Hurthle Cell Cancer of the Thyroid

There are several types of cancer that can affect the thyroid gland. This month I’m going to talk about Hurthle (HEERTH-hul) cell cancer. It is a rare cancer that is also called Hurthle cell carcinoma or oxyphilic cell carcinoma. Hurthle cell cancer can be more aggressive than other types of thyroid cancer. Surgery to remove the thyroid gland is the most common treatment.

Symptoms

While Hurthle cell cancer doesn't always cause symptoms, it is sometimes detected during a physical examination, or an imaging test done for some other reason.

Signs and symptoms of Hurthle cell cancer may include:

• A lump in your neck, just below your Adam's apple
• Pain in your neck or throat
• Hoarseness or other changes in your voice
• Shortness of breath
• Swallowing difficulty

These signs and symptoms don't necessarily mean you have Hurthle cell cancer. They may be indications of other medical conditions -- such as inflammation of the thyroid gland or a noncancerous enlargement of the thyroid (goiter).

The best thing to do at this time would be to make an appointment with us at Palmetto Endocrinology so we can address any signs or symptoms that worry you.

Causes

It's not clear what causes Hurthle cell cancer.

Doctors know that cancer begins when a cell develops errors in its DNA -- the genetic material that contains instructions for biochemical processes in your body. When DNA is altered or damaged, these genes may not function properly, causing cells to grow out of control and eventually form a mass (tumor) of cancerous (malignant) cells.

Risk factors

Factors that increase the risk of developing thyroid cancer include:

• Being female
• Being older
• Having a history of radiation treatments to the head and neck

Complications

Some possible complications of Hurthle cell cancer include:

• Problems with swallowing and breathing. They can occur if the tumor grows and presses on the food tube (esophagus) and windpipe (trachea).
• Spread of the cancer. Hurthle cell cancer can spread or metastasize to other tissues and organs, making treatment and recovery more difficult.

Diagnosis

Tests and procedures used to diagnose Hurthle cell cancer include:

• Physical exam. Your neck will be examined, checking the size of your thyroid and seeing whether your lymph nodes are swollen.
• Blood tests. Blood tests may reveal abnormalities in your thyroid function that give us more information about your condition.
• Imaging tests. Imaging tests, including ultrasound and CT, can help us determine whether an abnormal growth is present in the thyroid.
• Removing a sample of thyroid tissue for testing (biopsy). This is a procedure I can do in the office. During a thyroid biopsy, a fine needle is passed through the skin of your neck guided by ultrasound images. The needle is attached to a syringe, which withdraws a sample of thyroid tissue. The sample is analyzed in a laboratory for signs of cancer.

Treatment

Treatment for Hurthle cell cancer usually requires surgery to remove the thyroid. Radiation therapy and chemotherapy may be options.

Surgery

Total or near-total removal of the thyroid (thyroidectomy) is the most common treatment for Hurthle cell cancer. During a thyroidectomy, the surgeon removes all or nearly all of the thyroid gland and leaves tiny edges of thyroid tissue near small adjacent glands (parathyroid glands) to lessen the chance of injuring them. The parathyroid glands regulate your body's calcium level.

Surrounding lymph nodes may be removed if there's suspicion that the cancer has spread to them.

After surgery, your doctor will prescribe the hormones to replace the hormones produced by your thyroid. You'll need to take these hormones for the rest of your life.

Radioactive iodine therapy

Radioactive iodine therapy involves swallowing a capsule that contains a radioactive liquid. Radioactive iodine therapy may be recommended after surgery because it can help destroy any remaining thyroid tissue, which can contain traces of cancer. Radioactive iodine therapy may also be used if Hurthle cell cancer has spread to other parts of the body.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. During radiation therapy, you're positioned on a table and a machine moves around you, delivering the radiation to specific points on your body. Radiation therapy may be an option if cancer cells remain after surgery and radioactive iodine treatment or if Hurthle cell cancer spreads.

Targeted drug therapy

Targeted drug treatments use medications that attack specific abnormalities within cancer cells. Targeted therapy may be an option if your Hurthle cell cancer returns after other treatments or if it spreads to distant parts of your body.

Targeted drug therapy is an active area of cancer research. Doctors are studying many new targeted therapy drugs for use in people with thyroid cancer.

Coping and support

A diagnosis of Hurthle cell cancer can be challenging and frightening. With time you'll find strategies to help you manage the stress and anxiety of a cancer diagnosis. Until then, here are some ideas to help you cope:

• Find someone to talk with. You may feel comfortable discussing your feelings with a friend or family member, or you might prefer meeting with a formal support group. Support groups for the families of cancer survivors also are available.
• Let people help. Cancer treatments can be exhausting. Let friends and family know what would be most useful for you.
• Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But choose goals that you can reach.
• Take time for yourself. Eating well, relaxing and getting enough rest may help combat the stress and fatigue of cancer

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.