2015-16 Cancer Network Annual Report

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Renaming One Type of Thyroid Cancer: What Do We Need to Know?

Recently, a proposed change in the classification of a type of thyroid cancer has caused concern for patients – who are calling their doctors to ask important questions. “Does this mean I didn’t have cancer after all?” “Can I stop taking my medication?” “Can we stop my regular scans?”

Sentara Cancer Network includes the Sentara·EVMS Comprehensive Head and Neck Center, a U.S. News and World Report Top-50 Head and Neck Cancer programs in the United States. We want to offer our expertise in explaining what this change means for patients.

Each year, there are 65,000 people diagnosed with thyroid cancer, and this change is expected to affect about 10-20 percent of thyroid cancer patients who have a diagnosis of “encapsulated follicular variant of papillary thyroid carcinoma” or EFVPTC. The proposed name change is to NIFT-P which stands for non-invasive follicular thyroid neoplasm with papillary-like nuclear features, which removes the word carcinoma (cancer in the cells.)

This type of thyroid tumor doesn’t grow like cancer typically does. It’s composed of cells that show up as cancer if a small sample is taken out (in a needle biopsy) but when the entire tumor is removed, it hasn’t grown into other nearby cells. It’s self-contained and may never do what cancer does: grow uncontrollably. Monitoring will still be recommended, but the treatment plan will likely be less aggressive.

The study published in the Journal of the American Medical Association Oncology found that non-invasive EFVPTC have a low risk of adverse outcome, and even with variations in treatment, all of the 109 patients studied were alive with no evidence of disease at final follow up, some up to 26 years later. This new study’s findings are consistent with previous research regarding this type of thyroid cancer.

This is an important study, and it reflects our own experiences treating head and neck cancer. The team at the Sentara·EVMS Comprehensive Head and Neck Center has been using a similar philosophy for the past two years, because of our in-depth knowledge of the different behaviors of thyroid cancer and tumors. Our current practice has been to put this term underneath all references to thyroid cancer in the patients’ medical chart. We’ve adjusted our practice to accommodate the differences in this specific kind of tumor and we’ve counseled patients that it’s not aggressive.

This change is endorsed by a number of groups like the American Academy of Otolaryngology, The American Head and Neck Society, The British Association of Endocrine and Thyroid Surgeons. Additionally, there are six criteria that the tumor must meet to be in order to be classified as something other than a cancer. A less extensive surgery can reduce the risks of complications, and the expense of treatments. Patients may be able to take lower doses of suppressive thyroid medication and experience fewer side effects.

One of the benefits of less aggressive treatment, for example, just removing a lobe rather than the entire thyroid can be to lower medical costs. According to the American Thyroid Association, thyroid cancer has a high risk of bankruptcy, especially in younger patients. Diagnosis of cancer adds to the financial burdens of patients, with testing, ultrasounds and scans. They must also cope with anxiety and depression about potential cancer recurrence as well. The American Cancer Society notes that thyroid cancers diagnoses have risen rapidly, tripling in the past three decades. Some of this rapid increase may be due to more frequent detection with ultrasounds, CT scans and other imaging studies.

This may change the diagnosis of people who had thyroid cancer in the past, with an official diagnosis of NIFT-P. Only your health care team can discuss your personal history with you, but yes, this may change some people’s diagnosis as a cancer survivor. For patients who think they may have a NIFT-P diagnosis, they can schedule a review of the pathology with their doctors, and perhaps gain some peace of mind. Be sure to continue your medication and scans until your physicians determine whether a new course of treatment is indicated.

This change does not diminish thyroid cancer, and many thyroid cancers are extremely serious. Thyroid cancer includes anaplastic, medullary and differentiated types and patients with these cancers should continue their recommended course of treatment under the supervision of their cancer care team.

Today, it’s an individualized assessment, with tumor boards and cancer conferences like the ones at Sentara Cancer Network helping to ensure the most expertise is applied to each case. Sentara Cancer Network has EVMS head and neck fellowship-trained surgeons and endocrinologists, medical oncologists, radiation oncologists, pathologists and specialists who work together on each case. Our specific focus on this type of cancer allows us to treat the specifics of these intricate and potentially disfiguring cancers. Our team approach benefits patients, and we hope that our in-depth knowledge of this topic helps clarify this recent recommendation for a name change.

Sincerely,

Dr. David Lieb, FACE, FACP, Eastern Virginia Medical School, Endocrinologist

Dr. Daniel Karakla, FACS, Eastern Virginia Medical School, Head and Neck Surgeon

Dr. Marc Silverberg, FACP, Sentara Cancer Network, Head and Neck Pathologist