Parathyroid cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a neuroendocrine tumoura tissue mass that forms from groups of unhealthy cells that develops in the parathyroid glands. The parathyroid glands are four, pea-shaped organs found in the neck near the thyroid gland. These glands produce the parathyroid hormonea chemical substance produced by glands in the endocrine system that regulates various functions in the body (PTH or parathormone), which is responsible for the storage and regulation of calcium in the body.
Neuroendocrine cancers are a complex group of tumours that develop in the neuroendocrine system, which is responsible for regulating important bodily functions such as heart rate, bloodthe red bodily fluid that transports oxygen and other nutrients around the body pressure and metabolism. They most commonly develop in the gastro-intestinal tract, pancreasa long, flat organ that sits between the stomach and the spine that plays a key role in digestion and blood sugar regulation and the lungs; however, they can develop anywhere in the body. These tumours develop from neuroendocrine cellsthe basic structural and functional unit of all living things, which are responsible for receiving signals from the nervous system and producing hormones and peptides (small proteins) in response.
Parathyroid cancers are found equally in men and women, and is most commonly found in people between the ages of 40-60. However, they can develop at any age.
Treatment
If a parathyroid cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for parathyroid cancers may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- En bloc resectionremoval of the entire tumour in a single piece with a healthy margin of tissue surrounding it.
- Lymphadenectomysurgical removal of lymph node(s).
- Tumour debulkingremoval of as much of the tumour as possible when complete tumour removal is not possible, also known as cytoreduction.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of parathyroid cancer remains unknown, certain inherited conditions may increase your riskthe possibility that something bad will happen of developing the disease:
- Familial isolated hyperparathyroidism (FIHP).
- Multiple endocrine neoplasia type 1 (MEN 1) syndrome.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Some of the information regarding risk factors was obtained from the Parathyroid Cancer Treatment (PDQ) page published by the National Cancer Institute.
Symptoms
Many symptoms of parathyroid cancer develop as the result of hypercalcemia (excess calcium production caused by a tumour pressing against the gland). Hormonal symptoms of parathyroid cancer may include:
- General weakness.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Nauseato feel sick or likely to vomit and/or vomiting.
- Unexplained weight loss/loss of appetite.
- Unusually increased thirst.
- Polyuriafrequent urination.
- Constipationa condition where a person has difficulty passing faeces/stools.
- Difficulties concentrating.
Other symptoms of parathyroid cancer may include:
- Persistent abdominal, side and/or back pain.
- Bone pain.
- Easily broken bones.
- Lump in the neck.
- Changes in the voice, such as hoarseness.
- Difficulties swallowing.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Some of the information regarding symptoms was obtained from the Parathyroid Cancer Treatment (PDQ) page published by the National Cancer Institute.
Diagnosis
If your doctor suspects you have thyroid cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- MIBG scana type of medical imaging that uses radioactive tracers to detect overactive parathyroid glands or neuroendocrine tumours; also known as a MIBI or sestamibi scan.
- SPECT scan (single photon emission computed tomography)a type of CT scan that uses a radioactive tracer and computer technology to create 3D images of areas inside the body.
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Blood teststesting done to measure the levels of certain substances in the blood.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
