Parathyroid Cancer

What is parathyroid cancer?

Parathyroid cancer, a very rare cancer, is a disease in which cancer (malignant) cells are found in the tissues of the parathyroid gland. The parathyroid gland is at the base of the neck, near the thyroid gland. The parathyroid gland makes a hormone called parathyroid hormone (PTH), or parathormone, which helps the body store and use calcium.

Problems with the parathyroid gland are common and are usually not caused by cancer. The parathyroid gland may become overactive and make too much PTH, a condition called hyperparathyroidism. This causes too much calcium to be found in the blood. The extra PTH also takes calcium from the bones, which causes pain in the bones, kidney problems, and other types of problems. There are other conditions that can cause the parathyroid gland to make too much PTH. It is important for a doctor to determine what is causing the extra PTH. Very rarely, hyperparathyroidism is caused by cancer of the parathyroid gland, and too much PTH will be produced by the tumour. A rare inherited disorder of the parathyroid called familial isolated hyperparathyroidism may increase the risk of developing parathyroid cancer. A rare inherited disorder of the endocrine glands called multiple endocrine neoplasia 1 has also been linked with an increased risk of developing parathyroid cancer.

A doctor should be seen if there are the following symptoms: bone pain, a lump in the neck, pain in the upper part of the back, weak muscles, difficulty speaking, or vomiting.

If there are symptoms, the doctor will conduct a physical examination and feel for lumps in the throat. The doctor may also order blood tests and other tests to check for cancer or other types of tumours that may not be cancer (benign tumours).

The chance of recovery (prognosis) depends on whether the cancer is just in the parathyroid gland or has spread to other parts of the body (stage) and the patient’s general health.

Stage Explanation

Stages of parathyroid cancer

Once parathyroid cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for parathyroid cancer.
Localised

The cancer is in the parathyroid gland and may or may not have spread into nearby tissues.
Metastatic

The cancer has spread beyond nearby tissues to lymph nodes in the area or to other parts of the body, such as the lungs, liver, bone, membrane around the heart, and pancreas.
Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the original place or in another part of the body.

Treatment Option Overview

How parathyroid cancer is treated

There are treatments for all patients with parathyroid cancer. Medical treatment to lower high blood levels of calcium caused by the disease is very important for all patients. In addition, three kinds of treatment are used:

1. Surgery (taking out the cancer).
2. Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
3. Chemotherapy (using anticancer drugs).

Surgery is the most effective treatment for parathyroid cancer. A doctor may remove the parathyroid gland (parathyroidectomy) and the half of the thyroid on the same side as the cancer (ipsilateral thyroidectomy). Nearby muscles, tissues and nerves may also be removed to prevent the cancer from spreading.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the parathyroid gland.
Treatment by stage

Treatment for parathyroid cancer depends on the type and stage of the disease and the patient’s age and overall health.

Localised Parathyroid Cancer

Treatment may be one of the following:

1. Surgery to remove the parathyroid gland (parathyroidectomy), the half of the thyroid on the same side as the cancer (ipsilateral thyroidectomy), and possibly other tissues around the thyroid. Medical treatment before surgery for high blood calcium levels and other complications of hyperparathyroidism is very important.
2. Surgery followed by radiation therapy.
3. Radiation therapy.

Metastatic Parathyroid Cancer

Parathyroid cancer which has spread beyond nearby tissues to areas such as the lungs may appear soon after surgery, or as much as 20 years later. Because parathyroid cancer tends to be slow-growing, some patients live for many years even after the cancer has spread.

Treatment may be one of the following:

1. Surgery to remove the cancer from the places where it has spread.
2. Medicine to reduce the amount of calcium in the blood.
3. Surgery followed by radiation therapy.
4. Radiation therapy.
5. Chemotherapy.

Recurrent Parathyroid Cancer

In about half of patients who have surgery for parathyroid cancer, the disease recurs (comes back), usually within 2 to 5 years. Because parathyroid cancer tends to be slow-growing, repeated surgeries to remove cancer which has come back can lower the level of parathyroid hormone and extend survival.

Treatment may be one of the following:

1. Surgery to remove the cancer which has come back in the area of the thyroid or in other parts of the body.
2. Medicine to reduce the amount of calcium in the blood.
3. Surgery followed by radiation therapy.
4. Radiation therapy.
5. Chemotherapy.


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