indiacancer.org - Parathyroid Cancer

Parathyroid Cancer

		What are the Parathyroid glands?
		What is Parathyroid Cancer?
		How does Parathyroid Cancer present?
		How is Parathyroid Cancer detected?
		What is staging and grading?
		How is Parathyroid Cancer treated?
		What are the side effects of treatment for parathyroid cancer?
		What is the importance of follow up?

What are the Parathyroid glands?

The parathyroid are a set of four small glands located at the base of the neck, close to the thyroid gland, either in its substance, or along its posterior surface, or very close to it.

The parathyroid are involved in maintaining calcium metabolism, and they do this with the help of a hormone they produce called parathyroid hormone (PTH).

The four Parathyroid Glands

	What is Parathyroid Cancer?

Although problems in parathyroid function are not uncommon, a cancer of the parathyroid is more of a rarity.

The cancer is an adenocarcinoma, which is a form of cancer arising from glandular tissue.

Parathyroid Cancer may spread to other remote tissues like the bones, when it is known as metastatic Parathyroid Cancer. The cancerous cells will still be of the parathyroid variety, even though they are lodged in an alien tissue.

	How does Parathyroid Cancer present?

	The usual way Parathyroid Cancer presents (otherwise known as symptoms of Parathyroid Cancer) is as follows: The problems are usually caused by excessive production of PTH by the cancer. This results in taking up of calcium from the bones, thus weakening them. There is excessive calcium found circulating in the blood, and this may cause kidney problems as well. The presentation is as follows:
		Pain in the bones.
		A swelling in the center of the neck, anteriorly.
		Fractures without , or on the slightest of traumas (pathological fractures).
		Renal failure (failure of the kidneys to function).
		Weak muscles.
		Pain in the back.
		Difficulty in speaking.
	All these problems maybe caused by hyperparathyroidism, which is a non malignant condition in which excessive PTH is produced. The doctor must first rule out hyperparathyroidism, which happens to be more common, before coming to a diagnosis of Parathyroid Cancer.

	How is Parathyroid Cancer detected?

	There are several steps to establishing the presence of a Parathyroid Cancer:
		The doctor takes a history of the patient's symptoms.
		The doctor examines the patient physically, and looks for swellings in the neck.
		A series of investigations are performed. Those specific for Parathyroid Cancer include:
		Serum PTH levels. USG neck, to look for the lesion and identify its position. In an ultrasound or USG, after applying a special gel on the neck, a small device ( a microphone which emits sound waves is passed over the neck surface). The echoes (reflections of the sound waves) are converted into a picture by the computer. CT scan of the neck, for better delineation of the lesion. A CT scan, consists of a series of detailed pictures with very thin slices taken radiologically through the body and which are decoded with the help of a computer. For a hyperfunctioning parathyroid, a Thallium - Technetium subtraction scan, a very special imaging test for the parathyroid may also be asked for.

	What are staging and grading?

These are terms with which you must become familiar, if you are dealing with any form of cancer.

When we stage a cancer, we try to establish carefully degree of spread of the cancer and if indeed there is spread, to what extent and involving which organs.

The grading of a cancer is a microscopic issue, in which the pathologist lets you know how aggressive this particular type of cancer is ; well differentiated means less aggressive, moderately differentiated intermediately aggressive and poorly differentiated more aggressive.

Both grading and staging help your clinician to establish the prognosis or how serious your disease is and what is going to be the likely outcome.

Staging may require additional imaging tests such as CT Scan, MRI, Sonography of the abdomen, IVU, Bone scan or chest X-ray.

	How is Parathyroid cancer treated?

	A lot depends on the patient's constitution, the grade of his disease and its staging. Patients are usually treated by a team of specialists which utilizes a multipronged approach. This includes an endocrinologist, an oncosurgeon and a radiotherapist. The plan of treatment is tailored to fit a patient's requirements. If necessary, chemotherapy may become an add on. Treatment strategies. The bastion of Parathyroid Cancer treatment is surgery. Along with the parathyroids, a part or the whole of the thyroid may have to be removed. If there is spread to adjacent lymph nodes, some form of lymph node dissection in the neck may also have to be performed. Surgery for removal of the parathyroids is known as parathyroidectomy. Surgery for removal of the thyroid is known as thyroidectomy. The alternative local therapy to surgery is radiation therapy. This involves the use of high energy, penetrative rays to destroy cancer cells. It affects cancer cells only in the zone treated. Radiation therapy is also employed for palliation i.e. control of symptoms alone in an advanced cancer. Radiation therapy can also be used in adjunct to surgery or chemotherapy, either before or after. Teletherapy or external radiation is given via a machine remote from the body while brachytherapy or internal radiation is given by implanting a radioactive source within the involved tissues. Patients may or may not require both modalities of radiation. Radiotherapy, after initial planning, usually takes just 5 to 10 minutes per day, 5 days a week for about 6 weeks. This time period is flexible depending upon the modality of radiation used. Besides local therapy, the best attempt to control cancer cells circulating in the body and lodged at places other than the parathyroids is by using systemic therapy (therapy which affects the entire systems of the body) which is in the form of injections or oral drugs. This form of treatment is called chemotherapy. This form of treatment is given in a cyclical manner (each set of drugs is repeated usually after every 3-4 weeks). Chemotherapy can also be used in combination with surgery, radiotherapy or both, either before or after. For localized Parathyroid Cancer, one of the following options may be entertained. Parathyroidectomy, without or without partial or total thyroidectomy, with or without lymph node dissection in the neck.Surgery, followed by radiation.Radiation alone (experimental).
	For metastatic Parathyroid Cancer, one of the following options may be entertained:
		Parathyroidectomy, without or without partial or total thyroidectomy, with or without lymph node dissection in the neck.
		Surgery for palliation, that is symptomatic relief, by removing as much of the parathyroid gland as is possible, in order to bring down the levels of PTH.
		Medical treatment to reduce the levels of calcium in the body.
		Surgery, followed by radiation.
		Radiation alone (experimental).
		Chemotherapy.

	What are the side effects of Parathyroid Cancer treatment?

	As far as surgery is concerned, the main problems are those of calcium depletion. If all the parathyroids have been removed, calcium supplements may have to be given lifelong. PTH replacement is available very rarely in our country. If the thyroid gland has been removed as well, the patient will require lifelong supplementation of thyroid hormones.. Unfortunately treatment for cancer does cause damage to the healthy tissues. Please ask the clinician about any possible side effects before any form of treatment commences. The effects of radiation depend upon the dose of radiation, the size of the area radiated, and the number and size of each fraction. The commonest side effect is extreme fatigue. Although bed rest is good, most radiotherapists advise the patient to be as mobile as possible. Another common problem is that of radiation dermatitis in which the skin covering the radiated area becomes red, dry, itchy, and may show signs of scaling off. This will slowly settle down after radiation ceases, but there may be a permanent 'bronzing' of the skin. It is important to note here that this skin problem is associated only with teletherapy or external radiation therapy. Radiation also may cause nausea and vomiting, diarrhea, urinary discomfort. There may also be a fall in the white blood cells, which are needed by humans to fight infection. Usually the radiotherapist can suggest the drugs and diet necessary to alleviate such problems. The various drugs in chemotherapy cause a varied spectrum of side effects. The severity and variability of these symptoms are very individualistic, changing from patient to patient. Some of the common side effects are:
		Skin rashes.
		Loss of hair.
		Diarrhea.
		Vomiting.
		Tingling and numbness in the fingers and toes.
		Hearing loss.
	Most are temporary and recede after therapy is over. Hair growth gradually starts after cessation of chemotherapy. The medical oncologist will usually be able to reduce the severity and spectrum of these side effects. The psychology of the patient is very important during therapy. Better psychologically prepared the patient is, better are his chances of having decreased side effects. The patient should drink large quantities of water while the therapy is in progress, and preferably avoid uncooked or raw food. Water should be filtered or boiled. Any relative or person who has any sort of infection such as common cold should be asked to desist from coming close to the patient.

	What is the importance of follow up?

The importance of followup cannot be overemphasized. It is a fatal fallacy to assume on the patient's part that once the primary or the first phase of treatment is over, then he or she is cured. It must be stressed here that cancer has a notorious proclivity of coming back again and again. The only way to fight this is to pick up any problem when it is still early, so that it can be nipped in the bud. And the only way to do this is to follow up when the doctor calls you for the next visit. Each such visit will include a detailed history, a physical examination (including an internal i.e. a rectal or vaginal examination ), a chest x-ray, an ultrasonography or a CT scan, and various other blood studies as indicated.