Hurthle Cell Cancer

Symptoms:

There are a few signs and symptoms that are associated with thyroid cancer, and specifically Hurthle cell cancer. However, in the earliest phases of the disease, these characteristic signs and symptoms may not be present. Those signs and symptoms could also be indications of other medical conditions, including the noncancerous enlargement of the thyroid, a condition known as goiter, and an infection of the thyroid gland.

Some of the signs and symptoms of Hurthle cell cancer may be:

• Shortness of breath
• A fast-growing lump (nodule) in the neck, just below the Adam's apple. This is the most common clinical sign.
• Trouble swallowing
• Enlarged and swollen lymph nodes in the neck
• A continuous cough that isn't associated with an upper respiratory infection
• Hoarseness or other changes in the voice
• Pain in the neck or throat, which could sometimes extend to the ears.

Causes:

Even though this disease is believed to be associated with alterations in DNA including some related to the aging process, the exact cause of Hurthle cell cancer is still not known.

The genetic material that contains the instructions for every chemical process in the body is called DNA. Some of the genes in the DNA program cells to die at the right time or slow cell division, and some of them promote cell division. However, the processes that help repair DNA are controlled by other genes. These genes might not function properly when DNA is altered or damaged, which causes cells to grow out of control and eventually form a tumor of malignant (cancerous) cells.

Hurthle cell cancer has been linked to radiation exposure, as is the case with other thyroid cancers.

Doctors still don't know how to classify Hurthle cell cancers. Usually, they are considered a subgroup of follicular tumors of the thyroid that develop in the follicle cells of the thyroid. Thyroid hormones, such as triiodothyronine and thyroxine, are manufactured in these cells. However, some researchers believe that Hurthle cell cancer should be considered a distinct category of thyroid malignancies.

Complications:

Some of the possible complications of Hurthle cell cancer and other thyroid tumors may include:

Difficulty swallowing and breathing:
In case the tumor grows and presses on the esophagus, this complication could occur.

Spread of the cancer:
The cancer could spread or metastasize to other tissues and organs, making therapy more difficult and diminishing the chances of recovery in case Hurthle cell cancer treatment begins late, or it isn't treated properly.

Treatments:

A number of treatment options are available for Hurthle cell cancer, including:

Surgery:
The best treatment for Hurthle cell cancer is surgery. In a procedure called a near total thyroidectomy, all or nearly all of the thyroid gland is removed. To lower the likelihood of parathyroid injury, tiny edges of thyroid tissue will be left near the adjacent parathyroid glands. The body's calcium levels are regulated by these small parathyroid glands. To determine if the cancer has spread to the surrounding lymph nodes, they will be removed.

A complete physical exam will be conducted before the surgery, including a heart evaluation in order to determine the risk of cardiac complications during the operation. In case someone has a bleeding disorder that could become problematic, it will be revealed by blood tests. Beginning the night before the operation, the patient shouldn't eat or drink anything.

Unintended injury to the recurrent laryngeal nerve is the greatest risk that is associated with this operation. This injury could cause either complete loss of voice, or temporary or permanent hoarseness. Infection, damage to the parathyroid and excessive bleeding are some of the other possible complications of this surgery. To ensure that post-surgical bleeding hasn't occurred and that the patient is able to breathe normally, he/she will need to stay in the hospital for a day or two after the surgery.

Thyroid hormone medication:
The patient will be prescribed the synthetic drug levothyroxine after surgery for Hurthle cell cancer. This medication will replace the hormones that are no longer being produced because of the absence of the thyroid. Patients should take these synthetic hormones for the rest of their life. Blood tests will help determine the correct dose, which will minimize the risk of side effects; otherwise, these medications are quite safe.

External beam radiation:
In this approach, radiation treatment is delivered to attack malignant cells. People who haven't had success with radioiodine therapy could try external beam radiation. To deliver radiation to cancer cells, this approach uses a special X-ray machine called a linear accelerator. Specific areas where cancer cells are present will be targeted, which will minimize damage to nearby healthy tissue. A temporary reddening and sensitivity of the skin in addition to fatigue could be some of the side effects of this treatment.

Radioactive iodine therapy:
In addition to surgery for Hurthle cell cancer, the patient may also be prescribed radiation therapy that uses a capsule containing radioactive iodine 131. Using a modest dose of radiation in a procedure called "remnant ablation", it could destroy any microscopic thyroid tissue that remains after the operation. In order to eliminate any malignant cells that have spread to other parts of the body such as the bones and lungs, a higher dose of radioiodine could sometimes be used.

Usually, about six weeks after surgery, radioactive iodine therapy will be administered as an outpatient procedure.

Dry mouth, sore throat, neck tenderness, vomiting, nausea and decrease in taste sensations are some of the rare side effects of radioiodine therapy. Within about two days after the start of treatment, nearly all traces of the radioactive iodine are excreted from the body. Because of risks to the fetus and newborn, women who are pregnant or breast-feeding aren't recommended this treatment. After this treatment, men should wait several months before attempting conception, and women at least six months.

Prognosis:

Not Available

Expert's opinion: