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Parathyroid Cancer

Parathyroid Cancer
City of Hope’s comprehensive approach to parathyroid cancer encompasses sophisticated diagnostic techniques and leading-edge surgical, radiotherapy and chemotherapy treatments for these types of cancers. City of Hope also employs new experimental therapies, which may not be available elsewhere, to fight advanced, aggressive parathyroid cancers.

Parathyroid cancer patients at City of Hope receive treatment from a coordinated, multidisciplinary team of surgeons, oncologists, endocrinologists, radiation oncologists, nurses, supportive care specialists and others, ensuring the highest possible standard of care.
 
About Parathyroid Cancer
 
Parathyroid tumors occur in the parathyroid glands, four small glands located behind the thyroid. Although the majority of parathyroid tumors are benign, carcinomas of the parathyroid (parathyroid cancer) do develop, and it is important to be able to properly diagnose and treat them.

The parathyroid glands secrete a hormone called parathyroid hormone (also known as PTH or parathormone), which regulates the body’s calcium levels. PTH acts on special PTH receptors in three key areas of the body: the bones, kidneys and intestines.

PTH mobilizes the bones to release stored calcium, increases calcium reabsorption from the kidneys, and increases calcium absorption in the intestines via activation of vitamin D. The more PTH secreted, the higher the resulting level of blood calcium. Like many systems in the body, the parathyroids respond to feedback inhibition, so that if blood calcium is very high, this signals the parathyroid glands to reduce PTH production.

When parathyroid tumors develop, they cause heightened production of PTH, which in turn results in elevated blood calcium levels (a condition known as hypercalcemia). The tumor may affect a single gland, or tumors may occur simultaneously in multiple glands. This is more common in certain genetic diseases.

Parathyroid cancer is generally slow-growing and rarely metastases. However, the hyperparathyroidism (excess production of PTH) caused by the parathyroid tumors can be quite dangerous. Additionally, parathyroid tumors have a reasonably high degree of recurrence. Therefore, adept surgical management and supportive care to manage percalcemia is important in effective treatment of parathyroid cancer.
 
 
Parathyroid Cancer Risk Factors
 
  • Age: Most patients are diagnosed in their 40s or 50s.
  • Family history of parathyroid tumors
  • External radiation exposure, especially to the head and neck
  • End-stage renal disease/hemodialysis patients
 
Parathyroid Cancer Symptoms
 
Most parathyroid cancer symptoms are caused by the hypercalcemia that develops. Symptoms of hypercalcemia include the following:
 
  • Weakness
  • Feeling very tired
  • Nausea and vomiting
  • Loss of appetite
  • Being much more thirsty than usual
  • Urinating much more than usual
  • Constipation
 
 
Other symptoms of parathyroid cancer include the following:
 
  • Pain in the abdomen, side or back that doesn't go away
  • Pain in the bones
  • A broken bone
  • A lump in the neck
  • Change in voice such as hoarseness
  • Trouble swallowing
  • Kidney stones
  • Renal insufficiency
  • Peptic ulcer disease
  • Recurrent severe pancreatitis
  • Anemia
 

Staging

Staging is the process of finding out if and how far a cancer has spread. The stage of a cancer is one of the most important factors in choosing treatment options and predicting your chance for cure and long-term survival.
 
Staging is based on the results of the physical exam, the physician’s impression during or after surgery to remove the tumor (presence or absence of the tumor to the thyroid and other organs) and imaging tests (ultrasound, computed tomography scan, magnetic resonance imaging, chest X-ray and/or radioisotope scans).
 
There is no standard staging process for parathyroid cancer. Parathyroid cancer is described as either localized or metastatic:
 
  • Localized parathyroid cancer is found in a parathyroid gland and may have spread to nearby tissues.
  • Metastatic parathyroid cancer has spread to other parts of the body such as the lungs, liver, bone, pericardium (the sac surrounding the heart), pancreas or lymph nodes.
 

Diagnosing Parathyroid Cancer

Parathyroid cancer is not easy to diagnose. It is often difficult to distinguish between a benign parathyroid tumor and parathyroid cancer. Therefore, a variety of tests may be used to establish a diagnosis.
 
Neck palpation

This simple test, which involves your doctor feeling the area around the front of your neck near the thyroid gland, may reveal a cancerous parathyroid tumor. More than 30 percent of parathyroid cancers present with a palpable neck mass.
 
Blood tests

Parathyroid hormone level
Extremely high levels of parathyroid hormone (PTH) may indicate parathyroid cancer yet benign parathyroid adenomas also cause elevated parathyroid hormone levels. Generally, the levels seen in parathyroid cancer are significantly higher.

Serum calcium level
Increased PTH production from either a benign parathyroid adenoma or a malignant parathyroid carcinoma, results in hypercalcemia, producing substantially elevated serum calcium levels. Patients with serum calcium levels exceeding 14 mg/dL, particularly those with a palpable neck mass, may be more likely to have parathyroid cancer.

Alkaline phosphatase level
In many cancers, increased alkaline phosphatase levels serve as a tumor marker indicating bone metastases. In parathyroid cancer, the mobilization of calcium from the bones to the blood also causes alkaline phosphatase levels to increase. These levels are generally elevated significantly beyond the normal range in parathyroid cancer patients

Renal function tests
Certain indicators of renal function such as levels of blood urea nitrogen and creatinine, are more likely to be abnormal in parathyroid cancer.

Sestamibi Scan
In this test, your doctor injects a solution of the radioactive isotope Technetium-99m-sestamibi (sestamibi is the name of the molecule to which the technetium is attached) intravenously. The technetium emits low-energy gamma rays, which can be counted and turned into an image by a “gamma camera” in a process known as scintigraphy.

The premise of the test is that the radiolabeled sestamibi is absorbed by hyperfunctioning (overactive) parathyroid glands, but not in normal parathyroid glands. Therefore, the malfunctioning gland (whether it is a benign adenoma or a malignant carcinoma) can be precisely identified.

Ultrasound
To further characterize your parathyroid tumor, your doctor may suggest an ultrasound. This simple, quick and painless test passes a wand, called a transducer, which emits sound waves, over the neck area to produce an image. Based on this image, your doctor can determine the size, shape and exact location of the parathyroid tumor.

CT, MRI and PET scans
Computed tomography (CT) and magnetic resonance imaging (MRI) scans are sometimes used to stage parathyroid cancer. Staging means gauging the extent of spread of the cancer. They are also used to check for recurrence of the cancer in the neck and if it has spread to other parts of the body. However, CT or MRI scans are rarely used for a definitive initial diagnosis. Posititron emission tomography (PET) scans use a modified sugar compound called fluorodeoxyglucose (FDG). The scan picks up areas of cells that preferentially absorb the FDG. PET scans are also useful to assess spread throughout the neck and in order to monitor for possible recurrence.

Venous sampling
If imaging tests do not show which parathyroid gland is overactive, blood samples may be taken from veins near each parathyroid gland to find which one is making too much PTH.

Biopsy
Unlike in thyroid cancer, biopsy in parathyroid cancer is typically not recommended. If your doctor suspects parathyroid cancer and intends on doing a biopsy to confirm it, you may wish to seek a second opinion. This is because in doing a parathyroid biopsy, there is a significant risk that the capsule of the parathyroid may rupture, causing microscopic tumor cells to seed, or spread – a disastrous consequence.

Parathyroid Treatment Options

Department of Surgery
First-line treatment for parathyroid cancer is surgery. The recommended procedure involves removing the entire parathyroid gland, along with that half of the thyroid gland nearest the tumor (hemithyroidectomy) and nearby lymph nodes. If the recurrent laryngeal nerve is involved, it must also be resected. If the cervical lymph nodes are involved, a more extensive “lateral neck dissection” is then performed.

If the tumor has affected neighboring tissue and cannot be completely removed, then debulking of the tumor (removing as much of the tumor as possible) is performed.

Because parathyroid cancer grows very slowly, cancer that has spread to other parts of the body may be removed by surgery and the disease process may be controlled for a considerable period of time. This is known as metastasectomy.

Surgery for parathyroid cancer sometimes damages nerves of the vocal cords. There are treatments to help with speech problems caused by this nerve damage.

During surgery, the lymph nodes are examined and may be removed if cancerous. In medullary thyroid cancer, in addition to total thyroidectomy, a central neck dissection (removal of all lymph nodes and fatty tissues in the central neck area) is usually performed.

In many cases of well-differentiated, localized thyroid cancer, thyroidectomy affords an excellent chance of cure or long-term survival. However, radioiodine therapy (discussed below) is usually given to destroy any residual thyroid cancer cells that may remain after thyroidectomy. Regular follow-up visits with your physician, which includes diagnostic scans, are important to detect any recurrence.

Radiation Therapy
In general, radiation therapy is rarely used to control tumor growth and reduce hormone production. In some cases, external radiation to the neck in microscopic residual disease has been shown to help in curbing recurrence.

Follow-up
Because parathyroid cancer can recur, parathyroid cancer patients should be followed closely for any signs of recurrence or metastasis. This is accomplished by regular physical exams that include neck palpation, monitoring of blood levels of calcium and parathyroid hormone, as well as sestamibi or thallium scans to detect hyperfunctioning parathyroid tissue. Ultrasound, computed tomography and magnetic resonance imaging may also be useful imaging methodologies.

Supportive Care

To manage patients after surgery who have low calcium levels, the following may be prescribed:
 
  • Calcium supplements
  • Calcitriol

Occasionally, the parathyroid cancer patient continues to have some degree of hypercalcemia, which can be managed with:
 
  • IV fluids
  • Diuretics
  • Drugs that inhibit bone resorption
  • Drugs that inhibit PTH secretion

Clinical Trials
City of Hope has several clinical trials involving experimental therapies for advanced solid tumors of the head and neck. Some of these may apply to parathyroid cancer.  Click here for more information.

Resources

All of our patients also have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
EndocrineWeb
EndocrineWeb is a comprehensive Web site for thyroid, parathyroid and other endocrine disorders intended for the education of patients and their families. All pages were written by physicians who treat these diseases.
www.endocrineweb.com
 
Phone: 800-ACS-2345
For TYY: 866-228-4327
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
www.cancer.org
 
National Comprehensive Cancer Network (NCCN)
Phone: 888-909- NCCN (6226)
The National Comprehensive Cancer Network is an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
www.nccn.org
 
National Cancer Institute (NCI)
Phone: 800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
www.cancer.gov
U.S. Dept. of Health and Human Services National Institutes of Health (NIH)
Phone: 301-496-4000
For TYY: 301-402-9612
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health and Human Services.
www.nih.gov
 

Parathyroid Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
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