Role of Surgery in Diagnosing Thyroid Cancer

Transcript: Marcia S. Brose, MD, PhD: Once a patient has been diagnosed with thyroid cancer, often by a fine needle aspirate, which is the first method of detection for thyroid cancer, they’re referred to a surgeon. At that point, a surgical intervention is usually planned. At that surgical intervention, the thyroid is usually removed. Most of the time, it is removed in its entirety. Sometimes, very rarely, half of the thyroid is removed. If there is any possibility that there are lymph nodes involved, they will also be removed at the same time. That’s usually the case when, on ultrasound, they look like they have been affected. Or they may have been biopsied previously. A patient will have both their thyroid as well the lateral lymph nodes removed at that time. That provides pathologic information and confirmation of the full diagnosis of thyroid cancer.

Sometimes patients will actually be diagnosed with a thyroid nodule but it doesn’t look like it needs to be removed at that time. And so that nodule may be followed on ultrasound for a period of time. At that point, the physician will look to see how big it is getting, how fast it is growing, and where it is located. Is it staying inside of the thyroid or does it look like it’s starting to approach the capsule and might be getting in trouble there? All of these things would be worrisome signs that this is, indeed, not a benign thyroid nodule but is an invasive cancer. These would all be signs that would then lead to a surgical intervention. A patient would have surgery to fully evaluate what is actually going on with that thyroid nodule.

Johannes (Jan) Smit, MD, PhD: The purpose of the diagnostic workup is to determine whether the patient does or does not have thyroid cancer. If there is a very high suspicion for thyroid cancer, surgery will follow. The surgery will provide you with the answer of whether or not the nodule is malignant. The purpose of the diagnosis is not to determine the risk of the thyroid cancer patient dying or not dying from thyroid cancer. This is done after initial surgery. Having said that, when we have a very aggressive tumor that is large and grows fast, we are, of course, afraid that the patient might have metastases. In that case, we will do a more extensive diagnostic workup, including CT scans of the lungs and neck. We will also probably do more extensive imaging with scans like FDG-PET and things like that.

If we have a patient with metastases or a very aggressive local tumor, we know that the prognosis will be worse. But still, patients like this can be treated well with surgery and radioactive iodine if they have differentiated thyroid cancer. We can cure patients, for instance, with pulmonary metastases. At this stage of diagnosis, it’s very hard to have an idea about the prognosis of a patient.

Transcript Edited for Clarity