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What is the treatment for papillary cancer? Which specialist should I see for?

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Practicing since : 2005
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I have two main questions: 1) After someone is diagnosed with papillary cancer, should she be followed up by an oncologist or should she continue with an endocrinologist? 2) Also, can you please let me know what is the treament plan for someone diagnosed with papillary cancer? Do they not need follow up lung xrays, Pet Scans, or whole body scans in addition to blood work and occassional ultrasounds? All my daughter is getting after her thyroidectomy is blood work and an occassional ultrasound and I am worried due to her ongoing throat discomfort and/or infections. I don't feel ultrasounds are conclusive enough and this is the reason why: My daughter was diagnosed with a prolactinoma at 13 and with a thyroid nodule at 23 on the right side of her thyroid. The thyroid nodule was benign but after a second follow up and ultrasound, it was found that she had several other more recent nodules. The endo continued advicing follow ups but I did not feel that never ending follow ups and ultrasounds where conclusive enough. I decided to have her seen by a surgeon rather then continue to wait. She had a total thyroidectomy at which time we were told that cancer indeed was found inside one of the smaller nodules on the left side. She did not have any other post op treatment, medication, procedure, or diagnostic studies other then a follow up ultrasound after 6 months and blood work. We have been told that her Thyroidglobulin level has been "normal". However, for the last year she has been experiencing throat pain, discomfort, strep throat like symptoms. She has been seen by the endo, ent, and her primary numerous times about it. She has been diagnosed with either strep throat or acid reflux. The symptoms continue. I had her checked by an endocrinologist at Moffit Cancer Center in April regarding as a second opinion and had her bring all of her previous records. The endo had the Moffit pathologist review her surgical slides and he found a discrepancy with the pathologist's report at the time of surgery. Two pathologists from Moffit then reviewed the surgical slides and determined that the cancer was not only inside the nodule as we were told at the time of her thyroidectomy, but also adjacent to the adipose tissue. Moffit did not call to alert us of this discrepancy. I found out when I requested to see their records. Once I realized the discrepancy, I called Moffit and they then suggested an ultrasound. She had the ultrasound last month and she was told she was fine and to return in 3 months. I however requested a copy of the report. The report indicates the following: one node having mild cortical thickening with small cetral fatty hilum and two other nodes which appear tubular with mildly thickened cortinces. No vascularity noted. To me, that does not sound fine. She had blood work done as well and her TSH was 5 (??). Can someone please help? She is hoping to return to the ENT to see if he can remove her tonsils due to this ongoing throat ache, dryness, and irritation. She is also scheduled for a follow up with the endo at Moffit in October and I want to go with her and be able to ask the right questions and get the right answers. I don't know if I should be requesting more concrete tests then an ultrasound and if she should be going for follow up to an oncologist instead of an endocrinologist. To make matters worse, her insurance ends in October. I don't know what we'll do after that regarding her continued medical care. Please help. Thank you so much.
Posted Wed, 25 Jul 2012 in Cancer
Answered by Dr. Pravin Banodkar 4 hours later
Thanks for the detailed history which was very informative indeed.

I would like to inform you that she will surely need an opinion of an oncologist . The Oncologist will review her clinically and may ask for an FNAC which is called Fine Needle Aspiration Cytology . It would give a more appropriate study of the cells in the area .

The Ultrasonography reported no vascularity which is a good sign . Sign of vascularity is more commonly a malignant lesion or growth because of inherent activity of rapidly proliferating cells .

She will however surely need an Oncology opinion .

The following medical care is appropriate for patients with papillary carcinoma, a relatively common well-differentiated thyroid cancer:

A scnitiscan is needed after 4-6 weeks of surgery. If any thryoid tissue is left, patients must receive radioiodine therapy to detect and destroy any metastasis and residual tissue in the thyroid. Administer therapy until radioiodine uptake is completely absent. Radioiodine treatment may be used again 6-12 months after initial treatment of metastatic disease where disease recurs or has not fully responded.

Administer the thyroid hormone replacement levothyroxine to patients for life, especially after total thyroidectomy. Treatment consists of administering replacement levothyroxine.

To be able to comment on the TSH levels, I would like to know the units and the standards for your lab. They would usually mention the normal when they report the results. This is so as different labs use different protocols for measurement.
A complete physical exam, TSH and thyroglobulin measurement, and antithyroglobulin antibodies titration is required every 6-12 months after surgery.
Awaiting your reply

Above answer was peer-reviewed by
Follow-up: What is the treatment for papillary cancer? Which specialist should I see for? 58 minutes later
A couple of things. You mentioned she needed a "scnitiscan" after she had surgery. What is that? Her surgery was @ 2 years ago. She did not have anything other then blood work and ultrasound. The endo at the time told us she did not need the radioactive iodine because the cancer was found inside the nodule. As indicated before, I just recently happened to find out that this was not true. I do not have info on the TSH levels but will try to see if my daughter can email the lab as she is now out of the country. What type of "oncologist" should she see? Aren't there different specialties? Should she see an oncologist who specializes in head and neck or endocrine or what and does she then stays with that doctor for continued follow ups? Also, I am hoping to have her tonsils removed. Would this interfere or worsen any possible cancer that may have returned? It is very difficult for me to find information and those who I have called do not return my calls. Thank you for all of your advice. I will try to find an oncologist as soon as hear back what type should I be looking for to set up an appointment.
Answered by Dr. Pravin Banodkar 5 minutes later

Thanks for the reply

Scintiscan is an imaging test that uses a radioactive substance (called a tracer) and a special scanner to find or confirm the presence of specific tumour cells. Most oncology institute would have this scanner and would be able to perform the test.

I would suggest her to consult a head and neck oncosurgeon.

If I were to be her treating doctor, I would hold the tonsil removal till the above matter gets cleared by the Oncosurgeon.

Hope this answers your query. Let me know if you need any other information.
If all your queries are answered, please close this discussion.

Above answer was peer-reviewed by
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