Thyroid No More Surgery # 6: How to Avoid Another Thyroid Cancer Neck Dissection for Recurrent Lymph Node Disease

Thyroid No More Surgery # 6: How to Avoid Another Thyroid Cancer Neck Dissection for Recurrent Lymph Node Disease

Thyroid No More Surgery # 6: How to Avoid Another Thyroid Cancer Neck Dissection for Recurrent Lymph Node Disease

Thyroid No More Surgery: How to Avoid Another Thyroid Cancer Neck Dissection for Recurrent Lymph Node Disease

Background:

Thyroid papillary cancer is the most common type.It has as a common feature early spread to neck lymph nodes. It is common that the rush to operate by your primary and surgeon results in failure to evaluate the presence of abnormal neck node disease.This results in an inadequate first surgery, and the need for a later neck dissection. Many surgeons fail to do a complete neck dissection leaving you to have persistent disease. When is is found the knee jerk action is to have another major surgery to remove these cancer nodes.

What can you do now to avoid another hospitalization,major surgery,lost work and the pain, suffering and co-pay expense associated?

Here is an action plan for you.

  1. Defer the surgery and tell your primary you need to think about having another surgery.
  2. Collect all your records,pathology reports,imaging, radioiodine treatment records.
  3. Seek out a certified endocrine neck clinical thyroidologist ECNU ( aace.com).
  4. Ask them about alternatives to another neck dissection.
  5. If they do not do Ethanol ablation (PEI)for neck cancer lymph nodes, ask them who does this procedure as an outpatient?
  6. What is the procedure PEI for recurrent cancer neck lymph nodes and when should it be used?
  7. The injection of small amounts of 200 proof medical grade ethanol under ultrasound guidance into cancer lymph nodes can ablate the cancer. This PEI treatment should not be a replacement for an official first neck dissection but only after failure to remove all the cancerous lymph nodes.This method has been proven effective in studies from Mayo Clinic and from Europe. PEI saves the need for more surgery, and saves money by avoiding hospitalization and another major surgery.
  8. What is the procedure to get evaluated for PEI?
  9. After finding an ECNU endocrinologist that does PEI, apply for a consult.
  10. If after the consultation you are a candidate, you will be set to have your cancer node ablated in his out-patient thyroid center. Major reasons to refuse PEI treatment is finding invaded lymph nodes by ultrasound or during the PEI if the patient has significant pain to abort the PEI.
  11. What is the procedure?
  12. After mapping your neck and locations of the troublesome lymph nodes, the neck would be prepared in the usual way for a biopsy. The sonographer helping will locate the lymph node and the sonologist will insert the #27-25 needle with the syringe filled with 1-3 cc Ethanol depending on the size of the node.
  13. A small amount of ethanol is injected to make sure the needle is in the lymph node.
  14. If the patient does not feel and pain the sonologist begins the treatment by small injections in the node until the entire insides are ablated.
  15. The removal of the needle may cause slight pain.
  16. Each additional cancer node is ablated by the same method.
  17. Pre-Post PEI thyroglobulin TG  will be monitored.
  18. Follow up studies are at 4 weeks.
  19. 6 month and yearly endocrine neck ultrasound studies are needed to look for recurrence or a failed PEI treatment.
  20. The Santa Monica Thyroid Center’s Richard Guttler teaches PEI to other endocrinologists and does PEI in his center.Call Matthew Foss at 310-393-8860 for evaluation details.
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