Thyroid No Surgery #3 The Art of Refusing a Surgery for a Small Micro-Papillary Thyroid Cancer
It a patient is told they have cancer it can be nervous time for sure. However, not all cancers are the same. Some such as pancreas cancer is very serious for the patients long term survival. Others like basal cell skin cancer may not impact survival at all. Thyroid cancer comes in all different flavors. One type is very aggressive with short life span, and the others are less aggressive. One type called classic papillary cancer may be so slow growing that it may never grow at all. What should the patient do when confronted with a thyroid cancer diagnosis?
- Determine what type of thyroid cancer.
- If it is a papillary thyroid cancer you need to determine the size of the tumor and it’s location within the thyroid gland.
- If it is a micro-papillary cancer and it is <1.5 cm and located within the lobe away from the capsule and recurrent nerve you have a cancer that may never grow.
- What do you do and how do you get this needed information to make an informed opinion on the need for surgery?
- Your primary and his surgeon will push you to have surgery ASAP. There is no hurry to have surgery with this indolent cancer.
- Get your records including the ultrasounds and actual pathology slides from the needle biopsy for review by a thyroidologist or endocrinologist with an interest in thyroid cancer.
- If your expert second opinion agrees it is a micro-papillary classic thyroid cancer but it is small and safely inside the thyroid gland, and there are no abnormal lymph nodes to biopsy then you have all the information you need to explore the potential that you may not need SURGERY.
- The program to treat these “safe” cancers is called Active Surveillance.
- The patients records are stored in a registry for 50 years. Your records will be available to your future physicians.
- The patient returns for yearly endocrine neck ultrasound studies to determine if the micro-cancer has grown.
- The size increase is very small (3 mm). That means if it increases 3 mm you are a candidate for “rescue” surgery. However, studies have shown that very few ever increase in size over 22 years.
- The late surgery if needed is as safe or safer that if the surgery was done at the beginning.
- The value to Active Surveillance is that you may never need surgery at all.It will change the cancer followup testing and treatment.It could save you from unnecessary radioiodine therapy as well.
- This is available to patients who have told their family about the choice and had received support from them for not having surgery at the beginning.
- There are patients who are nervous about a cancer even if harmless to be in their neck for a lifetime, but no not want the standard removal of the thyroid gland.
- The available alternative to total removal or lobe removal is radiofrequency ablation (RFA) of the micro-cancer while leaving the gland intact. This is still being studied at present and has promise.
- If the surgery is your choice it can be a lobectomy instead of a more serious total thyroidectomy.
- If you want to keep your thyroid gland even though it has a small harmless micro cancer, then ACTIVE SURVEILLANCE (AS) is an excellent alternative to surgery.
- Santa Monica Thyroid Center’s Richard Guttler MD,FACE,ECNU has an AS program with registry storage of records for 50 years with Thyroid Cancer Care Collabrative TCCC.
- Call the administrator Matthew Foss at 310-393-8860 for details and a second opinion BEFORE you have the surgery for your <1.3 cm micro-papillary classic thyroid cancer.