Surgical Oncology — Thyroid cancer
UC Davis Comprehensive Cancer Center offers comprehensive, multidisciplinary care for patients with endocrine cancers — tumors of the thyroid, which regulate metabolism, and the parathyroid, which controls blood calcium — aimed at preservation of critical functions, prevention of disease recurrence and optimization of quality of life.
Your team of cancer specialists will include experts in surgical oncology who have received specialized training in endocrine surgery, as well as close collaboration with other health care professionals, including our surgical oncology clinical nurses, research nurses, radiologists and endocrinologists.
Thyroid and parathyroid tumors may be either benign or malignant. Your doctor will begin with evaluation measures such as examining your throat with an endoscope, or using imaging studies such as ultrasound, CT scan, PET scan or MRI scan. A fine needle aspiration (FNA) biopsy with or without the use of ultrasound may be recommended to help determine the type of tumor and to assist your doctor in making a treatment recommendation.
Other rare endocrine tumors (paragangliomas, carotid body tumors, glomus tumors) are managed in our referral center. These tumors require a careful preoperative workup and detailed discussions with patients regardingtreatment options and what to expect after the procedure.
Surgery is often performed as an outpatient or overnight procedure. Tumors of the thyroid and parathyroid are typically managed with minimally invasive surgery. All surgeries utilize real-time recurrent laryngeal nerve monitoring to help prevent injury to the recurrent laryngeal nerve, the nerve to your voicebox.
Specific surgical techniques for thyroid cancer can include:
- Thyroid lobectomy: Removal of part of the thyroid gland.
- Total thyroidectomy: Removal of the entire thyroid gland.
- Minimally invasive thyroidectomy: Removal of part or all of the thyroid gland using small (1.5- to 2-inch) incisions. Patients undergoing a small-incision procedure may experience less pain and an improved cosmetic outcome than with the traditional open incision.
- Minimally invasive video-assisted thyroidectomy (MIVAT): Removal of all or part of the thyroid gland using a small (1-inch) neck incision through which the thyroid and surrounding structures can be seen with the help of a lighted magnifying scope/camera, similar to that used for laparoscopic procedures.
- Central neck dissection: Surgery to remove lymph nodes on either side of your trachea/windpipe. These lymph nodes are the most likely to harbor a cancer from an underlying thyroid malignancy.
- Modified radical neck dissection: Removal of the fat-pad that contains the lymph nodes in the neck along the jugular vein and above the collarbone. This procedure is considered “modified” because the surgeon attempts to preserve important muscles, nerves and blood vessels in the neck.
- Probe-assisted thyroid surgery for complete resection of metastatic disease: For patients with recurrent thyroid cancer or with biopsy-proven lymph node spread, removing all sites of disease can be complicated. A small dose of radioactive iodine given prior to surgery allows your surgeon to use a radioactivity detector probe to remove all thyroid tissue and areas of metastasis.
Specific surgical techniques for parathyroid tumors, most of which are benign, can include:
- Minimally invasive radio-guided probe-based (MIRP) parathyroidectomy: MIRP technology identifies faulty parathyroid glands on an individual basis. Removing just the nonfunctioning gland(s) preserves function in the remaining, healthy glands.
- Four-gland parathyroid exploration: A type of surgery whereby all glands are visually evaluated and the abnormal appearing one(s) removed.
- Subtotal parathyroidectomy: This procedure removes three parathyroid glands and part of a fourth. Sometimes, all four glands will be removed and part of the smallest gland will be autotransplanted.
- Parathyroid autotransplantation: The parathyroid tissue in the neck is removed, and a small amount transplanted into either the forearm or the neck – an easily accessible location on the body for continuing medical evaluation or procedures. This procedure is typically performed for patients in whom all four parathyroid glands are affected.
- Intra-operative parathyroid hormone monitoring: People with overactive parathyroid glands produce parathyroid hormone (PTH) in large amounts. This can be detected in the blood. Your surgeon can use this test to be sure all abnormal glands have been removed. Prior to surgery, your blood PTH will be checked. It should be high. Once your surgeon has located the abnormal gland and removed it, your surgeon will check your blood PTH again. The level should have dropped by 50 percent of baseline and be within normal range within 10 minutes. If it is, then no further surgery needs to be done. If it is not, then your surgeon will look for additional abnormal parathyroid glands. (See: four-gland parathyroid exploration)
- Central neck dissection: Surgery to remove lymph nodes on either side of your trachea/windpipe. These lymph nodes are the most likely to harbor a cancer from an underlying thyroid or parathyroid malignancy.
Martinez, S.R., S. Beal, S.L. Chen, A. Chen, P.D. Schneider. Adjuvant external beam radiation for medullary thyroid carcinoma. Journal of Surgical Oncology. 2010 Aug.; 102(2):175-8.
Beal, S.H., S.L. Chen, P.D. Schneider, S.R. Martinez. An evaluation of lymph node yield and lymph node ratio in well-differentiated thyroid carcinoma. The American Surgeon. 2010 Jan.; 76(1):28-32.
Leggett, M.D., S.L. Chen, P.D. Schneider, S.R. Martinez. Prognostic value of lymph node yield and metastatic lymph node ratio in medullary thyroid carcinoma. Annals of Surgical Oncology. 2008 Sept.; 15(9):2493-9.
Oncologists Specializing in Thyroid Cancers
Michael Campbell, M.D.
Assistant Professor of Surgery
Anthony Yang, M.D.
Assistant Professor of Surgery
Thomas J. Semrad, M.D., M.A.S.
Assistant Professor of Medicine, Hematology and Oncology
Alison Semrad, D.O.