Historically, surgery was the first line of treatment for patients with thyroid cancer. Now, as targeted therapies and other new medications emerge, surgery for certain patients may become more of a secondary option if those treatments fail. This new context could potentially change how some procedures are conducted.

Otolaryngologist and head and neck surgeon Dr. Zoukaa Sargi, joined a panel discussion on thyroid cancer care during the annual American Society of Clinical Oncology (ASCO) meeting. Sargi specialises in head and neck cancers and will provide a surgeon’s perspective on how thyroid cancer treatment is evolving.

“For many years, thyroid cancer was mostly treated with surgery,” said Sargi, professor of otolaryngology and neurosurgery at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. “As the science evolved and our understanding of the disease progressed, other treatment options became available. As a result, this cancer is now managed in a truly multidisciplinary fashion, in which surgery plays a role but must be incorporated into a more complex treatment plan.”

A More Nuanced View of Surgical Care

Twenty years ago, many patients with thyroid cancer received total thyroidectomies, and many had lymph nodes surrounding the thyroid removed as well. These procedures saved many lives, but they also generated long-term side effects. Now, with new therapies that target specific tumor genome variations, patients have many more choices.

“Our understanding of the nuances about the extent of surgery required and how surgery may impact a patient’s quality of life have significantly changed,” said Sargi.  This has now modified surgery both for early thyroid cancer and for advanced thyroid cancer. “We can counsel patients better and engage them in decisions about how extensive a surgery they want and how to mitigate the potential side effects of surgery. Every patient, every individual cancer has its unique molecular and biological behavior. It’s important to come up with a personalized treatment plan incorporating all modalities.”

Future Impact

Quality of life is particularly important in thyroid cancer care because many patients are diagnosed when they are young, some as early as in their teens, and many in their 20s and 30s. The average age of a patient at time of thyroid cancer diagnosis is 51, according to the American Cancer Society. This means that both patients and providers are often quite motivated to minimize long-term treatment side effects as much as possible.

“Most of these patients will survive their cancer, and they may live another 20, 30, even 60 years,” said Sargi. “Cancer care decisions could impact them for decades after they finish their treatments. That has to be part of the conversation.”

Source: Sylvester Comprehensive Cancer Center