Parathyroid Treatment Approaches

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.