Treatments for medullary thyroid cancer

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You may be offered the following treatments for medullary thyroid cancer (medullary carcinoma). Your healthcare team will suggest treatments based on your needs and the stage of the cancer. They will work with you to develop a treatment plan.

Localized or regional medullary thyroid cancer has not spread outside of the thyroid. It is most often treated with surgery to remove the thyroid. Hormone therapy is used to replace the hormones that are normally made by the thyroid.

Metastatic medullary thyroid cancer has spread to distant parts of the body. It may be treated with targeted therapy or chemotherapy.

Recurrent medullary thyroid cancer means that the cancer has come back (recurred) after it has been treated. Treatment will depend on where the cancer recurs. It is treated with surgery, external radiation therapy, targeted therapy or chemotherapy.

Surgery

Surgery is the first treatment for most medullary thyroid cancers. Some medullary thyroid cancers are associated with multiple endocrine neoplasia type 2 (MEN2). People with MEN2 can develop more than one type of tumour. If you also have a pheochromocytoma or a parathyroid gland tumour, these may also be removed with surgery. For pheochromocytomas, treatment with medicines to control blood pressure may be necessary before surgery.

Total thyroidectomy completely removes the thyroid. It is usually the first type of surgery done.

Neck dissection removes lymph nodes from the neck. The surgeon may also remove other tissues around the thyroid. The type of neck dissection done depends on the size of the tumour and if the doctor thinks there is cancer in the lymph nodes in the neck based on the results of an ultrasound. It is often done at the same time as the total thyroidectomy.

Find out more about surgery for thyroid cancer.

Hormone therapy

Hormone therapy is used to replace the hormone thyroxine, which would normally be made by the thyroid. It is also used to slow down the growth of any remaining cancer cells and help prevent the cancer from coming back, or recurring. It is a standard treatment after surgery to remove all of the thyroid.

The type of hormone therapy used is levothyroxine (Synthroid, Eltroxin). It is given as a pill once a day. You will have to take levothyroxine for the rest of your life if you have a total thyroidectomy.

Find out more about hormone therapy for thyroid cancer.

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is not commonly used to treat medullary thyroid cancer, but external radiation therapy may be offered after surgery for stage 3 or 4 cancers. It may also be used to treat medullary thyroid cancer that has spread to many nearby tissues or that can't be completely removed with surgery to try to reduce the chance of it coming back in the neck.

Find out more about radiation therapy for thyroid cancer.

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. You may be offered targeted therapy for metastatic medullary thyroid cancer. Targeted therapy drugs that may be used include:

  • vandetanib (Caprelsa)
  • cabozantinib (Cabometyx)
  • selpercatinib (Retevmo)
  • pralsetinib (Gavreto)

Find out more about targeted therapy for thyroid cancer.

Chemotherapy

Chemotherapy uses anticancer drugs to destroy cancer cells. You may be offered chemotherapy for metastatic medullary thyroid cancer if targeted therapy doesn't work. It is usually given as a palliative treatment to help relieve symptoms. Chemotherapy drugs used for medullary thyroid cancer include doxorubicin (Adriamycin) and dacarbazine.

Find out more about chemotherapy for thyroid cancer.

Clinical trials

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

Expert review and references

  • Shereen Ezzat, MD, FRCPC, FACP
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