Treatments for metastatic or recurrent parathyroid cancer

Metastatic parathyroid cancer means cancer that started in the parathyroid gland has spread to other parts of the body, such as to the lymph nodes, the lungs or bone.

Recurrent parathyroid cancer means that the cancer has come back after it has been treated.

The following are treatment options for metastatic or recurrent parathyroid cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Surgery is the main treatment for metastatic or recurrent parathyroid cancer. Your healthcare team may use different terms to describe the surgery. These terms include a parathyroidectomy or an en bloc resection. A parathyroidectomy removes one or more parathyroid glands. The term en bloc resection refers to a surgical method that can be used in different parts of the body, including the parathyroid glands. It means that the tumour and the tissue around it are removed as one piece (en bloc).

The surgeon removes the tumour, the parathyroid gland or glands, and a small amount of surrounding tissue called the surgical margin. Part of the thyroid is removed. 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) are also removed.

An en bloc resection may be done to remove a local recurrence (cancer that has come back in the same part of the body as the original tumour).

A pathologist looks at a sample of the surgical margin under a microscope. If there are no cancer cells in the surgical margin, it is called a negative surgical margin. If there are cancer cells, it is called a positive surgical margin. Doctors use this information to plan further treatment.

A neck dissection (lymphadenectomy) removes lymph nodes from the neck. It is done during the en bloc resection if the surgeon suspects the lymph nodes contain cancer based on imaging tests or if any enlarged lymph nodes are seen during surgery. Find out more about a neck dissection.

You may have surgery to remove metastases in the lung, liver or bone that are causing hypercalcemia. If all of the cancer can’t be removed, you may have debulking surgery to remove as much cancer as possible. These surgeries are done to relieve symptoms (called palliative surgery).

Side effects of surgery will depend on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for metastatic or recurrent parathyroid cancer may cause these side effects:

• hematoma in the neck (a collection or pool of blood outside a blood vessel under the skin)
• vocal cord paralysis (caused by damaged to the recurrent laryngeal nerve)
• hypocalcemia (low levels of calcium in the blood)
• hypoparathyroidism (low levels of parathyroid hormone)

Find out more about surgery for cancer and side effects of surgery.

Chemotherapy uses drugs to destroy cancer cells.

Chemotherapy is not used very often for metastatic or recurrent parathyroid cancer. It may be offered after surgery or on its own if surgery can’t be done.

There are no standard chemotherapy drugs used to treat parathyroid cancer. If you have chemotherapy, the type of chemotherapy given will depend on your needs and treatment plan.

Side effects of chemotherapy will depend mainly on the drug, the dose, how it’s given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about chemotherapy.

Talk to your doctor about clinical trials open to people with parathyroid cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

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.