Treatments for parathyroid cancer

If you have parathyroid cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for parathyroid cancer, your healthcare team will consider:

• whether the cancer is localized, metastatic or recurrent
• the calcium level in the blood

You may be offered one or more of the following treatments for parathyroid cancer.

Surgery is the main treatment for parathyroid cancer. Depending on the stage, you may have one or more of the following types of surgery.

En bloc resection removes the tumour and surrounding areas as one piece (en bloc) so there is a clear surgical margin. For parathyroid cancer, it includes removing one or more of the parathyroid glands and usually part of the thyroid. Some fat and muscles in the neck, tissues around the windpipe (trachea), nearby lymph nodes and the nerve that goes to the larynx (recurrent laryngeal nerve) may also be removed along with the tumour. An en bloc resection is the first surgery done for most parathyroid cancers. For a short time after an en bloc resection, you may be given extra calcium (injected into a vein or taken as a pill) until blood calcium levels return to normal.

Neck dissection (lymphadenectomy) removes lymph nodes from the neck. It is done if the surgeon suspects the lymph nodes contain cancer based on imaging tests. If any enlarged lymph nodes are seen during surgery, they will be removed. Find out more about neck dissection.

Debulking means removing as much of the cancer as possible. It may be done to control symptoms (called palliative surgery) of recurrent parathyroid cancer that has come back in the neck or chest. Many people with recurrent parathyroid cancer have more than one operation to help control symptoms.

Side effects of surgery will depend mainly on the type of surgery, the part of the body and your overall health. Surgery for parathyroid cancer may cause infection and a hematoma in the neck. It will often cause scars on your neck that usually fade as they heal. If the recurrent laryngeal nerve, esophagus or windpipe is damaged during surgery, it can cause hoarseness of the voice and difficulty swallowing.

Find out more about surgery in cancer treatment.

Before surgery, treatment for hypercalcemia is given. Hypercalcemia is when there is too much calcium in the blood. Many people with parathyroid cancer will develop hypercalcemia because one or more parathyroid glands are overactive and make too much parathyroid hormone (PTH). PTH controls the calcium level in the blood. Hypercalcemia can cause serious and life-threatening health problems if not treated.

Treatment for hypercalcemia may include the following.

Replacing fluids in the body treats dehydration (the loss of too much water). Dehydration often happens in people with hypercalcemia. Drugs called diuretics, such as furosemide, are given after rehydration to increase calcium released from the kidneys into the urine.

Bisphosphonates are drugs that help slow the breakdown of bone. They are given to lower blood calcium levels. Find out more about bisphosphonates.

Calcitonin is a hormone that helps control the level of calcium in the blood. It is normally made by the thyroid, but can also be made in a lab and given as a drug (Calcimar or Miacalcin). Calcitonin slows down the release of calcium from bones and increases the amount of calcium released from the kidneys into the urine.

Calcimimetics, such as cinacalcet (Sensipar), are drugs that signal the body to make less PTH and lower blood calcium levels.

Denosumab (Xgeva) is a monoclonal antibody that may be used to lower blood calcium levels if bisphosphonates don't work.

Side effects of treatment for hypercalcemia will depend mainly on the type and dose of drug used and how long you take the treatment. Talk to your doctor about any side effects that you can expect from treatment for hypercalcemia.

Find out more about hypercalcemia.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is not usually used to treat parathyroid cancer. Usually parathyroid cancer does not respond well to the effects of radiation therapy (it is not radiosensitive). But it is hard to tell if radiation therapy can be useful in some cases of parathyroid cancer because the cancer is rare and researchers can study only a small number of people.

For some cases of parathyroid cancer, external beam radiation therapy to the neck may be used after surgery to kill cancer cells left behind and reduce the risk of the cancer coming back. This includes when there are cancer cells in the surgical margin.

Side effects of radiation therapy will depend mainly on the total dose of radiation and the treatment schedule. Some common side effects of radiation therapy for parathyroid cancer are fatigue, skin problems, such as redness, sore mouth and throat and difficulty swallowing.

Find out more about external beam radiation therapy.

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is not usually used to treat parathyroid cancer. Generally, chemotherapy is not effective for parathyroid cancer. But it may be used for some cases of metastatic or recurrent parathyroid cancer when surgery can’t be done. The goal of chemotherapy is to help achieve a remission, often only for a short period of time.

There are no standard chemotherapy drugs used to treat parathyroid cancer But some drugs have been used alone or in combination, including dacarbazine (DTIC), 5-fluorouracil (5-FU, Adrucil), cyclosphosphamide (Procytox), methotrexate, doxorubicin (Adriamycin) and lomustine (CeeNU, CCNU).

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for parathyroid cancer are a low white blood cell count, nausea and vomiting, diarrhea and hair loss.

Find out more about chemotherapy.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

For about half of the people with parathyroid cancer, the cancer will come back (recur) after surgery. It usually happens 2 to 5 years after the initial surgery. So follow-up is an important part of cancer care. You will need to have regular follow-up visits. These visits allow your healthcare team to monitor your progress and recovery from treatment and check for recurrence.

During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping. They will also ask about any symptoms you have.

Your doctor may do a physical exam, including

• checking your pulse and blood pressure
• feeling your neck for lumps or enlarged lymph nodes

Tests are often part of follow-up care. You may have:

• blood tests to check for high levels of calcium and PTH
• an ultrasound of the neck to check if the cancer has come back (local recurrence) or spread to lymph nodes
• a parathyroid (sestamibi) scan to check if the cancer has come back
• a CT scan or an MRI of the neck, chest or abdomen to look for metastatic cancer

Some clinical trials are open to people with parathyroid cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

To make the decisions that are right for you, ask your healthcare team questions about treatment and questions about follow-up.