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Hurthle cell cancerBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660
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Hurthle (HEERT-luh) cell cancer is a rare form of cancer affecting the butterfly-shaped thyroid gland in the front part of the lower neck. The thyroid secretes hormones that are essential for regulating your body's metabolism.
Hurthle cell cancer is also called Hurthle cell carcinoma or oxyphilic cell carcinoma. Hurthle cell cancer is one of several types of cancer that affect the thyroid.
Hurthle cell cancer can be more aggressive than other types of thyroid cancer. Surgery to remove the thyroid gland is the most common treatment for Hurthle cell cancer.
Signs and symptoms of Hurthle cell cancer may include:
- A fast-growing lump (nodule) in your neck, just below your Adam's apple
- Pain in your neck or throat
- Hoarseness or other changes in your voice
- Shortness of breath
- Swallowing difficulty
These signs and symptoms don't necessarily mean you have Hurthle cell cancer. They may be indications of other medical conditions — such as inflammation of the thyroid gland or a noncancerous enlargement of the thyroid (goiter).
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
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It's not clear what causes Hurthle cell cancer.
Doctors know that cancer begins when a cell develops errors in its DNA. DNA is the genetic material that contains the instructions for every biochemical process in your body. When DNA is altered or damaged, these genes may not function properly, causing cells to grow out of control and eventually form a mass (tumor) of cancerous (malignant) cells.
Factors that increase the risk of developing Hurthle cell cancer include:
- Being female
- Older age
- Radiation treatments to the head and neck
Possible complications of Hurthle cell cancer include:
- Difficulty swallowing and breathing. This can occur if the tumor grows and presses on the esophagus and trachea.
- Spread of the cancer. Hurthle cell cancer can spread (metastasize) to other tissues and organs, making treatment more difficult and diminishing the chances of recovery.
Preparing for your appointment
Start by making an appointment with your family doctor or a general practitioner if you have signs and symptoms that worry you. If Hurthle cell cancer is suspected, you may be referred to a doctor who specializes in treating thyroid disorders (endocrinologist) or a doctor who specializes in treating cancer (oncologist).
Because appointments can be brief, it's often helpful to arrive well prepared. Here's some information to help you get ready and what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Consider asking a family member or friend to come with you. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
- Gather information about your family health history, including thyroid diseases and other diseases that run in your family.
Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For Hurthle cell cancer, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- What treatments are available, and which do you recommend?
- What's my prognosis?
- What types of side effects can I expect from treatment?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any dietary or activity restrictions that I need to follow?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to discuss points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- Have they gotten worse?
- Do you have any family history of cancer? What type?
- Have you ever had cancer? What type and how was it treated?
- Have you ever received radiation treatments to the head or neck area?
Tests and diagnosis
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Tests and procedures used to diagnose Hurthle cell cancer include:
- Physical exam of the thyroid. Your doctor will examine your neck, checking the size of your thyroid and seeing whether your lymph nodes are swollen.
- Blood tests to check thyroid function. Blood tests may reveal abnormalities in your thyroid function that give your doctor more information about your condition.
- Imaging tests. Imaging tests can help your doctor determine whether an abnormal growth is present in the thyroid. Ultrasound is often used to create images of the thyroid gland. In other cases, imaging tests may include computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).
- Removing a sample of thyroid tissue for testing. If your doctor finds a tumor on your thyroid, a biopsy can help determine whether the tumor is cancerous or not. During a thyroid biopsy, your doctor passes a fine needle through the skin of your neck. Ultrasound imaging may be used to guide the needle into the tumor. The needle is attached to a syringe, which is used to withdraw thyroid tissue through the needle. The sample is sent to a laboratory where it's examined for signs of cancer.
Treatments and drugs
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Treatment for Hurthle cell cancer may include:
Surgery to remove the thyroid
Total or near-total thyroidectomy is the most common treatment used for Hurthle cell cancer. During this operation, all or nearly all of the thyroid gland is removed. The surgeon leaves tiny edges of thyroid tissue near the adjacent parathyroid glands to lower the likelihood of parathyroid injury. These small parathyroid glands regulate your body's calcium level. Surrounding lymph nodes may be removed if there's suspicion that the cancer has spread to them.
The greatest risk associated with the operation is unintended injury to the recurrent laryngeal nerve, which could cause temporary or permanent hoarseness or a loss of your voice. Other complications include damage to the parathyroid, excessive bleeding and infection.
After surgery for Hurthle cell cancer, your doctor will prescribe the hormone levothyroxine (Levoxyl, Levothroid, others), which replaces the hormone no longer being produced because of the absence of the thyroid. You'll need to take this synthetic hormone for the rest of your life.
Radioactive iodine therapy
Radioactive iodine therapy involves swallowing a capsule that contains a radioactive liquid.
Radiation therapy using a capsule containing radioactive iodine-131 is often prescribed following surgery for Hurthle cell cancer. It may help to destroy any microscopic thyroid tissue that remains after surgery. At times, a higher dose of radioiodine can be used to eliminate any malignant cells that have spread to other parts of the body.
Radioiodine therapy can cause temporary side effects including sore throat, dry mouth, decrease in taste sensations, neck tenderness and nausea.
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table with a machine moved around you delivering the radiation to specific points on your body. Radiation therapy may be an option if cancer cells remain after surgery and radioactive iodine treatment.
Radiation therapy side effects include a sore throat, a sunburn-like skin rash and fatigue.
Although many alternative or nontraditional treatments — from vitamins to herbs — are sometimes promoted for use in treating cancer, none has been proved helpful in the management of Hurthle cell cancer or other types of thyroid cancer. If you have questions about a specific alternative treatment, talk with your doctor about the potential risks and benefits of the treatment.
There are few specific measures you can take to prevent Hurthle cell cancer. However, you may be able to lower your risk by reducing your exposure to radiation from X-rays and other sources whenever possible.
Coping and support
A diagnosis of Hurthle cell cancer can be challenging and frightening. Even when a full recovery is likely, you may worry about a recurrence of the disease. But no matter what your concerns or prognosis, you're not alone. Here are some strategies and resources that may make dealing with this cancer easier:
- Know enough to make decisions about your care. Find out enough about your condition in order to feel comfortable making treatment decisions. Ask your doctor about your cancer, as well as your treatment options and their side effects. The more you know, the more confident you'll be when it comes to making decisions about your care. Look for information in your local library and on reliable websites. Start with the National Cancer Institute and the American Cancer Society.
- Maintain a strong support system. Friends and family can be your best allies as you face cancer. They often want to help, so take them up on offers to make meals or provide transportation. Sometimes the concern and understanding of a formal support group of cancer survivors can offer a unique type of emotional support and encouragement. You may also find you develop deep and lasting bonds with people who are going through the same things you are. There are also support groups for the families of cancer survivors.
- Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able to work full time, for example, but you may be able to work at least half time. In fact, many people find that continuing to work can be helpful.
- Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or limit what you do.
- Lai SY, et al. Management of thyroid neoplasms. In: Flint PW, et al. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05283-2..X0001-8--TOP&isbn=978-0-323-05283-2&uniqId=230100505-57. Accessed Dec. 28, 2011.
- Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Falls Church, Va.: American Thyroid Association. http://thyroidguidelines.net/revised/taskforce. Accessed Dec. 28, 2011.
- Thyroid carcinoma. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Dec. 28, 2011.
- What you need to know about thyroid cancer. National Cancer Institute. http://cancer.gov/cancertopics/wyntk/thyroid. Accessed Dec. 28, 2011.