An Overview of Differentiated Thyroid Cancer

Transcript:
Lori Wirth, MD: Hello, and welcome to Cure Expert Connections on differentiated thyroid cancer. I’m Lori Wirth. I’m an associate professor of medicine at Harvard Medical School in Boston, Massachusetts, and the medical director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Today, I have with me a panel of health care experts, a patient advocate, and a patient of mine and his wife. Let’s have them introduce themselves. Dr Bryan McIver, do you want to go first?

Bryan McIver, MD: Thank you, Lori. My name is Dr Bryan McIver. I am an endocrinologist by training, and endocrine oncologist by enthusiasm, and I work at Moffitt Cancer Center in Tampa, Florida, where I see almost exclusively patients with thyroid nodules and thyroid cancer.

Lori Wirth, MD: Thank you, Bryan. Gary, how about having you introduce yourself?

Gary Bloom: Thanks, Lori. My name is Gary Bloom and I’m the executive director of ThyCa, Thyroid Cancer Survivors’ Association. I was diagnosed with papillary thyroid cancer back in 1995, and I have been no evidence of disease since August of 1998.

Lori Wirth, MD: Thank you very much, Gary. We also have Jim Lesniak, who is my patient, and Jim’s wife, Molly. Jim and Molly, do you want to introduce yourselves?

Jim Lesniak: Hi, I’m Jim Lesniak. My cancer came in October or November of 2014. I still have a few tumors and I’ve been relying on Dr Wirth for 6, 7 years.

Molly Lesniak: I’m his wife, Molly, and I’ve just been along for the ride.

Lori Wirth, MD: Well, I have to give a special thank you to both of you, Jim and Molly, for joining us today. It’s a really special gift that you’re giving to the community to join us today and to share your personal experience with thyroid cancer, and it’s especially special for me to do this with you. Welcome everyone. Our panel is going to spend the next 60 minutes or so discussing treatment options for differentiated thyroid cancer and talking about some of the insights and experiences that we’ve had both from a medical point of view, the advocacy point of view, and of course, the patient and care givers’ point of view. Let’s start out talking about a brief overview of thyroid cancer. Thyroid cancer really is an umbrella diagnosis. We have a number of different types of thyroid cancer. There are differentiated thyroid cancers, poorly differentiated thyroid cancer, anaplastic thyroid cancer, and then also medullary thyroid cancer. Today, we’re going to be focusing on differentiated thyroid cancer, but even with the diagnosis of differentiated thyroid cancer, there are multiple subtypes. Maybe I could ask Bryan to go into a little bit more of an explanation of what we’re talking about when we’re talking about differentiated thyroid cancer.

Bryan McIver, MD: Yes. Thanks, Lori. Differentiated thyroid cancer, as you pointed out, is a group of cancers rather than a single diagnosis. It’s a group of cancers that are all derived from a single cell type, which is the cell in the thyroid gland that makes thyroid hormones. Something goes wrong in that cell and in the chromosomes of that cell; they acquire a mutation or another abnormality, and that leads that cell to subdivide and grow. Depending on the specific genetic cause of the cancer, it causes the growth and spread of the cancer to develop in different ways. The most common is papillary thyroid cancer, described because it has papillae, little thorns within it under the microscope. That papillary thyroid cancer tends to grow within the thyroid gland, spread into surrounding lymph nodes, and can, if left in place, begin to invade into the surrounding structures. Then, in the longer term, if it’s left there for long enough, it can spread into other sites, especially in the lung. Follicular thyroid cancer, derived from the same cell but with a different genetic driver, spreads in different ways. It will spread often by invading into the tissues of the neck, or by spreading through the blood stream into other sites including the bone and other soft tissues as well. Poorly differentiated thyroid cancer is a more aggressive version of these cancers. The worst of the worst, anaplastic thyroid cancer, falls outside of that domain of the differentiated thyroid cancer but is often a devastating disease.

Transcript edited for clarity.