Q. What are the causes and risk factors of endocrine cancer?
A. While doctors can seldom explain why one person gets endocrine cancer and another doesn't, we do know that the disease is not contagious; no one can "catch" endocrine cancer from another person. Scientists do not know exactly what causes this disease, but research does show that some people are more likely to develop it than others. Some endocrine cancers are inherited (run in the family). If there is a strong family history of endocrine cancers of the same type – or of different types – you may also have a tendency to develop a cancer of this type.
Q. What are the symptoms of endocrine cancer?
A. Because endocrine cancer can occur in glands in different parts of the body, the symptoms are different for different types. The most common symptom of thyroid cancer, which is by far the most common type of endocrine cancer, is a lump or swelling in the neck. Symptoms of other types vary widely. If you have symptoms that concern you, you should see your doctor.
Q. How do you diagnose endocrine cancer?
A. The doctor will ask about your medical history and will do a careful physical exam. You most likely will be asked to give blood for hormone measurements, and you may also be asked to have an ultrasound, CT scan or MRI to enable the doctor to determine where the growth is located and whether it has spread.
The only sure way to tell whether cancer is present is with a biopsy. The doctor removes a small sample of tumor tissue, which is examined under a microscope by a pathologist. If cancer cells are found, the pathologist will usually determine the stage or grade of the tumor, which tells whether the cancer is spreading. Based on the biopsy results, your doctor may refer you to a specialist in endocrine cancer.
For some tumors, it is not possible to tell if a tumor is benign or malignant (cancerous) before an operation. In these cases, the only way to know if a tumor is cancer is to examine the entire tumor after surgery, and to see if there is evidence of residual tumors after the main tumor is removed.
Q. What are the treatment options for endocrine cancer?
A. Because of advances in diagnosis and treatment of endocrine cancer, a longer and better life is possible for patients today. Treatment planning takes into account the size and location of the tumor, whether it is likely to grow slowly or rapidly, and the general health and age of the patient. Four types of treatments may be used:
Surgery is the most common treatment for endocrine cancer. The goal of the surgery is to completely remove the tumor and a safe margin of the tissue around it. Depending on the outcome of the surgery, the doctor may also recommend chemotherapy or radiation therapy.
Radiation therapy uses high-energy rays to damage cancer cells and stop their growth. Radiation therapy is generally given in the outpatient department of a hospital or clinic. Most often, patients receive radiation therapy five days a week for five to six weeks.
Hormone therapy uses hormones, usually given as pills, to stop cancer cells from growing. In treating endocrine cancer, hormones can be used to stop the body from making other hormones that might make cancer cells grow.
Chemotherapy is the use of drugs to kill cancer cells. Some drugs are given by mouth; others are injected into a blood vessel or muscle. The drugs travel through the bloodstream to nearly every part of the body. Chemotherapy is usually given in cycles: a treatment period followed by a rest period, then another treatment period, and so on.
In addition to these treatments, thyroid cancer also has a special treatment that is very specific to this type of cancer. Because the thyroid is the only gland in the body that stores iodine, many thyroid cancers are treat (after surgery) with a radioactive form of iodine, which delivers high doses of radioactivity only to the thyroid cells that can store this molecule.
Patients may also want to talk with the doctor about taking part in a research study, called a clinical trial, involving new treatment methods.
Q. What are the side effects of treatment?
A. The methods used to treat endocrine cancer are very powerful. That's why treatment often causes side effects. Fortunately, most side effects are temporary.
The side effects of chemotherapy depend on the drugs given and the individual response of the patient. Chemotherapy commonly affects rapidly growing cells, such as blood cells that fight infection and cells that line the digestive tract. As a result, patients may have side effects such as lower resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. They may also lose their hair. These side effects usually end after chemotherapy is finished.
During radiation therapy, patients may notice a number of side effects. They may become unusually tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the area being treated are also common. Patients should be gentle with the treated area of skin. Lotions and creams should not be used without the doctor's advice. When the chest and neck area is treated, patients may have a dry, sore throat and may have some trouble swallowing. Sometimes, they have shortness of breath or a dry cough. Radiation therapy to the abdomen may cause nausea, vomiting or diarrhea. Some patients may have tingling or numbness in their arms, legs and lower back. These side effects gradually disappear when treatment is over.
Loss of appetite can be a problem for patients receiving chemotherapy or radiation therapy. Researchers are learning that patients who eat well are better able to tolerate the side effects of their treatment. Therefore, good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles and organs. Many patients find that eating several small meals and snacks throughout the day is easier than trying to have three large meals.
The side effects that patients have during cancer therapy vary from person to person and may even be different from one treatment to the next. Doctors try to plan treatment to keep problems to a minimum. Doctors, nurses and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
Q. What should I ask my doctor when diagnosed with endocrine cancer?
A. Here are some questions you may want to ask your doctor:
- How can this disease be treated?
- What are my treatment choices?
- How successful is the treatment likely to be?
- Would a clinical trial be appropriate for me?
- What are the expected benefits of treatment?
- What are the risks and possible side effects of treatment?
- Will I have to change my normal activities?
- Can I keep working during treatment?
- How often will I need checkups?
Your doctor is the best person to give advice about working or to answer questions about other activities. Many patients find it also helps to talk with others who are facing similar problems. This kind of help is available through cancer-related support groups. Social services, clergy, nursing personnel or your doctor can offer suggestions as to where to seek assistance with emotional support.