Thyroid cancer

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Research in thyroid cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat thyroid cancer. They are also looking for ways to improve the quality of life of people with thyroid cancer.

The following is a selection of research showing promise for thyroid cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage thyroid cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Biomarkers

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A change in a biomarker can mean that a person has a certain type of cancer. If your doctor thinks you might have thyroid cancer, biomarker tests that look for these changes may help confirm the diagnosis. Biomarkers can also help doctors predict if the cancer will come back, the prognosis or the response to treatment in people with thyroid cancer.

Researchers are looking at the following biomarkers to see if they can help doctors diagnose, predict a prognosis for and find out which treatments will benefit a person with thyroid cancer.

BRAF gene mutations can cause cancer cells to grow and spread. Researchers found that the BRAF V600E gene mutation can appear in thyroid cancer cells. The presence of this gene mutation has limited value as a single screening or diagnostic test for thyroid cancer (Human Pathology, PMID 26232865; European Journal of Surgical Oncology, PMID 27923591). But papillary carcinoma that has the BRAF V600E gene mutation may be more likely to grow and spread quickly. Papillary carcinoma with this gene mutation also has a higher risk of coming back, or recurring, than tumours that don’t have the mutation. Knowing whether or not a tumour has the BRAF V600E gene mutation can also help doctors plan treatment and follow-up. It is important to note that several other studies show that the BRAF V600E gene mutation may not be helpful in determining prognosis, so more research is clearly needed (Diagnostic Cytopathology, PMID 26152656; Thyroid, PMID 26671072; Cellular Physiology and Biochemistry, PMID 26871894; PLoS One, PMID 27936049; Chinese Journal of Oncology, PMID 28535653).

Gene-based tests find differences between normal genes and genes that are changed (mutated) in cancer cells. Microarray analysis is a type of gene-based test that allows researchers to look at many genes together to see which ones are turned on and which ones are turned off. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. Researchers hope that developing more gene-based tests will help doctors identify the best treatments for certain cancers, including thyroid cancer. Gene-based tests will also help doctors tailor more treatments to each person’s cancer based on their unique genetic makeup (International Journal of Molecular Sciences, PMID 28574441).

MicroRNA is short, single-stranded RNA. Doctors believe it controls which genes are turned on or off. 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 help doctors diagnose thyroid cancer and find recurrence (Molecular and Cellular Endocrinology, PMID 25258301; Clinical Endocrinology, PMID 25510178; Endocrine, PMID 27473101; Oncology Letters, PMID 28599426; International Journal of Molecular Sciences, PMID 28294980).

Sentinel lymph node biopsy (SLNB)

Researchers are studying SLNB as an alternative to a neck dissection for people with thyroid cancer. The sentinel lymph node is the first lymph node in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes. If an SLNB biopsy shows that there isn’t cancer in the sentinel lymph node, the surgeon doesn’t need to do a neck dissection. If cancer is found in a sentinel lymph node, the surgeon will likely do a neck dissection. So far it is unclear whether SLNB can improve survival for people with thyroid cancer (Surgery, PMID 25633731; Endocrinología, Diabetes y Nutricion, PMID 28895542).

Researchers have also found that using carbon nanoparticles can help identify the sentinel lymph node and lymph nodes that have cancer in them during thyroid cancer surgery. This may help lower the number of lymph nodes removed and protect the parathyroid glands during surgery to treat thyroid cancer (Otolaryngology – Head and Neck Surgery, PMID 25897006; OncoTargets and Therapy, PMID 28280359; International Journal of Surgery, PMID 27989915).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for thyroid cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for thyroid cancer.

Active surveillance

Active surveillance means using a series of tests on a regular schedule to follow the progression of a disease when there aren’t any signs or symptoms. Studies show that active surveillance may be a treatment option when there is very little chance that micropapillary carcinoma of the thyroid will grow or spread. (Thyroid, PMID 26426735; World Journal of Surgery, PMID 26744340; European Journal of Surgical Oncology, PMID 28343733).

Surgery

Researchers are studying the following surgery techniques as treatment options for thyroid cancer. Both of these techniques may leave a smaller scar than conventional open surgery, or no scar at all.

Endoscopic surgery allows the surgeon to remove the thyroid by inserting long, thin instruments through small incisions, or cuts, in the neck, chest or armpit instead of making one large incision in the neck (International Journal of Endocrinology, PMID 26379706; Journal of Craniofacial Surgery, PMID 25692899; Journal of Cancer Research and Therapeutics, PMID 27461608).

Robotic surgery uses a computer to move instruments connected to robotic arms. The operation is done through several small incisions. Doctors are using robotic surgery to remove the thyroid through an incision in the armpit so there is no incision in the neck (Chinese Medical Journal, PMID 27625085; Surgical Endoscopy, PMID 28337546, PMID 27422244, PMID 27317039).

Find out more about research in cancer surgery.

Radiation therapy

Radioactive iodine (I-131) therapy is used to treat papillary and other thyroid carcinomas that take up iodine. It is given to destroy cancer cells left behind after surgery and to lower the risk that cancer will come back, or recur. Some doctors question the need for this treatment in people who have a low risk of recurrence. Researchers found that low-dose I-131 was just as effective as high-dose I-131 at destroying any remaining thyroid tissue after surgery. They are still trying to find out if low-dose I-131 is as effective as high-dose I-131 in preventing thyroid cancer recurrence (Nuclear Medicine Communications, PMID 25793928, PMID 28362717; European Thyroid Journal, PMID 28868259).

Other studies are also looking at not giving I-131 after surgery to people who have very low thyroglobulin levels. Results so far show that these people have a very low risk for cancer recurrence because they are less likely to have thyroid cancer cells remaining after the tumour is surgically removed (Endocrine-Related Cancer, PMID 26503963).

Find out more about research in radiation therapy.

Targeted therapy

Researchers are studying targeted therapy drugs to see if they can stop the growth of cancer cells in people with progressive or advanced thyroid cancer. They are also looking at how targeted therapies can help treat thyroid cancer that doesn’t respond to radioactive iodine (I-131) therapy (called radioactive iodine-refractory thyroid cancer).

Cabozantinib (Cometriq) is a tyrosine kinase inhibitor that is showing promise in treating metastatic medullary carcinoma. Studies found that people who received this drug had longer rates of progression-free survival compared to those given a placebo. A phase 3 trial found that it was most effective in people with a RET M918T or RAS mutation (Cancer, PMID 27525386; Expert Review of Clinical Pharmacology, PMID 26536165; Bulletin du cancer, PMID 28477875).

Lenvatinib (Lenvima) improves progression-free survival in people with radioactive iodine-refractory thyroid cancer during phase 2 and 3 clinical trials. In 2015, the US Food and Drug Administration approved the use of lenvatinib for thyroid cancer in the United States and recently in Canada (Future Oncology, PMID 26075440; New England Journal of Medicine, PMID 25671254; Cancer, PMID 25913680).

Selumetinib (AZD6244) seems to help thyroid cancer cells take up I-131. Research continues to look at the effectiveness of selumetinib, especially when used along with radioactive iodine (I-131) therapy (ClinicalTrials.gov, NCT01843062).

Find out more about research in targeted therapy.

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. The following is noteworthy research into supportive care for thyroid cancer.

A second cancer is another type of cancer that can develop in people treated for cancer. Thyroid cancer survivors who received certain types of treatment or have a certain genetic makeup may have a higher risk for developing a second cancer. Knowing more about this risk will help doctors monitor people treated for thyroid cancer so they can find and treat a second cancer as early as possible (Archives of Endocrinology and Metabolism PMID 26222230; Journal of the National Cancer Institute, PMID 26538627).

Learn more about cancer research

Researchers continue to try to find out more thyroid cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage thyroid cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for thyroid cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

 

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The molecules inside the cell that program genetic information. DNA determines the structure, function and behaviour of a cell.

ribonucleic acid (RNA)

The molecules inside the cell that help transmit the genetic information that controls many cell functions, including the type of proteins a cell makes.

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