The rise in Thyroid Cancers (TC) in Sri Lanka has raised concerns among oncologists whose efforts to halt these disturbing trend initiatives during this Cancer awareness month has resulted in several new initiatives being introduced by the National Cancer Control Programme (NCCP ) to raise more awareness among the public that Thyroid Cancer which is one of the commonest cancers in Sri Lanka, is curable with very successful outcomes when detected early and treated in time by qualified physicians
The Sunday Observer spoke to the Registrar in Community Medicine, NCCP, Dr. Saddharma Weerakoon to enlighten readers on how to detect TC symptoms early and why it is so important to seek medical advice at the slightest suspicion of any symptoms.
Excerpts
 Dr. Saddharma Weerakoon |
Q. Thyroid Cancer (TC) has been recently cited as the 2nd commonest cancer among females and 4th commonest cancer in both sexes. Yet many persons with TC are still very ignorant about basic facts concerning thyroid cancer. So tell us what exactly is Thyroid Cancer?
A. Thyroid is a small gland at the front side of the neck. Thyroid cancer originates from the cells of the thyroid gland. There are several types of thyroid cancers.
Q. Mention some of the most common of these cancers you find 1) globally and 2) in Sri Lanka
A. There are several types of thyroid cancers. The most common types are;
1. Papillary Carcinoma:
2. Follicular carcinoma:
3. Medullary carcinoma:
4. Anaplastic carcinoma:
These are the common types globally as well as in Sri Lanka. Papillary carcinoma is the most common thyroid malignancy, representing approximately 80 percent of thyroid cancers. The first three types usually have a good prognosis. For example, 5-year survival for localised papillary carcinoma is almost 100 percent. However anaplastic carcinoma usually has a poor prognosis.
Q. What is the prevailing incidence of TC in Sri Lanka? How many new cases are detected annually?
A. In 2020, 2308 females and 518 males were diagnosed with thyroid cancer.
Q. Do you see an increase in the number of diagnosed new cases in the recent past?
A. Yes. The trend of thyroid cancer incidence in Sri Lanka is increasing. This trend is more prominent among females.
Q. Why is there this gender difference?
A. Up to now we know that females are more prone to get thyroid cancer. Males have less probability of getting thyroid cancer but if they get thyroid cancer, usually it is a more aggressive type than females. Scientists have suggested possible explanations for this observation, but the available evidence is still inconclusive.
Q. What are the risk factors for developing thyroid cancer?
A. There are multiple factors that increase the risk of thyroid cancer. Some of them are;
* Sex:
Thyroid cancers (like almost all diseases of the thyroid) occur about 3 - 4 times more often in women than in men.
Hereditary conditions:
There are several inherited conditions which increase the risk of thyroid cancer. About 8 out of 10 medullary thyroid carcinomas result from inheriting an abnormal gene. These cases are known as familial medullary thyroid carcinoma. Inherited syndromes like Familial Adenomatous Polyposis, Multiple Endocrine Neoplasia Type 2 (MEN 2), Cowden disease, and Carney Complex, type 1 increase the risk of thyroid cancer.
However, thyroid cancer risk increases even without any known inherited syndrome mentioned above. If someone has a first-degree relative (parent, brother, sister, or child) with thyroid cancer he or she has an increased risk of thyroid cancer. Still, most people who develop thyroid cancer do not have an inherited condition or a family history of the disease.
Thyroiditis: Some autoimmune conditions in the thyroid gland can increase the risk of thyroid cancer.
Long-term Multinodular Goiter: Recent studies suggest that long-term multinodular goiters can have a higher risk of developing thyroid cancer.
Radiation: Radiation exposure is a proven risk factor for thyroid cancer. People can be exposed to radiation in occupational settings like the health sector. They should take the necessary precautions to minimize exposure.
Q. What about environmental pollution caused by vehicular fumes and chemicals from factories?
A. As discussed earlier, exposure to radioactive agents is a known risk factor. However, new research evidence is emerging about the link between environmental pollution and thyroid cancer. Scientists have identified some chemical toxins (Polychlorinated biphenyls, some pesticides, etc.) which increase the risk of thyroid cancer.
Q. Where does thyroid cancer usually start?
A. In cells in the thyroid gland
Q. How fast does it take for thyroid cancer to spread? Does this depend on the individual?
A. The spread and severity of thyroid cancer mainly depend on the type of cancer.
Q. At what age is TC most common? I read that young women are among the most vulnerable. Is this correct?
A. Yes. Young women are more prone to get thyroid cancer. High incidence is observed between the 25 to 40 years age group.
Q. Can children get TC? Or only adults
A. Children also can get thyroid cancer. But the chances of them developing it are less compared to adults.
Q. What are the early symptoms of TC? (elaborate)
A. Thyroid nodule which is a lump in the thyroid gland is the most common early symptom. More attention should be paid to the recent onset and progressively enlarging nodules. Along with the thyroid nodule, there may be other local symptoms as well which one should watch out for, e.g hoarseness of voice, and difficulty in breathing and swallowing.
Q. If detected early can you cure TC
A. Yes, most thyroid cancers can be treated successfully, and the success rate is high if detected early.
Q. Are there different stages in Thyroid Cancer? If so, how many?
A. There are several types of classifications. But the usual practice is to classify cancer into 4 stages. Stage 1 includes early cancer and stage 4 includes late-stage cancers.
Q. How do you treat thyroid Cancer?
A. The treatment relies on several factors such as the type of thyroid cancer, stage at diagnosis, existing health conditions of the patient, and the available facilities. However, the treatment may include surgery and radioiodine therapy.
Q. Usually how long does it take for a healthy person without pre-existing diseases to recover?
A. It depends on many factors. Such time duration cannot be defined.
Q. Sri Lanka is still in the midst of a Covid pandemic and emerging new respiratory diseases as well. How vulnerable are persons with TC to these diseases?
A. In general cancer patients are susceptible to acquiring communicable diseases due to their poor immunity and nutritional status. Therefore, they should take extra precautions.
Q. If a patient recovers, does that mean she/he has recovered completely or is simply in remission like some other cancers?
A. That again depends on the type and the stage of the thyroid cancer. Since most of the thyroid cancers have a good prognosis.
However, as there is a chance of recurrence, proper follow-up is very important.
Q. What is the most advanced stage of TC?
A. Stage IV
Q. When a patient reaches this stage how do you treat him/her?
A. Treatment modalities will be the same. But their prognosis can be poor because they have complicated cancer with distant metastasis.
Q. If a woman wants to get herself tested for thyroid cancer where can she go?
A. If a person has suspicions about symptoms that she/he may be having thyroid cancer or complains of symptoms related to the thyroid gland, he or she can visit the nearest hospital for clinical examination by a qualified doctor. If further evaluation is required, they will be referred to a Surgical or Ear, Nose, and Throat (ENT) clinic. In addition, health staff in the Healthy Lifestyle Centres and Well Women Clinics also perform the clinical assessment if required. Pregnant mothers will be examined at the AnteNatal Clinics by the doctor as a routine.
Q. Some countries have introduced screening for Thyroid Cancer at the national level. Does Sri Lanka have such a program?
A. At the moment, there is no national-level population-based screening program for thyroid cancer.
Q. What has the National Cancer Prevention Programme in recent years done to minimise the incidence and create more awareness of Thyroid Cancer?
A. The National Cancer Control Programme (NCCP) has developed a National Guideline for the Early Detection of Common Cancers for all Lankans, which includes Thyroid Cancer as well.Currently, the NCCP is also in the process of providing required training for the primary health care staff. As a routine, the NCCP conducts activities to raise public awareness about thyroid cancer. In addition, the NCCP is also currently working with experts to develop an Atlas on Human Carcinogens relevant to Sri Lanka which will provide guidelines on how to identify and take precautions against confirmed carcinogens.
Q. Once a patient is discharged from a hospital after treatment for TC are there any follow-up programs in state hospitals?
A. Yes. Follow-up is an important component of the treatment. These patients are usually treated with radioactive iodine. Therefore, they should follow the instructions given by the health staff.
Q. Are these facilities available in hospitals across the country?
A. Yes. Now cancer treatment facilities have expanded up to district level. The main hospitals of every district have a cancer treatment unit with relevant consultants. However, certain specific treatment options may be limited to the main centers such as Apeksha Hospital Maharagama, Karapitiya, Kandy, Thelippalie. But routine follow-up can be done at the district level.
Q. Do you have enough staff now that many qualified oncologists have started leaving the country for various reasons.?
A. Losing an oncologist or another specialist is a drawback for the country. But with the commitment of the health staff including consultants, the cancer services in the country are not disturbed due to the lack of human resources. However, there are centers that may need more human resources.
Q. As we are now in a hi-tech age, are there any new advances in detecting and treating Thyroid Cancer early to ensure quicker recovery?
A. Yes, diagnostic facilities are advancing daily. Currently, hospitals in the government sector are equipped with the required facilities to diagnose thyroid cancer accurately.
Q. What do you consider as gaps in delivering quality care for patients with Thyroid Cancer?
A. Radioactive iodine therapy is a specific and essential treatment option for thyroid cancer. This facility needs to be expanded.
Q. How would you like to see them filled?
A. These facilities cannot be provided overnight as it requires some infrastructure development in the regional centres. On the other hand, special precautions should be taken as we are working with radioactive agents. Maximum utilisation of the available facilities should be a priority during the current situation.
Q. Do you have a message for our readers on reducing exposure to the risk of Thyroid cancer?
A. Thyroid cancer is one of the few cancers which has a very good prognosis.
Definitive treatment options are available in government hospitals to cure most thyroid cancers. Hence, please do not follow unknown or unconfirmed treatment options which will lead to losing your money and life ultimately.