Thyroid cancer: Metastatic and advanced
Thyroid cancer may spread (metastasize) to the lymph nodes, lungs, bone and occasionally brain. Sometimes, thyroid cancer is very large and starts growing into structures in the neck, such as the windpipe (trachea), the food pipe (esophagus), blood vessels, muscles, or nerves. This is considered "locally advanced" thyroid cancer.
Fortunately, metastasesMetastases - spread of cancer will often take up iodine at first. Therefore RAIRAI - radioactive iodine may still be a useful treatment for patients with metastases. RAI is particularly useful for small lung metastases that may not be visible by CAT scan, but are seen on a radioactive iodine scan. Metastatic thyroid cancer, that is large enough and visible on ultrasound or CAT scan, should be surgically removed. This is a common treatment for lymph node metastases in the neck. However, for tumors that either lose the ability to take up radioactive iodine or are not surgically resectable, new clinical trials are currently enrolling patients that have metastases (determined by high thyroglobulin levels). A list of these trials can be seen on the websites listed below.
2. Clinical trials
Many of the current clinical trials for treating metastatic papillary carcinoma, follicular carcinoma, Hurthle cell carcinoma, or medullary carcinoma involve the use of commercially available, small molecule kinase inhibitors, such as sorafenib (Nexavar®, Bayer) or sunitinib (Sutent®, Pfizer, Inc.). Initial results are promising, however more studies are required to determine which patients benefit the most from these drugs. Patients considering enrollment in a clinical trial should read the list of conditions below from the National Cancer Institute. They can also call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) and ask for a customized search of the PDQ database, which provides information on current studies.
From the National Cancer Institute, National Institutes of Health
NIH Publication No. 00-4830
- Clinical trials are research studies that involve people. Each study tries to answer scientific questions and to find better ways to prevent, diagnose, or treat cancer.
- In cancer research, a clinical trial is designed to show how a particular anticancer strategy for instance, a promising drug, a gene therapy treatment, a new diagnostic test, or a possible way to prevent cancer affects the people who receive it.
- A clinical trial is one of the stages of a long and careful cancer research process. Getting promising results from testing a new drug on mice, for example, is a preliminary step to human research studies. Treatments that work well in mice do not always work well in people.
- People can benefit from clinical trials. In treatment trials, for example, participants receive high-quality cancer care and will be among the first to benefit if a new approach is proven to work.
- Only eligible people can participate in a clinical trial. Each study has its own guidelines for who can participate. Generally, participants are alike in key ways such as the type and stage of cancer, age, gender, and other factors.
- There may be drawbacks. New treatments under study are not always better than, or even as good as, standard care. And they may have unexpected side effects. Through a process called "informed consent" you will learn about a study's treatments and tests, and their possible benefits and risks, before deciding whether or not to participate.
- In treatment trials involving people who have cancer, placebos are very rarely used.
- Many treatment trials are designed to compare a new treatment with a standard treatment. The standard treatment is the best treatment currently known for a cancer, based on results of past research. In these studies patients are randomly assigned to one group or another.
- Clinical trials take place all over the country in cancer centers, other major medical centers, community hospitals and clinics, physicians' offices and veterans' and military hospitals.
- Health plans and managed care providers do not always cover all patient care costs in a study. What they cover varies by plan and by study. Ask a doctor, nurse, or social worker from the study to help you determine in advance what costs are covered. The research costs, such as data management, are covered by the study sponsor.
3. Useful websites
http://www.clinicaltrials.gov. This is the website for the U.S. Government's Clinical Trials Database. This database provides information about clinical research trials for thyroid cancer and other diseases. This list describes clinical trials that are recruiting new participants.
http://thyroid.org This is the American Thyroid Association website. It is a renowned professional association of thyroid specialists in the U.S.A.
ThyroidTrials.org This is the American Thyroid Association's (ATA) compendium of clinical trials for thyroid diseases, including thyroid cancer. The ATA Trial finder is a one-stop site to search multiple information sources, including public and private information sources and trials screened by experts from the American Thyroid Association.
http://www.thyca.org/ This website is maintained by a non-profit organization of survivors of thyroid cancer.