papillary thyroid cancer


I went to the dentist yesterday for a routine check up and cleaning.  (I’m happy to report that I have no cavities!)  As the days got closer to my appointment, I found myself thinking about the dental x-rays and wondering about radiation exposure.  As a cancer survivor, the last thing that I want or need in my body is more radiation.  The RAI (Radioactive Iodine  – also known as I-131) was more than enough for me, thank you.  I know that there is radiation in the x-rays, but didn’t know how much. 

Knowledge is Power!  I have the means to find out and educate myself on radiation.  And that is what I did.  I started with the FDA site and found an article called “Reducing Radiation for Medical X-rays” that had tons of information.  I didn’t know the specifics about x-rays until I read it in the FDA article.  It said “X-rays are a form of electromagnetic radiation that can penetrate clothing, body tissue, and internal organs. An X-ray machine sends this radiation through the body. Some of the radiation emerges on the other side of the body, where it exposes film or is absorbed by a digital detector to create an image. And some of it is absorbed in body tissues. It is the radiation absorbed by the body that contributes to the “radiation dose” a patient gets.”

The FDA also had this short video on their site about radiation and x-rays:

The more research I found, the more concerned I got.  Advancements in technology are leading to new kinds of scanners, like the cone-beam CT scanner used at many dental offices.  According to the NY Times article Radiation Worries for Children in Dentists’ Chairs, “Some states have in effect no inspections of dental X-ray units,” said Dr. G. Donald Frey, professor of radiology at the Medical University of South Carolina and a past president of the American Association of Physicists in Medicine. While inspectors generally evaluate machine performance, few attempt to measure the overall radiation risk to the patient’s organs.  “States tend not to want to regulate the practice of medicine or dentistry,” Dr. Frey said.

The real “jaw dropper” was the video called “The Price of a Smile” posted by the NY Times.   This video digs a little deeper into some of the new technology embraced by some dentists and orthodontists.  It really makes you wonder if money has become more important than health.  Here is the video:  http://video.nytimes.com/video/2010/11/22/us/1248069363524/the-price-of-a-smile.html

My vision for this post was to share information on radiation and x-rays used in the dental profession as well as other medical professions.  However, after reading a few articles and watching a couple short videos on the dental industry’s use of x-rays and scans, I found more than I expected.  It was more than I wanted to be “exposed” to. 

As for my dental visit, I was never even asked to have any x-rays done.  I had them over a year ago, but they did not see the need for them during my visit.  Go figure!  (Oh and I’m happy to report no cavities.) 

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It’s easy to crunch the numbers on thyroid cancer and assume it is a disease fast on the rise. Incidence has more than doubled since the early 1970s, and for women, it is the cancer with the fastest-growing number of new cases.

But not every statistic tells the obvious tale. Despite the increase, thyroid cancer — a very treatable disease that develops in a butterfly-shaped gland in the neck — is still relatively uncommon.

Many people develop benign lumps, known as nodules, in the neck, but only one in 20, or less than 45,000 cases a year, are malignant. Even fewer patients have an aggressive form of the disease, which has a survival rate of nearly 97 percent after five years and results in an estimated 1,690 deaths each year. Over the last few years, however, studies showing there has been a significant increase in incidence, and even mortality, in certain groups have caused much debate in the scientific community.

“I don’t think there is any question that there is an increasing incidence of thyroid cancer,” said Dr. Kenneth Burman, chief of the endocrine section in the department of medicine at Washington Hospital Center in Washington, D.C. “But it is not that simple. The question is whether or not it is related to detection and radiological studies, or if it is related to an authentic rise in thyroid cancer.”

It is a question that still remains largely unanswered. Evidence from the Surveillance, Epidemiology and End Results database, a registry of cancer cases that is kept by the National Cancer Institute, leaves little question that there are more cases of thyroid cancer today than three decades ago. But the more important question, as Dr. Burman points out, is whether these statistics indicate a true rise in the disease or are simply a result of better diagnostic tools.

Over the last three decades, ultrasound and fine-needle biopsies have helped diagnose thousands of cases that would never have been found before. In many cases, nodules are discovered by accident during another medical investigation.

A study published in The Journal of the American Medical Association first brought this issue to light in 2006. Researchers concluded that the reported 140 percent increase in thyroid cancer from 1973 to 2002 was simply a result of “increased diagnostic scrutiny.”

They argued that a true increase in incidence would be reflected in every stage of the cancer. But the study showed that 87 percent of the increase was from small papillary thyroid cancer tumors — the most common and treatable type of thyroid cancer — that were less than two centimeters in size. Many of these cases, the researchers say, would never have caused any problems. In fact, studies have shown that thyroid cancer is found in nearly 4 percent of all fine-needle aspiration biopsy specimens.

“These cases have been there all along,” said Dr. Louise Davies, assistant professor of surgery in the division of otolaryngology, head and neck surgery at Dartmouth Medical School. “We just didn’t see them until now. Understanding this requires that you think about the word ‘cancer’ in a different way than we usually do. You can have increased rates of incidence without changing the number of people who die.”

But the mortality rate is a little more complicated than that. Survival rates, after five years, increased 4.7 percent in women, who are three times as likely to develop the disease as men, from 1974 to 2001. In men, however, the annual percentage change in thyroid cancer mortality increased significantly, by 2.4 percent, from 1992 to 2000 — the highest jump of any cancer. That is one reason many other experts argue that diagnostic tools are not the only factor.

“I think it is an oversimplification to say the increase in diagnosis is from the overuse of technology and only relates to small tumors that are insignificant,” said Dr. Steven Sherman, medical director of the endocrine center at the University of Texas M.D. Anderson Cancer Center in Houston. “There is a component that relates to increased technology, but until we can do a better job at predicting the outcomes for individuals who develop cancer we still need to treat each case.”

Physicians are fairly clueless about what else could account for this mysterious rise in incidence. Exposure to radiation from the Chernobyl nuclear power plant accident in 1986 and radioactive fallout from nuclear weapons testing in the 1950s have long been linked to thyroid cancer, but they would not account for all the new cases.

Regardless of the reported increase in small tumors, the standard of care for thyroid cancer remains the same as it was two decades ago. Patients must undergo a thryoidectomy, a surgical procedure that removes all or half of the thyroid gland. Afterward, many patients also require a radioactive iodine treatment, which kills any remaining cancer cells.

Dr. Bryan McIver, a physician in the division of endocrinology, diabetes, metabolism and nutrition at the Mayo Clinic in Rochester, Minn., said of the surgical default, “Even though the evidence does not support that it is beneficial, there is an increasing trend in the U.S., and probably worldwide, to treat all thyroid cancers in the most aggressive way.”

As a result, surgeons like Dr. Davies think the increase in diagnosis does patients with small tumors a disservice. “I don’t think it is helpful when patients pick it up by accident,” she said. “It distracts them from the problem they came in with and leads to unnecessary treatment. The mortality rate of papillary thyroid cancer is lower than the surgical complication rates.”

Since thyroid cancer has long been thought of as a disease that requires surgery, experts are starting to rethink how they approach the rapidly increasing number of small tumors.

“Sometimes I think we are doing more harm than good with these small tumors,” Dr. McIver said. “But there is also going to be a subset of these small tumors that are caught early and would have caused a problem. It’s hard to ignore a diagnosis of cancer.”

This article is from the New York Times

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I am all about promoting thyroid cancer awareness month in September.  That is why I was super-excited when I found out that Dear Thyroid had a blog tour to help spread the word.  They posted the following on their site:   “During the month of September, Dear Thyroid is going on a blog tour to promote awareness for thyroid cancer. For this blog tour, we’ll be asking bloggers to write a post on their own blog that addresses some questions provided by Dear Thyroid regarding thyroid cancer and thyroid cancer awareness. On the day we are scheduled to make a “stop” at your blog, Dear Thyroid will post a brief description of your blog along with a link from our website to yours.”
September 2, 2010 is the day the link to this post that you are reading at this very moment will be featured on the Dear Thyroid site.  So pleeeeease continue to show your support by sharing this post with others and making a “virtual” difference.  (Thank you!!)  Below are the questions from Dear Thyroid and my answers.  And away we go…
  • What kind of thyroid cancer were you diagnosed with? How many years have you been a survivor?

I was diagnosed with Papillary Thyroid Cancer in October 2008.  I believe that I became a cancer survivor the moment after I was given the diagnosis.  That is when I started my fight.  Some consider themselves cancer survivors once they become cancer-free, which for me was May 2009.  After going through this battle, I see anyone diagnosed with cancer as an immediate survivor.

  • September is thyroid cancer awareness month. What does that mean to you? Why do you think awareness is important? How do you spread awareness?

To me, thyroid cancer awareness month means joining forces to spread the word about prevention, early detection and the facts about thyroid cancer.  One of the reasons I started my Thyroid Cancer Survivor blog was to spread awareness about thyroid cancer and to share my journey as a cancer survivor with others.  Awareness is important because it gives people a better chance to check their neck and find thyroid cancer earlier.

  • Many thyroid cancer patients have been told, “If you have to get cancer, thyroid cancer is the one to get.”  What do you think of that statement? When you’re told this, how do you respond?

When my doctor told me that I had papillary thyroid cancer, I was shocked.  I remember him telling me that if I had the option to pick which cancer I would want, I would want thyroid cancer.  At the time, it made me feel better.  I didn’t know too much about thyroid cancer back then.  I guess my doctor was trying to make me feel better and take some of the fear away.  Now I know that cancer is cancer.  One is not better or worse.  No type of cancer should be minimized.  I’ve also heard people refer to thyroid cancer as the little “c”.  It’s not worth getting upset about.  That only feeds those cancer cells. I usually smile and let them know cancer does not come in a “lite” version.

  • Dear Thyroid is constantly working to dispel the myth that thyroid cancer is the good cancer or the easy cancer. What other myth would you like to dispel regarding thyroid cancer?

Some of us get to go through the radioactive iodine treatment, people asked me if I glowed in the dark.  It was tempting to say yes, but the truth you don’t glow in the dark.  That is a myth!

Another myth is that once the cancer treatment is over and you get a clean scan, you can put it behind you. Thyroid cancer survivors have to go back every six months the first few YEARS for scans and blood work.  There is a 30% recurrence rate, so it is very important to stay on top of it.  Thyroid cancer is never over.  That is the myth.  It is a lifelong battle because those sneaky thyroid cancer cells are always trying to multiply.

  • What one thing would you tell the world about thyroid cancer?

This cancer journey has given me a new perspective and appreciation for life.  I am so grateful to be a survivor.

  • What advice would you give to a newly diagnosed thyroid cancer patient?

You are not alone.  You will get through it.  Learn all that you can about it (Tips for ThyCa Newbies and ThyCa is a good place to start).  Be an advocate for your health. You are responsible for your health and to speak up.  Never be afraid to ask the doctor a question.  Talk about how you are feeling.  Find people who have gone through it. Use it as an excuse to follow a dream and do something you have always wanted to do!

Dear Thyroid is a thyroid support community and literary brand. Our goal is to connect patients with each other, to create awareness for thyroid diseases and cancers, and to give all thyroid patients a voice. We come together as a united front to invoke change on behalf of thyroid patients worldwide. Thyroid patients are invited to submit letters to their thyroids, thyroid rants and raves, and other literary creations. Help us to create awareness for thyroid diseases and cancers by wearing your disease on your sleeve and by requesting one of our free awareness bands. Visit DearThyroid.org to learn more!

Summer is almost over. (frown) The back to school bug is in the air.  September is just around the corner.  You know what that means? Yep. You got it.  Thyroid Cancer Awareness month is almost here.  So I’m taking a moment to be proactive and get this virtual pep rally going!

Let me start by giving you some of the history behind Thyroid Cancer Awareness month.  According to the Thyroid Cancer Survivors’ Association (ThyCa), “Thyroid Cancer Awareness Month is a worldwide observance, sponsored and initiated by ThyCa: Thyroid Cancer Survivors’ Association. It began in 2000, as a week in September. In 2003, it expanded to the whole month of September…Thyroid Cancer Awareness Month promotes thyroid cancer awareness for early detection, as well as care based on expert standards, and increased research to achieve cures for all thyroid cancer. People and organizations in 55 countries around the world take part.

As a thyroid cancer survivor, I am on a mission to spread awareness and do my part to help others.  This blog gets the word out about thyroid cancer, cancer survivorship and more.   Are you playing a part to spread awareness?  If you need some tips, take a look at ThyCa’s 10 Tips on How to Help.

Last week I went for my six month follow-up thyroid ultrasound.  I was pleasantly surprised to be greeted by a very nice person at the front desk who treated me like a person with feelings instead of a person ordering cheese at the deli. (Next in line!)  Even Marie, the Ultrasound Technician was compassionate and relaxed.  She really took her time with me during the ultrasound.

The last time I had the ultrasound, they found two lymph nodes that were swollen.  My Endo said that we would keep an eye on it during the next follow-up ultrasound.  So this time when I was laying on the table with the warm gel on my neck and the ultrasound wand sliding around, my nerves were shot. 

Marie told me that there were two lymph nodes sticking out on the left side.  They were in the same area as the ones that were swollen six months ago.  Oh No!  She moved around and hovered the wand over the other side of my neck and found two more that were sticking out.  I felt sick and a wave of fear rushed over me.  Marie said “off record” that the lymph nodes looked like regular ones to her.  Well that did not make me feel better.  What Marie didn’t know is that I found out after my thyroidectomy that the cancer had spread to five  of the seven lymph nodes they removed during the surgery.

When I left the appointment I decided not to let the potential upsetting news get me down.  I walked back out as a thyroid cancer survivor!  I have not heard any good news or bad news yet.  I’m waiting for the results.  My appointment to go over the ultrasound results and blood work is not until February 2.  I can’t remember if my doctor called me prior to our appointment last time or not. 

Waiting for the results is starting to take a toll on me.  I am so good at focusing on gratitude and holding on to the fact that everything is going to be alright.  I consider myself to be a positive person with a wonderful support network that are here for me through it all.  But this waiting for results thing is really difficult.

I’ve been really emotional the past couple of days.  I feel really sensitive to everything and on edge.  The fear of what might be lurking in those lymph nodes is in the back of my mind.  I’m scared.  I hope and pray that the cancer has not come back to more lymph nodes.  Regardless, I can’t do anything about it now except write this post and know that the other people reading this understand.  And in turn it helps me to not feel so alone.

If possible, I’d like to keep my “thyroid cancer survivor” status for the rest of my life.  That’s what I was yesterday and again today and hopefully tomorrow as well.  But to stay on top of those sneaky thyroid cancer cells, my Endo Dr. recommended a thyroid ultrasound and blood work tests twice a year for a very long time to come.  Oh Joy…NOT!

I just made my “thyroid-less” ultrasound appointment for next week.  (Since I had a total thyroidectomy last January, I now refer to it as a “thyroid-less” ultrasound.)  This will be my second time doing the six month check of my neck routine.  The first time (post-cancer) I had the ultrasound done, the technician seemed to hover over the upper left side of my neck. She smoothly glided the ultrasound wand around the gel over my neck without any cause for suspicion.  Then she got to that one spot on the left and I felt my stomach start to form imaginary knots.  It’s one of the worst feelings in the world…overwhelming fear!

The results did show some swollen lymph nodes which usually happen if you’re getting sick.  Normally there is no cause for concern, but since I had cancer, my Endo Dr. wants to see what the results show next time.  I guess that is supposed to make me feel better?  So almost six months have gone by and I have only thought about the thyroid ultrasound a handful of times.  But the occurence in the number of thoughts dramatically increased after I made that ultrasound appointment for next week.  The overwhelming flood of thoughts and feelings are back! 

At times, being a cancer survivor is like being a passenger (or hostage) on a ship sailing along the sea of the unknown.  I’m not in control of where it will go.  At times, there are lots of storms out at sea.  Then without warning, the ship sails into peaceful, calm waters.  I found myself starting to feel a little sea-sick thinking about the upcoming ultrasound.

It starts with the fear-based thoughts.  “Is there going to be a swollen lymph node on the left side of my neck again?”  “I don’t want to go through this again.”  “What if they find another nodule in my neck?”  “I’m gonna have to have surgery again.”  “I feel so anxious.”  “I can’t stop thinking about it.”  “I know the cancer is back.” “I’m going to have to miss more time from work.” “People are probably so tired of hearing me talk about it.”

Then come the faith-based thoughts.  “Everything is fine in this moment.”  “My Higher Power is right here with me.”  “I am taking care of myself by getting the ultrasound.”  “Everything is fine.”  “I’m a survivor!”  “I’m going to keep things in perspective.”  “What’s the point of worrying?”  “I am focusing on the good thoughts and allow the negative ones to melt away.”  “I have so many friends and family that love and support me.”  “I am so grateful to be alive today.”  “I’m going to live each moment to the fullest!”

So back and forth my thoughts go over the course of the day.  And as I write about it, I feel a calmness coming over me.  There’s a quiet voice that let’s me know once again that it will work out the way it works out.  Besides, it will all be done by this time next week.  Well, at least done until the next six months go by. 🙂

Some may call it six degrees of separation, the butterfly effect or good timing, but I call it a small world.   Here’s the cool little story.  About a year ago, I started “tweeting” on the international social networking site called Twitter.  At the time I had just been diagnosed with having papillary thyroid cancer and was tweeting all about it.  That’s where I “virtually” met Chris Prestano.  She had also been recently diagnosed with thyroid cancer.  So we had a common bond.  (Now keep in mind that Twitter has millions of people on the site from all over the world.  What are the odds of Chris and I connecting?)

Chris and I eventually became friends on Facebook as well.  We needed a place that gave us more than 140 characters at a time to message back and forth!  We emailed and IM’d over the course of several months, keeping each other updated on our progress and treatments. 

I soon discovered that Chris was living in NYC and traveling to Johns Hopkins Hospital for her doctor’s appointments, treatments and all the other fun things we get to do when being treated for thyroid cancer.  Well that might not seem like such a big deal to you, but it was to me.  Why? Because I was also was going to Johns Hopkins Hospital for my treatment during that time!  Well that’s just the beginning, so read on…

Chris told me about an organization called ThyCa and how they had monthly thyroid cancer support meetings in Baltimore, MD.  This sounded great to me and it close enough for me to drive there.  I really wanted to connect with other people face to face who had experience to share about thyroid cancer.  I decided to go to my first ThyCa meeting in November.  Chris was going to be in town that same week, so we decided to meet at the meeting.  It was nice to finally meet her in person.  We went to lunch after the meeting and spent a couple hours sharing “our stories” and our ups and downs.  What strong women we are!  During lunch, we were talking about cancer fundraisers and how thyroid cancer is in the shadows of it all.  I mean how often do you see people walking around with a ribbon for thyroid cancer? Exactly!  We wanted to do something.  Chris mentioned the American Cancer Society’s Relay for Life and it sounded really interesting to me.  So that is when the seed was planted for what has now turned into our “Wings of Hope” team.

I was contacted by the wonderful Katie Schwartz, Founder of the amazing site Dear Thyroid to write a post on my blog in December for their upcoming “Thyoliday Blues and Truths” series. When Katie asked me to pick a date for Dear Thyroid to post it on their site, I went with December 1.  

It seemed like all of these “thybulous” things started to snowball.  Chris got more info about Relay for Life and registered our team. Angel (another thyroid cancer survivor and ThyCa meeting attendee) joined our team and we were super excited!  It was actually coming together.  And it just so happens that Dear Thyroid had been in contact with Chris and offered to provide us with shirts for Relay for Life!  

So December 1 came around and my blog post was on the first page of the Dear Thyroid site!  What a proud moment that was for me. (Here’s where it all comes back together again.)  I scrolled down and the very next post was one titled, “Chris Prestano, Thyroid Cancer Survivor & Fighter Is Racing For A Cure” written about Chris and our Wings of Hope Relay for Life team!!! What? Are you kidding me?  I just happened to pick December 1 for Dear Thyroid to put my blog post on their site and it was the same day that they posted the one Chris wrote about our team.  Oh come on!!!

So that’s the cool little story about how Chris and I were brought together by thyroid cancer and joined forces to kick cancer’s ass.  It’s a small world!

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