Our knowledge of cancer is always expanding. Researchers and healthcare professionals take the knowledge gained from research studies and use it to develop better practices that will help prevent, detect and treat thyroid cancer, as well as improve the quality of life of people with thyroid cancer.
The following information is a selection of research showing promise for thyroid cancer.
Early detection
Researchers are looking for better ways to find thyroid cancer early in people who have a higher than average risk of developing the disease.
Noteworthy research includes:
- People with a family history of thyroid cancer are at higher risk of developing the disease. A study found that ultrasound may be helpful in finding papillary thyroid cancer early in siblings of people with the disease. Ultrasound can often find thyroid nodules that cannot be felt (are not palpable). If ultrasound found a nodule 5 mm or larger, the participants in the study had a fine needle aspiration (FNA) biopsy, which helped confirm whether the nodule was non-cancerous (benign) or cancerous (malignant) (Thyroid, PMID* 22545722).
Diagnosis
A key area of research activity involves developing better ways to diagnose and stage thyroid cancer.
Noteworthy research includes:
- Researchers are studying sentinel lymph node biopsy (SLNB) in people with thyroid cancer as an alternative to a neck dissection. The sentinel lymph node is the first lymph node or group of lymph nodes that a cancer cell encounters when it spreads from the primary tumour. Doctors identify sentinel lymph nodes by injecting a radioisotope or blue dye. If cancer is found in the sentinel lymph node, the surgeon will likely do a neck dissection. So far it is unclear whether or not sentinel lymph node biopsy will be a useful tool for diagnosing thyroid cancer that has spread to the lymph nodes. Some studies have found that it is not always accurate. (World Journal of Surgery, PMID 21993615; BMC Cancer, PMID 21888655; Expert Review of Anticancer Therapy, PMID 20836678). Chinese researchers found that using carbon nanoparticles instead of blue dye was a better way to identify the sentinel lymph node. This may help to improve the accuracy of the technique in people with thyroid cancer, but more research is still needed (European Journal of Surgical Oncology, PMID 22521260). Currently, there is no direct evidence that SLNB is associated with long-term clinical and survival benefits in people with thyroid cancer. Further study is needed.
- A mutation in the BRAF gene can cause cancer cells to grow and spread. A certain BRAF mutation, BRAF V600E, is found in people with thyroid cancer. Researchers have found that testing cells removed by FNA biopsy for the V600E mutation in the BRAF gene at the time of ultrasound is helpful in distinguishing benign and malignant tumours in people with thyroid nodules (Journal of Clinical Endocrinology & Metabolism, PMID 22535974; Annales d’Endocrinologie, PMID 22503804; Clinical Endocrinology, PMID 21707687; Annals of Surgical Oncology, PMID 20945104).
- MicroRNA is short, single-stranded RNA. Doctors believe it regulates the expression of genes. MicroRNA is more commonly changed in cancer cells than in normal cells. Scientists have found that testing for microRNA in blood and tissue samples may be helpful in diagnosing thyroid cancer (Journal of Clinical Endocrinology & Metabolism, PMID 22472564; Cancer, PMID 22006248).
- Researchers are investigating gene expression profiling and DNA microarray studies as tools to diagnose cancer. Microarrays allow scientists to quickly and accurately analyze many genes at one time using special equipment. Gene expression profiling may help doctors distinguish between benign and malignant thyroid tumours, especially in cases where a clear diagnosis cannot be made (Thyroid, PMID 22280184).
Prognostic factors
Prognostic factors that may help determine the outcome of the disease are being studied in thyroid cancer. They can be used to predict the chances of recovery or of cancer coming back. Doctors may also use prognostic factors to help them make treatment recommendations.
Noteworthy research includes:
- People with papillary thyroid cancer whose tumours are positive for the BRAF gene mutation are more likely to have aggressive tumours and have a higher risk of recurrence than people whose tumours do not have the mutation. Testing the tumour for this gene mutation may help doctors confirm the diagnosis of thyroid cancer and plan treatment and follow-up (Annales d’Endocrinologie, PMID 22503804; Acta Cytologica, PMID 22156467; Cancer, PMID 21882184).
- MicroRNA may also be helpful in predicting the aggressiveness of papillary thyroid cancer. Researchers have found that certain types of microRNA are associated with a less favourable prognosis (Annals of Surgical Oncology, PMID 21537871).
Treatment
Researchers are looking for new ways to improve the treatment of thyroid cancer. Advances in cancer treatment and new ways to manage the side effects related to treatment have improved the outlook and quality of life for many people with cancer.
Noteworthy research includes:
- Radioactive iodine (I-131)therapy is used for well-differentiated thyroid cancers to destroy cancer cells left behind after surgery and reduce the risk of cancer recurring. However, some doctors question the need for this treatment in people who have a low risk of recurrence. Researchers are studying how the use of neck ultrasound and thyroglobulin blood levels after thyroid surgery may help to determine which people will benefit from I-131 (Thyroid, PMID 20954820). Researchers are also studying lower doses of I-131 to see if it is as effective as higher dose I-131 in treating low-risk thyroid cancer (cancer that is unlikely to spread). Two large European studies found that low-dose I-131 given with an artificial form of thyroid-stimulating hormone (thyrotropin alfa) was just as effective as high-dose I-131 at destroying any remaining normal thyroid tissue after surgery. Low-dose I-131 may also be associated with a lower rate of short-term complications (New England Journal of Medicine, PMID 22551128, PMID 22551127).
- Studies ofradioguided surgery are examining the use of intraoperative positron emission tomography (PET) probes or gamma probes. The probes are used after the injection of a radionuclide to help find hidden areas of cancer or remaining thyroid tissue. These methods appear to help ensure complete removal of the thyroid. This may reduce the number of additional surgeries and will reduce the complications related to persistent disease (Surgery, PMID 20965536; Thyroid, PMID 20950253). Researchers are also studying radioguided surgery as a way to treat recurrent thyroid cancer (Otolaryngology – Head and Neck Surgery, PMID 21952355).
- Researchers are investigating targeted therapies for their use in stopping the growth of cancer cells in people with advanced thyroid cancer.
- Sorafenib (Nexavar) is a tyrosine kinase inhibitor. It targets the tyrosine kinase that is formed from the mutated RET and BRAF genes. Researchers are studying sorafenib in people with advanced and metastatic thyroid cancer (Endocrine-Related Cancer, PMID 22285864; BMC Cancer, PMID 21834960).
- Preliminary results from a phase III trial found that vandetanib (Caprelsa) helps to prolong survival in people with metastatic medullary thyroid cancer whose disease is thought to be linked to a mutated RET gene (Journal of Clinical Oncology, PMID 22025146).
- Researchers are also studying other tyrosine kinase inhibitors (TKIs) for the treatment of advanced thyroid cancer, including sunitinib (Sutent) and axitinib (AG-013736) (Annales d’Endocrinologie, PMID 22503804; Nature Reviews Endocrinology, PMID 21862995; Head & Neck, PMID 21544895; ASCO**, Abstract e16024; Modern Pathology, PMID 21455200; Endocrine, PMID 20963554; Targeted Oncology, PMID 19876699).
- Researchers continue to study chemotherapy regimens to try to find additional treatment options for advanced thyroid cancer that is not responding to I-131 treatment. Current studies are examining the effectiveness of gemcitabine (Gemzar) and oxaliplatin (Eloxatin). Early results are promising and warrant further study (Medical Oncology, PMID 21947747).
Supportive care
Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects.
Noteworthy research includes:
- Dental and oral health can be affected when people with thyroid cancer receive high-dose radioactive iodine therapy. Certain studies are focusing on the effects of I-131 on the salivary glands and how to reduce or prevent those effects (Oral Disease, PMID 21029259).
- Thyroid cancer survivors may be at an increased risk of developing second primary cancers. The increased risk may be due to the type of cancer treatment given or the person’s genetic makeup (Surgery, PMID 22341041; Annals of Surgical Oncology, PMID 21573833).
*PMID is the National Library of Medicine PubMed abstract identity number.
**ASCO is the American Society of Clinical Oncology.
Find out more about the research process.