Can Thyroid Cancer Spread To The Brain

What Are The Types Of Thyroid Cancer

PAPILLARY THYROID CANCER. Papillary thyroid cancer is the most common type, making up about 70% to 80% of all thyroid cancers. Papillary thyroid cancer can occur at any age. It tends to grow slowly and often spreads to lymph nodes in the neck. Papillary cancer has a generally excellent outlook, even if there is spread to the lymph nodes.

FOLLICULAR THYROID CANCER. Follicular thyroid cancer makes up about 10% to 15% of all thyroid cancers in the United States. Follicular cancer can spread through the blood to distant organs, particularly the lungs and bones.

Papillary and follicular thyroid cancers are also known as wellDifferentiated Thyroid Cancers . The information in this brochure refers to these differentiated thyroid cancers. The other types of thyroid cancer listed below will be covered in other brochures.

MEDULLARY THYROID CANCER. Medullary thyroid cancer , accounts for approximately 2% of all thyroid cancers. Approximately 25% of all MTC runs in families and is associated with other endocrine tumors . In family members of an affected person, a test for a genetic mutation in the RET proto-oncogene can lead to an early diagnosis of medullary thyroid cancer and, as a result, to curative surgery. 75% of patients with Medullary thyroid cancer do not have a hereditary form.

Whole Brain Radiation Therapy

Ten patients received whole brain radiation therapy in our series, at doses ranging from 3054 Grays over 1030 treatments, with or without boost to the tumor bed. Of these patients, three had radiation given in the adjuvant setting and one in the neoadjuvant setting these patients were not considered assessable for response. In addition, two patients were treated in the preterminal disease setting and did not undergo reimaging after treatment. Of the remaining four patients who underwent reimaging after treatment and therefore were assessable for response, three were noted to have regression of their brain metastases whereas one patient had stable disease, although this assessment was performed on the last day of radiation treatment because of a change in the patient’s mental status during clinical deterioration.

For those patients who received whole brain radiation therapy, the overall survival from the time of diagnosis of brain metastasis was 9.5 months . For those patients who did not receive whole brain external bean radiation therapy, survival was 27.0 months . As stated earlier, two of the treated patients were considered to have terminal disease. However, eliminating these patients from the calculation increased the survival of the treated patients to only 10.8 months.

Brain Metastasis From Follicular Thyroid Carcinoma As First Manifestation Of The Disease

Jerez Hospital, Jerez/Cádiz, Spain.

Introduction: The prevalence of brain metastasis from differentiated thyroid carcinoma is 1%. Brain metastasis as the first manifestation of the disease is extremely uncommon.

Case report: We present a case of 44-year-old woman with headache and a tumor in right parietal zone. The patient has had multinodular goiter for 15 years, with two dominant nodules in left thyroid lobe. Both of them were isoechoic with hypoechoic halo and measured 2 cm. Fine-needle aspiration was benign and without changes over time. Computed tomography scan and magnetic resonance brain demonstrated a 6.2×6.5×5 cm right parietal lesion with bone erosion mimicking a meningioma. Laboratory tests were as followed: TSH 1.83 mcU/ml , T4L 0.94 ng/dl , thyroglobulin 3207 ng/ml and antithyroid antibodies were negative.

Surgery of brain tumor was performed and histopathology revealed a 6×5.7×2 cm dural metastasis and a 4×2.8 cm skull metastasis of follicular thyroid carcinoma. Later, total thyroidectomy detected a 2 cm well differentiated follicular thyroid carcinoma in left thyroid lobe, with a small capsular infiltration and without vascular and lymph node invasion.

After that, radiotherapy and radioactive iodine therapy was administered to the patient with an initial good response.

Volume 41

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Chemotherapy For Metastatic Brain Tumors

Because traditional chemotherapy cannot cross the blood-brain barrier, newer treatments called targeted therapy are used as the primary type of chemotherapy for treating metastatic brain tumors.

These drugs identify and attack cancer cells with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells.

Targeted therapies used to treat metastatic brain tumors include:

• Trastuzumab for breast cancer that has spread to the brain
• Erlotinib for the most common type of lung cancer that has spread to the brain

Patients Without Initial Evidence Of Distant Metastases

Fourteen of the 47 patients had no evidence of distant metastases at initial preoperative or postoperative staging. The median primary tumor size was 2.5 cm, significantly smaller than 4.5 cm for the group of 33 with initial distant metastases . The median interval between the diagnosis of thyroid carcinoma to diagnosis of brain metastases was 6.5 yr, which was significantly longer than the 0.9 yr for those with any initial distant metastases . Disease-specific mortality was 71%. The median disease-specific survival after diagnosis of brain metastases was 4.7 months for patients without any initially diagnosed distant metastases, which did not differ from those with brain metastases who had distant metastases in any site at initial disease staging .

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Questions To Ask The Doctor

• What treatment do you think is best for me?
• Whats the goal of this treatment? Do you think it could cure the cancer?
• Will this treatment affect my ability to have children? Do I need to avoid pregnancy for a while?
• Will treatment include surgery? If so, who will do the surgery?
• What will the surgery be like?
• Will I need other types of treatment, too? Whats the goal of these treatments?
• What side effects could I have from these treatments?
• What can I do about side effects that I might have?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• Whats the next step?

Surgery For Thyroid Cancer

Most patients with thyroid cancer have some type of surgery. Surgery is done to take out the tumor and all or part of the thyroid gland. Sometimes lymph nodes are taken out from the neck, too.

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. Possible side effects of thyroid surgery include:

• Bleeding or a blood clot in the neck
• Damage to the parathyroid glands
• Short or long term problems with your voice

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Patient Characteristics And Histology

The basic conditions of the patients are shown in Table 2. Of the 22 patients, 12 were male and 10 female . The mean patient age was 54.5 years at BM diagnosis. Fourteen patients presented other previous and/or synchronous distant metastases: lung , bone , liver , skin . The mean interval time between diagnosis of the first metastasis and BM was 2 years for these patients.

Table 2 Individual clinical findings of patients with BRAIN metastases from DTC.

Fourteen patients had papillary carcinoma, six patients had follicular carcinoma and two patients were unknown. Stages were pT0-2 for 12 patients, pT3-4 stage for eight patients, and unknown for two patients. Nodal involvement was present for 17 patients, absent for three patients, and unknown for two patients. Twelve patients had histological confirmation that the brain lesions were of thyroid origin through biopsy or resection. Nine cases showed vascular invasion, while 10 cases showed no invasion. Three cases were unknown. Necrosis was absent in all cases. Moderate nuclear atypia was observed in 6 cases, where as in 14 cases it was severe. BRAF mutation was found in 9 cases, while 7 cases were not. Six cases were unknown. Seven of 9 cases with BRAF mutation showed vascular invasion, which occurred in only 2 of 7 cases of patients without BRAF mutation.

How Serious Is My Cancer

If you have thyroid cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the spread of the cancer through the thyroid gland. It also tells if the cancer has spread to other organs of your body that are close by or far away.

Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside of the thyroid gland. Be sure to ask the doctor about the cancer stage and what it means for you.

Brain Metastases In Patients With Thyroid Cancer

ABSTRACT

Background:Objetive:Material and Method:Results:

REFERENCES

What Is Thyroid Cancer

Thyroid cancer is a type of cancer that starts in the thyroid gland. It happens when cells in the thyroid grow out of control and crowd out normal cells.

Thyroid cancer cells can spread to other parts of the body such as the lungs and the bone and grow there. When cancer cells do this, its called metastasis. But the type of cancer is based on the type of cells it started from.

So even if thyroid cancer spreads to the lung , its still called thyroid cancer, not called lung cancer.

The thyroid

Ask your doctor to use this picture to show you where your cancer is.

What Happens When Cancer Spreads To The Brain

If you or a loved one have been diagnosed with cancer, youve probably heard the term metastasis. This refers to when cancer develops in one part of the body and then spreads to another part of the body . This generally happens when cancer cells detach from the main tumor , travel through the bloodstream or lymphatic system and then settle in another part of the body and begin growing there, as well . The metastatic tumors are usually composed of the same type of cancer cells as the primary tumor, although they might develop new mutations.

When cancer spreads from a different part of the body to the brain, the metastatic tumors are referred to as brain metastases. The brain is a relatively common location for metastasis to occur. In fact, one in four cancer patients experience brain metastasis. And, brain metastases are the most common type of brain tumor diagnosed among adults. Although any type of cancer can spread to the brain, brain metastases most often originate from cancer in the lungs, breasts, kidneys or colon.

A Study Of 16 Pathologically Confirmed Cases Over 25 Years

Division of Medical Oncology, Mayo Clinic and Foundation, Rochester, Minnesota

Fax: 284-1803

Ian D. Hay M.D., Ph.D.

Division of Endocrinology and Metabolism, Mayo Clinic and Foundation, Rochester, Minnesota

Division of Medical Oncology, Mayo Clinic and Foundation, Rochester, Minnesota

Fax: 284-1803

Ian D. Hay M.D., Ph.D.

Division of Endocrinology and Metabolism, Mayo Clinic and Foundation, Rochester, Minnesota

Signs And Symptoms Of Advanced Medullary Thyroid Cancer

5 percent of thyroid cancer diagnoses. Detecting the cancer early can be difficult.

Medullary thyroid cancer commonly advances from the thyroid into the lymph nodes. Undiagnosed medullary thyroid cancer can spread into other neck tissues and eventually reach the liver, lungs, bone, and brain. Once it reaches distant parts of the body its unlikely to be cured.

When To See A Healthcare Provider

If you feel a new swelling or lump in your neck, or if an imaging test incidentally reveals a thyroid growth, it’s important to schedule an appointment with your healthcare provider right away.

During your appointment, your healthcare provider will:

• Perform a physical examination, including a neck examination
• Order an ultrasound of your thyroid
• Check blood tests that may include a thyroid-stimulating hormone , free thyroxine , and thyroid antibodies

Depending on the results of these tests, your primary care or family healthcare provider may refer you to a healthcare provider who specializes in thyroid care . An endocrinologist may take another look at the thyroid nodule with ultrasound in his or her office and perform a fine-needle aspiration biopsy to see whether cancer cells are present.

Thyroid Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.

The diagnosis of thyroid cancer has been on the rise both in the United States and worldwide, due in large part to the sophistication of high-resolution imaging tests. In other words, these thyroid nodules that would never have been found years ago are now being identified.

While the majority of these small nodules end up not being cancer, determining which ones are is keyâthis is because most thyroid cancers are curable, especially those that are small and have not spread.

Different Kinds Of Thyroid Cancer

There are 4 main types of thyroid cancer. They are listed below. Your doctor can tell you more about the kind you have.

• Papillary thyroid cancer is the most common kind of thyroid cancer. It may also be called differentiated thyroid cancer. This kind tends to grow very slowly and is most often in only one lobe of the thyroid gland. Even though they grow slowly, papillary cancers often spread to the lymph nodes in the neck.
• Follicular cancer is the next most common type. Its more common in countries where people dont get enough iodine in their diet. These cancers do not tend to spread to lymph nodes, but they can spread to other parts of the body, like the lungs or bones.
• Medullary cancer is a rare type of thyroid cancer. It starts in a group of thyroid cells called C-cells. C-cells make calcitonin, a hormone that helps control the amount of calcium in the blood.
• Anaplastic cancer is a rare type of thyroid cancer. It often spreads quickly into the neck and to other parts of the body, and is very hard to treat.

What You Need To Know

• Metastatic brain cancer is caused by cancer cells spreading to the brain from a different part of the body.
• The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin , colon, kidney and thyroid gland.
• Metastatic brain tumors are five times more common than primary brain tumors .
• Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.

Solitary Bone And Brain Metastasis In A Patient With Papillary Thyroid Carcinoma Mimicking Cavernous Angioma

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

2Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Korea

3Department of Pathology, Keimyung University School of Medicine, Daegu, Korea

Keywords: Brain Neoplasm metastasis Thyroid neoplasm

To the Editor,

What Is The Follow

Periodic follow-up examinations are essential for all patients with thyroid cancer, because the thyroid cancer can returnsometimes several years after successful initial treatment. These follow-up visits include a careful history and physical examination, with particular attention to the neck area. Neck ultrasound is an important tool to view the neck and look for nodules, lumps or cancerous lymph nodes that might indicate the cancer has returned. Blood tests are also important for thyroid cancer patients. Most patients who have had a thyroidectomy for cancer require thyroid hormone replacement with levothyroxine once the thyroid is removed . The dose of levothyroxine prescribed by your doctor will in part be determined by the initial extent of your thyroid cancer. More advanced cancers usually require higher doses of levothyroxine to suppress TSH . In cases of minimal or very low risk thyroid cancer, it is typically recommended to keep TSH in the normal range. The TSH level is a good indicator of whether the levothyroxine dose is correct and should be followed periodically by your doctor.

In addition to routine blood tests, your doctor may want to check a whole-body iodine scan to determine if any thyroid cancer cells remain. These scans are only done for high risk patients and have been largely replaced by routine neck ultrasound and thyroglobulin measurements that are more accurate to detect cancer recurrence, especially when done together.

Can Thyroid Cancer Spread To The Brain

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