU