Thyroid and Pancreas Cancer

Thyroid Cancer

• Location & Function:
  • The thyroid is a butterfly-shaped gland at the base of the neck.
  • It produces hormones (T3, T4) that regulate metabolism, heart rate, and many other bodily functions.
• Incidence & Risk Factors:
  • Thyroid cancer is one of the most rapidly increasing cancers in many countries, partially due to improved detection methods.
  • Risk factors include radiation exposure (especially in childhood), a family history of thyroid disease or inherited genetic syndromes (e.g., Multiple Endocrine Neoplasia), and certain lifestyle/environmental factors.
• Types of Thyroid Cancer:
  • Papillary Thyroid Cancer (PTC): The most common type, generally slow-growing, and often very treatable.
  • Follicular Thyroid Cancer (FTC): Less common than papillary; also typically has a good prognosis but can spread via the bloodstream.
  • Medullary Thyroid Cancer (MTC): Originates from parafollicular C cells (which produce calcitonin). Can be sporadic or part of a hereditary syndrome (e.g., MEN 2).
  • Anaplastic Thyroid Cancer (ATC): A rare, aggressive subtype with a poorer prognosis.

Disease Progression

• Early Stages:
  • Many patients have few or no symptoms early on, though a nodule may be detected via ultrasound or physical exam.
  • Papillary and follicular cancers grow slowly and can be asymptomatic for years.
• Advanced Local Disease:
  • As thyroid cancer grows, patients may notice a lump in the neck, difficulty swallowing, hoarseness, or a persistent cough.
  • Some cancers (especially anaplastic) can rapidly invade local structures in the neck.
• Metastasis:
  • Papillary and Follicular: Often spread to nearby lymph nodes in the neck, but can also metastasize to lungs or bones.
  • Medullary: Can spread to lymph nodes, liver, lungs, or bones.
  • Anaplastic: Aggressive and can quickly metastasize throughout the body.

Screening*

  General Population

• Current Guidelines:
  • There is no formal, routine thyroid cancer screening recommended for the general population by most major health organizations. This is largely because thyroid cancers, especially small papillary thyroid cancers, are often slow-growing and may be “overdiagnosed” if routine imaging is done in low-risk individuals.
  • Overdiagnosis can lead to unnecessary interventions (surgery, etc.) for tumors that may never cause clinical harm.

  High-Risk Individuals

• Family History & Genetic Syndromes:
  • Individuals with inherited conditions (e.g., Multiple Endocrine Neoplasia type 2 [MEN2] caused by RET gene mutations, familial adenomatous polyposis, Cowden syndrome, or a strong family history of thyroid cancer) may benefit from periodic screening.
  • Screening Method: An ultrasound of the thyroid—often annually or biennially—is generally recommended for these higher-risk groups starting at an appropriate age (e.g., childhood or adolescence in certain hereditary syndromes).
• Previous Radiation Exposure:
  • People with a history of head or neck radiation, especially in childhood, may have a higher risk of thyroid cancer and are sometimes screened with periodic ultrasound exams.
  • A physical exam checking for thyroid nodules can also be part of follow-up.

  Screening Modalities

• Physical Neck Exam:
  • Palpation for thyroid nodules or enlarged lymph nodes.
  • May detect relatively large nodules, but smaller lesions are typically found only via imaging.
• Thyroid Ultrasound:
  • The most sensitive method for detecting small nodules or structural abnormalities.
  • May be recommended for high-risk groups; it is not a routine screening tool for the general population because of the risk of overdiagnosis.
• Blood Tests:
  • TSH (Thyroid-Stimulating Hormone) level may be checked if a nodule or abnormal thyroid function is suspected.
  • Calcitonin is measured specifically in individuals at risk for medullary thyroid cancer, such as those with MEN2 syndromes.

Treatment Options

• Surgery
  • Total Thyroidectomy: Removal of the entire thyroid gland, commonly used for larger or multifocal cancers, or those with higher risk of spread.
  • Lobectomy (Hemithyroidectomy): Removal of one lobe of the thyroid, considered for smaller, low-risk papillary thyroid cancers.
  • Lymph Node Dissection: Removal of lymph nodes in the neck that may harbor metastatic disease.
• Radioactive Iodine (RAI) Therapy
  • Used primarily for differentiated thyroid cancers (papillary and follicular).
  • Targets residual thyroid tissue and microscopic disease after surgery, improving long-term outcomes.
  • Not typically used for medullary and anaplastic cancers, as these types do not take up iodine well.
• Thyroid Hormone Suppression Therapy
  • Patients often receive levothyroxine (T4) post-thyroidectomy.
  • The goal is to maintain a slightly low TSH level to reduce stimulation of any remaining thyroid cancer cells.
• External Beam Radiation Therapy
  • Used for certain advanced cases or anaplastic thyroid cancer that does not respond to surgery or RAI.
  • May help alleviate symptoms or slow progression.
• Targeted Therapy / Systemic Therapy
  • Tyrosine Kinase Inhibitors (TKIs): For advanced or metastatic thyroid cancers, especially medullary thyroid carcinoma and RAI-refractory differentiated thyroid cancer. Examples include:
    • Sorafenib and Lenvatinib for RAI-refractory papillary/follicular thyroid cancer.
    • Vandetanib and Cabozantinib for advanced medullary thyroid cancer.
  • Immunotherapy: While still under investigation, drugs like pembrolizumab (a PD-1 inhibitor) may be considered in certain refractory cases.
• Chemotherapy
  • Traditional chemotherapy is used less frequently, mainly for anaplastic thyroid cancer or as part of a multimodal approach when targeted therapies are not effective.

 

Summary

Thyroid cancer is generally treatable, particularly if detected early. Most cases (papillary and follicular) carry an excellent prognosis with a combination of surgery, radioactive iodine (when indicated), and lifelong thyroid hormone replacement. Medullary and anaplastic subtypes can be more challenging, requiring targeted therapy or multimodal treatment strategies. Ongoing developments in targeted and immunotherapies continue to improve outcomes for advanced or refractory thyroid cancers. Regular follow-up with imaging and thyroid function tests is essential for monitoring recurrence and adjusting therapy.

 

Pancreatic Cancer

• Anatomy & Function
  • The pancreas sits behind the stomach and has both exocrine functions (producing enzymes for digestion) and endocrine functions (producing hormones such as insulin).
  • About 90% of pancreatic cancers arise from the exocrine cells (most commonly adenocarcinoma).
• Epidemiology & Risk Factors
  • Pancreatic cancer is among the leading causes of cancer-related deaths worldwide, partly because it often goes undetected until advanced stages.
  • Major risk factors include:
    • Smoking (one of the strongest modifiable risk factors)
    • Chronic pancreatitis
    • Obesity and type 2 diabetes
    • Family history (hereditary syndromes, BRCA mutations)
    • Age (most cases occur in older adults)
• Symptoms
  • Early stages are often asymptomatic. When present, symptoms may include:
    • Abdominal or back pain
    • Unintended weight loss
    • Jaundice (especially if the tumor is in the head of the pancreas and blocks the bile duct)
    • Loss of appetite, nausea
    • New-onset diabetes

Disease Progression

• Local Growth
  • Tumors in the head of the pancreas often cause bile duct obstruction (leading to jaundice) earlier than tumors in the body/tail, but they can also infiltrate nearby structures like the duodenum and major blood vessels.
• Spread & Metastasis
  • Pancreatic cancer tends to spread early, commonly to local lymph nodes, the liver, and the peritoneal cavity.
  • Staging typically includes:
    • Resectable (operable)
    • Borderline resectable
    • Locally advanced (unresectable)
    • Metastatic (spread to distant organs)
• Diagnosis & Workup
  • Imaging studies (e.g., CT scan, MRI, endoscopic ultrasound).
  • Tissue biopsy (endoscopic or percutaneous) for histopathological confirmation.
  • CA 19-9 blood test can provide supportive information, though it’s not specific enough for screening.

Screening*

  General Population

• Current Guidelines:
  • There is no routine screening for pancreatic cancer in the general population. This is due to the low incidence in the general population combined with a lack of highly sensitive and cost-effective screening tests for early-stage disease.

  High-Risk Groups

  Screening for pancreatic cancer is primarily targeted toward individuals with significantly increased risk, such as:

• Familial Pancreatic Cancer (FPC):
  • Those with multiple family members affected by pancreatic cancer, especially first-degree relatives.
  • In some guidelines, if two or more first-degree relatives are affected, the individual may be considered for screening.
• Hereditary Syndromes:
  • BRCA2 or BRCA1 mutation carriers (especially if they have a strong family history of pancreatic cancer).
  • PALB2, ATM, Lynch syndrome (hereditary nonpolyposis colorectal cancer), Peutz-Jeghers syndrome, and CDKN2A (familial atypical multiple mole melanoma) are also associated with higher pancreatic cancer risks.
• Chronic Pancreatitis:
  • Individuals with a long history of chronic pancreatitis or hereditary pancreatitis (e.g., PRSS1 gene mutation) may be candidates.
• New-Onset Diabetes in Older Adults:
  • Not an official “screening” protocol, but there is research exploring whether certain profiles of new-onset diabetes, particularly in older individuals, might indicate occult pancreatic cancer and warrant imaging.

  Screening Modalities in High-Risk Individuals

• Endoscopic Ultrasound (EUS):
  • Highly sensitive for detecting small lesions in the pancreas, including cystic lesions and early tumors.
  • Useful for characterizing suspicious lesions and guiding biopsy if needed.
• MRI/MRCP (Magnetic Resonance Imaging / Magnetic Resonance Cholangiopancreatography):
  • Can visualize the pancreatic duct and surrounding structures, identify cystic lesions, and detect early changes.
  • May alternate annually with EUS in some high-risk protocols.
• CT Scan:
  • High-resolution CT can detect pancreatic masses, but for screening purposes, EUS and MRI are generally preferred due to better sensitivity for small lesions and lack of radiation exposure (in the case of MRI).
  • Still sometimes used in the diagnostic workup.

  Screening Interval

• Frequency:
  • Varies by protocol and level of risk, but commonly once a year (annually) or every 6 months in very high-risk cases.
  • Screening often starts at an earlier age (e.g., 10–15 years younger than the earliest diagnosis in the family) or by age 50, whichever comes first, depending on specific guidelines.

 

Summary

Pancreatic cancer is a challenging disease characterized by late detection, early metastasis, and historically low survival rates. Surgery remains the only potential cure, but is feasible for only a minority of patients. Chemotherapy (e.g., FOLFIRINOX or gemcitabine plus nab-paclitaxel) is the cornerstone of treatment for advanced disease, while targeted therapies (PARP inhibitors for BRCA-mutated tumors) and immunotherapy (for MSI-H tumors) offer emerging options for select subgroups. Palliative care plays a crucial role in maintaining quality of life, addressing pain control, nutritional needs, and psychosocial support. Despite its aggressive nature, ongoing research and new therapeutic strategies continue to improve outcomes modestly and provide hope for better long-term management in the future.

 

*Please note that screening programs may vary among different countries.