Staging Your Cancer
After it's been determined that you have cancer, the next step is figuring out what stage it's at. Staging helps your doctor determine future treatments. The stage you're at depends on your age, the size of the tumor, and whether it has spread.
In your research, you may come across different staging systems. But all of them follow about the same pattern. People who are younger and have smaller tumors are generally at the earlier stages of cancer and have higher chances of survival. People who are older and who have larger tumors are considered to be in the more advanced stages and have a reduced chance for survival.
In patients where the cancer has spread, the prognosis is worse than it would be if it had stayed local. The good news is, most patients can still be treated and survive.
What is the five-year relative survival rate?
This phrase refers to the percentage of patients who are still alive at least five years after their cancer is diagnosed. When they say early-stage papillary thyroid cancer patients have a five-year relative survival rate of 100 percent, it means 100 percent of those diagnosed in a given year are still alive five years later.
In most people, surgery is supplemented with RAI therapy. RAI is used to destroy any lingering thyroid tissue that was not removed by surgery or to treat thyroid cancer that has spread to other parts of the body. RAI is the only way to kill cancer cells in the thyroid gland without causing harm to other parts of the body.
Before receiving RAI, you will be asked to temporarily discontinue your thyroid hormone pills and eat a diet low in iodine. That's because you need high levels of TSH in order for the therapy to be most effective. Without enough thyroid hormone, your pituitary gland will produce more TSH, which, in turn, will encourage the papillary and follicular forms of cancer to take up the RAI that destroys them. The low-iodine diet is needed so that ingested iodine does not interfere with the iodine in the RAI.
The first dose of RAI is called the ablation dose, and it is usually given about six weeks after surgery to wipe out any remnants of thyroid tissue. After that, your doctor will determine your schedule of RAI treatments and how long you will need them. Some treatments for cancer will require a two- or three-day hospital stay, but others can be done on an outpatient basis.
In cases where the cancer has spread to other organs, patients may be given lithium before and after RAI. Lithium is best known as a treatment for bipolar disorder. In thyroid cancer, lithium enhances the effects of the RAI in cancer cells outside the thyroid, causing the RAI to remain in the cells for a longer duration.
After receiving high doses of RAI, you may be required to stay in an isolated room so that your radioactivity does not harm other people, including the hospital staff. Items in the hospital room may be covered in protective material so that patients who stay in the room after you do not become contaminated.
Upon discharge, you will be told to take precautions for several days so that you do not contaminate others. Here's a list from the AACE:
Use private toilets, and flush twice after each use.
Bathe daily and wash hands frequently.
Use disposable eating utensils or wash yours separately.
Sleep alone, and avoid prolonged close contact.
Launder your linens, towels, and clothes daily and separately from others.
Do not prepare food for others that requires prolonged handling.
Steer clear of small children.
The rigors of these guidelines can temporarily change your life. Janet, for example, sent her family to live with her parents.
During this time, Janet covered the furniture she used with sheets, ate off of paper plates, and wore latex gloves the entire time. She also confined herself to two rooms. Before her family returned, she did numerous loads of laundry and wiped down all the surfaces. She recalled the experience as rather strange.
Some people will experience permanent side effects from RAI. You may notice tenderness in your neck, nausea, stomach irritation, and dry mouth. Some women may notice that their periods become irregular, and men who receive large doses may be at risk for infertility. Women of childbearing age are advised not to get pregnant for six months to a year after RAI treatment.
If you've been asked to cut back on iodine for an upcoming RAI treatment, check out the Low-Iodine Cookbook online at the Thyroid Survivors' Association, Inc.'s Web site, at
If your cancer has spread to other organs or if you have medullary cancer that does not take up iodine, you may be given external beam radiation therapy or chemotherapy. External radiation involves a focused beam delivered from a machine outside the body. The powerful X-rays target and destroy the cancerous cells. Treatment is usually given five days a week for about six weeks. In some cases, the radiation can damage healthy tissue nearby. Some people also experience severe fatigue and temporary damage to the skin.
Chemotherapy involves anticancer drugs that are injected into the body or taken orally. The drugs enter the bloodstream, where they circulate throughout the body. The problem is, chemotherapy can often damage healthy cells along with the cancerous cells. The damage may put you at risk for infection, bleeding, and fatigue. You may also experience side effects such as nausea and vomiting, loss of appetite, hair loss, and mouth sores.