What Is Papillary Thyroid Cancer?

Cancers of the thyroid gland are usually classified into four types: Papillary, follicular, medullary and anaplastic thyroid cancer. The first two types are commonly called differentiated thyroid cancers, which are more common l and have a good prognosis. 

Overview

Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, accounting for about 80% of all thyroid cancers. It typically occurs in people between the ages of 30 and 50 and is more common in people assigned female at birth (PAFAB) than in people Assigned male at birth (PAMAB).¹

PTC arises from the follicular cells of the thyroid gland, which produce and store thyroid hormones. The cancerous cells form small, finger-like projections (papillae) that can be seen under a microscope. PTC is usually slow-growing and has a good prognosis, with a 10-year survival rate of over 95%.²

The exact cause of PTC is unknown, but it has been linked to exposure to ionising radiation, particularly in childhood.³

Symptoms of PTC may include a lump or swelling in the neck, difficulty swallowing, hoarseness or other voice changes, and enlarged lymph nodes. 

Treatment for PTC typically involves surgery to remove the thyroid gland (thyroidectomy), followed by radioactive iodine therapy to destroy any remaining cancerous tissue. In some cases, radiation therapy may also be used. Thyroid hormone replacement therapy is usually required after surgery to replace the function of the removed thyroid gland. 

Prognosis for PTC is generally good, although follow-up care and monitoring are important to detect any recurrence or metastasis.

There's more to learn about papillary thyroid cancer, including its diagnosis, staging, and management. Keep reading to discover more about this common type of thyroid cancer.

Causes of papillary thyroid cancer

Here are some possible causes and risk factors for papillary thyroid cancer:

• Exposure to ionising radiation, especially in childhood
• Family history of thyroid cancer
• Personal history of benign thyroid nodules or goitre 
• Certain genetic syndromes, such as familial adenomatous polyposis (FAP) and Cowden syndrome
• Gender (more common in PAFAB than PAMAB)
• Age between 30 and 50 years old
• Diets low in iodine, which may be more common in certain regions of the world
• Smoking, which may increase the risk of aggressive forms of thyroid cancer (although the link to papillary thyroid cancer specifically is not clear)
• Certain environmental factors, such as exposure to pesticides or industrial chemicals (although the evidence is limited and inconsistent)

Signs and symptoms of thyroid cancer

Here are some signs and symptoms of thyroid cancer that people may experience:

• A lump or swelling in the neck, sometimes painless
• Difficulty swallowing or breathing
• Hoarseness or other voice changes
• Enlarged lymph nodes in the neck
• Pain in the neck, sometimes spreading to the ears
• Cough, sometimes with blood in the sputum
• Fatigue or weakness
• Unexplained weight loss or gain
• Changes in bowel habits
• Changes in menstrual cycles (for PAFAB)

Management and treatment for thyroid cancer

Here are some common management and treatment options for thyroid cancer.

Surgery

Total thyroidectomy (removal of the entire thyroid gland) is the most common surgical option for papillary thyroid cancer. In some cases, a partial thyroidectomy (removal of only part of the thyroid gland) may be performed if the cancer is small and confined to one lobe of the thyroid.  Neck dissection (removal of lymph nodes in the neck) may also be performed if there is evidence of spread to these nodes.

Radioactive iodine therapy

After surgery, patients may receive a dose of radioactive iodine (RAI) to destroy any remaining thyroid tissue and/or cancer cells. RAI is taken orally in a capsule or liquid form and is absorbed by the thyroid tissue, which is destroyed by the radiation. RAI may also be used to treat any remaining cancer cells or metastases after surgery, or to treat recurrent or persistent disease.

Hormone replacement therapy

Because the thyroid gland produces hormones that regulate metabolism and other bodily functions, patients who undergo a total thyroidectomy will need to take thyroid hormone replacement therapy (levothyroxine) for the rest of their lives. This medication helps to replace the missing thyroid hormone and prevent hypothyroidism (low thyroid hormone levels).

Surveillance and Monitoring

After treatment, patients will need regular follow-up visits with their healthcare providers to monitor for any signs of recurrence or spread of the cancer. This may involve regular blood tests, imaging studies (such as ultrasound or PET scans), and physical exams. The frequency and duration of follow-up care will depend on the stage and characteristics of the cancer, as well as the patient's overall health.

Other Treatments

In some cases, other treatments such as external beam radiation therapy, chemotherapy , or targeted therapy  may be recommended, particularly for more aggressive forms of thyroid cancer or for recurrent or metastatic disease.⁴

These treatments are typically used in conjunction with surgery and/or radioactive iodine therapy, and are tailored to the individual patient's needs and circumstances.

FAQs

How is papillary thyroid cancer diagnosed?

Papillary thyroid cancer is typically diagnosed through a combination of physical exams, imaging tests (such as ultrasound, CT scan, or MRI), blood tests, and biopsy (sampling of thyroid tissue). A healthcare provider may refer a patient to an endocrinologist or a specialist in head and neck cancers for further evaluation and treatment.

Can papillary thyroid cancer be prevented?

While there is no sure way to prevent papillary thyroid cancer, there are some steps that may help reduce the risk of developing the disease. These include avoiding exposure to ionising radiation (especially in childhood), maintaining a healthy diet and lifestyle, and getting regular check-ups with a healthcare provider.

What are the risk factors of papillary thyroid cancer?

Some possible risk factors for PTC include:³ 

• Exposure to ionising radiation 
• Family history of thyroid cancer
• Personal history of benign thyroid nodules or goiter 
• Certain genetic syndromes
• Gender (PAFAB are more likely to get PTC compared to PAMAB) 
• Age (more likely to get PTC if you are between 30 and 50 years old) 
• Diet low in iodine
• Smoking 
• Certain environmental factors (although the evidence is limited and inconsistent).

How common is papillary thyroid cancer?

Papillary thyroid cancer is the most common type of thyroid cancer, accounting for about 80% of all cases.¹ 

When should I see a doctor?

It's important to see a healthcare provider if you notice any persistent or concerning symptoms such as: 

• A lump in the neck 
• Difficulty swallowing or breathing 
• Voice changes 
• Unexplained weight loss or gain 

Additionally, if you have any risk factors for thyroid cancer (such as a family history or exposure to radiation), it may be a good idea to discuss your options for screening and early detection with a healthcare provider.

Summary

Papillary thyroid cancer is the most common type of thyroid cancer, typically occurring in PAFAB  between the ages of 30 and 50. Symptoms include a lump in the neck, difficulty swallowing or breathing, voice changes, or unexplained weight loss or gain. 

Diagnosis is made through physical exams, imaging tests, blood tests, and biopsy. Treatment options include surgery, radioactive iodine therapy, hormone replacement therapy, surveillance, and monitoring. 

While there is no sure way to prevent papillary thyroid cancer, avoiding exposure to ionising radiation and maintaining a healthy lifestyle may help reduce the risk.