Thyroid cancer is a rare type of cancer accounting for less than 1% of all cancer cases in the UK, but worryingly the numbers are increasing year on year. Thyroid cancer affects the thyroid gland, a small gland at the base of the neck that produces two hormones, triiodothyronine (T3) and thyroxine (T4), which help regulate the metabolism. Thyroid cancer is most common in people in their thirties and those over the age of 60. Women are two to three times more likely to develop the condition than men.
Caught early, thyroid cancer is very amenable to treatment and many people are treated successfully, preserving a full life expectancy. However, early diagnosis and commencement of treatment is hugely important. Sadly, if that treatment comes too late and the thyroid cancer is already advanced and has spread to other areas of the body, it may not be possible to achieve a cure and treatment will only offer palliative benefits.
Thyroid cancer can be difficult to diagnose, and potentially missed, as the symptoms can appear innocent or similar to those of other conditions. The symptoms typically include a sore throat, hoarseness of the voice and a painless lump in the throat. Diagnosis can be delayed for a multitude of reasons: a patient may think that it isn’t worth seeking medical advice for these symptoms, as they don’t want to bother their GP with something as apparently minor; or a GP may suspect a less serious condition, such as a goitre. A goitre is a swelling of the thyroid gland that can be caused by an underactive thyroid, but also by puberty, menopause or a diet lacking in iodine. If thyroid cancer is misdiagnosed as a goitre, then appropriate investigations and treatment will be delayed or not happen at all and invaluable time to treat the cancer will be lost.
A patient presenting to a GP with the symptoms outlined above should be examined and questioned carefully about those symptoms. The GP should arrange a blood test to check the functioning of the thyroid. The blood test will indicate hormone levels in the blood and help to rule out thyroid conditions other than cancer. If the test does not indicate any other conditions, then cancer remains a possibility and the patient should be referred to hospital for further investigations. At a hospital and under the care of a specialist ENT (ear, nose and throat) team, a fine needle aspiration test will be performed, which involves taking a sample of cells from the lump in the neck to examine them under a microscope in order to identify whether they are cancerous and if so, how advanced and at what ‘stage’ the cancer has developed to. Sometimes the results from the fine-needle aspiration can come back inconclusive and in that scenario the investigation should be repeated, potentially under ultrasound. Thereafter, a CT scan or MRI may be required so that a personalised treatment plan can be created with input from a specialist oncology team.
Treatment for thyroid cancer is usually surgery known as a ‘thyroidectomy’ – surgery to remove the thyroid. It can be removed completely or partially, depending on the exact location, nature and size of the cancer and the age of the patient. Radiotherapy treatment may be offered to ensure that all cancer cells are eradicated and unable to return. After the thyroid is removed, patients are provided with medication that mimics the previous function of the thyroid and regulates their hormone levels.
Alison Johnson, clinical negligence partner at Penningtons Manches Cooper, represents patients and their families with cancer claims and is keen to highlight the importance of early diagnosis and treatment of head and neck cancers. Alison says: “At their worst, these cancers claim lives. Unfortunately, the clinical negligence team has seen the devastating impact that a delayed diagnosis of a head or neck cancer can cause and the huge loss that families suffer in those circumstances. In other cases we have been involved with, thankfully patients have been treated successfully but the delayed diagnosis of their cancer has still caused them considerable anxiety and may have impacted their health and care needs for life.
“For example, we previously investigated a claim of a delayed diagnosis of thyroid cancer due to hospital clinical negligence. Our client was referred correctly by the GP and underwent a fine needle aspiration in hospital. However, when the result was inconclusive, our client was reassured that all was well, rather than the test being repeated. This then led to a 15 month delay in diagnosis of the true nature of the condition, which was in fact thyroid cancer, and commencement of treatment - resulting in our client undergoing more extensive surgery, suffering lifelong complications from those operations and being understandably hugely worried about health and prognosis. Liability for the poor hospital care was admitted.”