Thyroid Cancer No Surgery 2018: You are 25 Years Old and Told You Have a Small Micro-Papillary Thyroid Cancer.
What are the alternatives to an immediate thyroidectomy or long term active surveillance?
Many patients don’t like either options and look for a third option.
In 2018 there is a third option of all ages with micro-papillary thyroid cancer. Older patients do better with AS than those <40 years.
Active surveillance may be the treatment for micro-papillary cancer but many will not be happy and opt of surgery at first. Those with a desire not to have surgery and don’t want a thyroid cancer in their neck for years can now consider thyroid cancer ablation therapy at the first sign of the disease and if they pass strict rules to be a candidate Active surveillance, but refuse to sign up.
Mayo Clinic is offering and studying the third path with ethanol ablation of the primary 10-15 mm cancers.
Santa Monica Thyroid Center’s private practice Richard Guttler is also offering ethanol ablation to selected cases.
Dr.Guttler treating a recurrent lateral neck lymph node papillary thyroid cancer with ethanol PEI. Same method can also treat primary micro-papillary thyroid cancers as a third option from surgery or active surveillance.
The Korean group headed by Dr. JH Baek is also looking into Thyroid RFA therapy of primary micro-papillary.
Call me at 310-393-8860 for details on all three programs.
Richard Guttler MD,FACE,ECNU
Reference and my discussion to follow.
Insights into the Management of Papillary Thyroid Micro-carcinoma
Thyroid 28 ( 1) 2018 23-31
Miyauchi et al
- You are told it is extremely unlikely it will grow the 3 mm to trigger a rescue surgery ( 5% ).
- They recommend Active surveillance.
- This means a lifetime of cancer follow up visits in 95% of the cases.
- You are young and do not look forward to 40+ years of examinations.
- Also the thought of a cancer in your neck for during your lifetime is also troubling.
- The alternative of thyroid surgery is also troubling as it is a major surgery with many complications and post op recovery problems and is costly.
- Unfavorable events with surgery were vocal cord paralysis, hypoparathyroidism, need to take thyroid hormone substitution therapy for life,and a neck scar.
- Rising health care costs due in part to thyroid surgery is 1.6 billion now and estimated to go to 3.5 billion by 2030.
- 20-40 year old patients need to remove the micro-cancer with surgery.
- Is there another way to destroy the small cancer without a full thyroidectomy?
- The answer is yes.
- The ablation of the micro-papillary while it is 10 mm when first diagnosed may be a third path to surgery or active surveillance for patients of all ages who do not want surgery or long term follow up with a cancer in their neck.
- There are two methods for ablation of primary micro-papillary cancers
- Ethanol Ablation PEI has been shown effective in ablation in studies presented at two national and international meetings by the Mayo clinic group headed by Dr.Ian Hay.
- Thyroid Radiofrequency Ablation RFA has been studied in Korea for the same indications.
- Professor Baek in Seoul Korea at Asan Medical Center.