Head and neck masses (and cancers) can affect nasal passages, sinuses, mouth, throat, larynx (voice box), swallowing passages, salivary glands and thyroid gland. Skin cancers that develop on the scalp, face or neck also may be considered head and neck cancers.
Oropharyngeal cancer is a disease in which malignant cells form in the tissue of oropharynx. Oropharynx is a middle part of the throat which includes the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx. Oropharyngeal cancers can be divided into two types, HPV-positive, which are related to human papillomavirus infection, and HPV-negative cancers, which are usually linked to alcohol or tobacco use.
Thyroid nodules are very common, and up to 60% of the population have thyroid nodules based on imaging studies such as ultrasound; however, more than 90% of those nodules are benign.
According to the American Cancer Society, 62,000 new patients will be diagnosed with thyroid cancer in 2016. Two out of three thyroid cancers are found in women, and it is the 5th most common type of cancer in women. During the past two decades there has been a steep rise in the incidence of well differentiated thyroid cancer that is in part due to earlier detection and increased imaging utilization, but the survival rate has remained unchanged. The majority of thyroid cancers that account for this increased incidence are smaller tumors that are less than 2 centimeters with indolent behavior — they rarely cause problems.
There are 4 major cell types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Well differentiated thyroid cancer accounts for more than 90% of the neoplasms of the thyroid gland. Papillary thyroid cancer is the most common type of well differentiated thyroid cancer. Thyroid cancer is more common in women and its incidence increases with age. Evidence suggests that family history of thyroid cancer, history of exposure to radiation, iodine deficiency and auto immune thyroiditis are associated with increased risk of thyroid cancer.
Evaluation of the thyroid gland usually includes clinical examination, laboratory values, and ultrasound imaging. Some patients may feel a mass in the neck or a nodule in the thyroid gland; sometimes they are found during a physical exam. Palpable nodules in the thyroid warrant evaluation by a thyroid specialist. Generally, nodules less than 1 cm should be observed without a need for biopsy. The majority of patients with thyroid cancer are asymptomatic and will have a normal thyroid blood test. If any suspicious nodule that meets the biopsy criteria is identified, an ultrasound guided fine needle aspiration biopsy may be considered. This is often done in during the office visit if feasible. The biopsy findings will be categorized based on Bethesda classification and may be reported as benign, malignant or suspicious, indeterminate, and non-diagnostic. Molecular genetic testing may offer additional information in indeterminate nodules.
The primary management of thyroid cancer is surgery when treatment is necessary. We now know that many smaller thyroid cancers of certain cell types can be treated with very limited surgery. If cancer is diagnosed, evaluation of the neck lymph nodes is usually done prior to surgical consideration. Extent of surgery will depend on multiple variables such as the presence of thyroid cancer in the lymph nodes. Additional treatment such as radioactive iodine may be indicated for a select group of patients with thyroid cancer. Surgical management of thyroid cancer is best done by surgeons with special interest in thyroid disease as high-volume surgeons are shown to have fewer complications. Your endocrinologist and thyroid surgeon will tailor specific treatment based on the extent of disease and your general health.
Patients with thyroid cancer will need periodic follow up examination by their physicians as the cancer can return many years after initial treatment in the neck. Patients who have undergone total thyroidectomy will need lifelong thyroid hormone replacement. Five-year overall survival for patients is excellent — with well differentiated thyroid cancer is above 95% for all stages combined and is near 100% in patients with early stage thyroid cancer.