This Thyroid Awareness Month, South First engages in a conversation with Dr Narayana Subramaniam, renowned Head and Neck Oncologist.
Representative image. (Wikimedia Commons)
In today’s world, thyroid issues are on the rise, capturing an increasing share of the spotlight. But did you ever stop to think that these issues might escalate into something as serious as cancer? While cancers like breast, cervical, and lung command considerable attention, thyroid cancer often lingers in the shadows, waiting to be brought to the forefront.
Ranked as the 12th most common cancer globally, it has a penchant for affecting women three times more frequently than men and is notably prevalent in younger age groups, too.
With January being Thyroid Awareness Month, South First engages in a conversation with Dr Narayana Subramaniam, renowned Head and Neck Oncologist and Director of Clinical Innovation at Sparsh Hospitals in Bengaluru.
In this exclusive interview, Dr Subramaniam sheds light on this particular form of cancer that takes root in the thyroid gland, where uncontrolled cell growth takes centre stage. Excerpts from our conversation:
Q. What is thyroid cancer?
A. Located in the front of our neck, the thyroid gland controls and regulates every possible system in our body. Thyroid cancers are quite common and there are four different types. The most common is “differentiated thyroid cancers”, presenting more often in women than in men.
Symptoms include a lump in the front of the throat that moves when swallowing, involvement of lymph nodes, change in voice, or difficulty swallowing due to the pressure on the windpipe and food pipe.
Q. What are some of the risk factors for thyroid cancer and are there effective ways to prevent it?
A. Risk factors for thyroid cancer include pre-existing thyroid disease, goiter (generalised enlargement of the thyroid gland), radiotherapy to the front of the neck, and family history of thyroid cancer. However, most cases are sporadic with no specific reason or genetic link. These cancers arise due to abnormalities in the cell repair cycle but are easier to handle with appropriate treatment.
Q. Is there any particular age group that is more prone to thyroid cancer?
A. Thyroid cancer, interestingly, can occur in pretty much any age group. There are two ends of the spectrum. The very elderly patients can have the more aggressive versions of thyroid cancer. The young patients, even children, can develop thyroid cancers. The ones that appear early, typically show good response to treatment.
There is another group of thyroid cancer that is seen among the middle-aged. It’s called medullary thyroid cancer, and those are slightly rare and need a different kind of treatment.
Q. What are the treatment options for thyroid cancer?
A. Most treatments for this condition centres around surgery. Surgical removal of the cancer from the body is often accompanied by additional treatments like radioiodine therapy. Our treatment philosophy is straightforward: Completely eradicate all cancer from the patient, wherever possible. Additional treatment may be necessary in some cases.
It’s crucial to remember, as with any cancer, that the initial treatment is the most important. When patients receive comprehensive treatment upfront, their prognosis is generally positive. Thyroid cancer has a 20-year survival rate, unlike most other cancers where a five-year survival rate is the norm. We often see a survival rate of 100 percent at 20 years for patients under 55 years of age in certain types of thyroid cancer.
Therefore, it’s vital to treat this cancer effectively and not take it lightly. Improper treatment can lead to difficulties with swallowing, speech, and other issues. Additionally, more extensive treatment may be required if the initial treatment is not handled correctly.
Q. Are there any specific symptoms to look out for?
A. The biggest problem we have is that awareness around these cancers is quite low. For example, if you talk about breast cancer, a woman with a breast lump will think of cancer straight away, right? If you have a lump in your abdomen, you will think of some kind of cancer, like stomach or liver cancer.
But here, because the anatomy is very complex, people don’t understand it. They’re not aware. We tend to neglect problems of the head and neck quite easily. So, we might have difficulty swallowing for weeks, which then become months, and months become years. And then, only when they cannot ignore it, they go to the doctor.
That should not be the case. The rule of thumb is very simple. If you have any abnormal symptoms, any funny feeling — whether it’s difficulty swallowing, a change in voice, or a lump somewhere in your throat that you can feel and it’s not going away in two or three weeks, get it checked out. Chances are it may not be cancer; nothing to be worried about, but still check.
We also have this misconception that these kinds of head and neck cancers are associated with tobacco or alcohol. It’s not true that only those who smoke/drink alcohol will get head and neck cancers. Cancers like thyroid cancers, don’t have any specific risk factors. So there’s nothing that you have done that could predispose you to them.
Q. Why is it that the incidence of thyroid cancer in higher in women?
Dr Narayana Subramaniam. (Supplied)
A. There are a couple of theories. I think the best working theory is that the thyroid gland, by nature, undergoes a lot more processes of transformation in women. And the reason for that is the thyroid gland produces a hormone called thyroxine, which regulates pretty much every system in the human body. Our muscle movement, neurological functions like cognition, cardiovascular system, everything functions adequately because of thyroxine in women. Because of the changes that happen in their body, primarily because of puberty, pregnancy, and childbirth, the amount of thyroxine required by the body goes up and down.
As a result, the thyroid gland has to change. Just like when you exercise more, your muscles get larger, similarly, the thyroid gland has a lot of evolution. And sometimes what happens is, during that process of evolution, there is a disorder in that process where tissues get damaged and repaired. And when there’s a disconnect between those processes, the cells may over proliferate and become cancerous.
Q. What are some unique challenges that women face when dealing with thyroid cancer?
A. What we see, unfortunately, when we have women with cancer is that they very often neglect their own health. The priorities of the family are sometimes a bit lower for women. So, the health-seeking pattern is a little different. Women often put off getting medical evaluation and getting treated. They wait until it’s a big problem, and the result of that is multifold.
Women with cancer have unique struggles and challenges that need to be addressed. The key is always awareness and the key is always “a stitch in time saves nine.” We can’t ignore it away, it just gets worse over time. So it’s always better to get evaluated and get treatment done.
Q. What are the latest advancements in thyroid cancer treatment?
A. As I mentioned before, the most common type is differentiated thyroid cancer and this type has an excellent survival rate, 99 percent survival in 20 years. On the other end, there is another type called anaplastic thyroid cancer. This is the most aggressive cancer in human beings.
Anaplastic thyroid cancer used to mean a death sentence. Less than 20 percent of people were alive at the end of one year. But there’s been a tremendous amount of work that’s been published in the last few years and we are seeing the impact of that. The approach has changed. Sometimes we use chemotherapy and immunotherapy. Before we operate, we shrink the tumour and this improves the survival rates.
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