Surgery is the primary treatment for parathyroid cancer. Surgery is used to:
It is important to manage hypercalcemia (increased blood calcium level) before surgery. Hypercalcemia is treated with intravenous fluids together with medications to increase calcium and water loss from the kidneys.
Before or during surgery, it is often difficult to tell how many of the 4 parathyroid glands are affected. Parathyroid tumours can be benign (non-cancerous) hyperplastic nodules or adenomas. Much more rarely, they can be malignant lesions known as parathyroid carcinomas. The type of surgery done depends mainly whether the doctor believes there is more than one tumour. It will also depend on whether the doctor suspects the tumour is benign or malignant based on:
Side effects of surgery depend on the type of surgical procedure.
En bloc resection is the preferred treatment for parathyroid cancer. Recognizing that the tumour is cancerous before or during surgery allows the surgeon to choose an en bloc resection. This surgery reduces the risk of local recurrence better than a parathyroidectomy (removal of only the parathyroid gland).
Surgical re-excision is the first choice for treatment of a local neck recurrence because it can provide long-term control of the disease.
Lymphadenectomy (removal of lymph nodes) is only done if the lymph nodes in the neck are enlarged or firm, which suggests the presence of disease. Lymphadenectomy is not a standard part of surgery because parathyroid cancer is slow growing and has low rate of spread to the lymph nodes. Removal of lymph nodes in the neck is called a cervical lymphadenectomy or cervical lymph node dissection.
Parathyroid cancer is a slow-growing cancer, so surgery to remove local metastases from the neck or lymph nodes, or distant metastases from the lungs, bone or liver, can provide good control of the disease. Whenever possible, surgery to remove metastatic tumours or as much of the tumour as possible is done to control hypercalcemia caused by the tumours.
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