Written by Celina Nadelman, MD
Finding a lump on your body is one of the most trying issues for primary care doctors, and of course one of the most terrifying moments for anyone. Why is it a challenging issue for primary care doctors? Because these superficial lumps and bumps cannot be diagnosed by physical exam or imaging studies alone.
According to the American Cancer Society, many people have thyroid nodules, but only 4-6% are cancerous. The most recent 2018 estimates for thyroid cancer in the United States state there have been approximately 53,990 new cases of thyroid cancer (40,900 in women and 13,090 in men) and about 2,060 deaths from thyroid cancer (1,100 women and 960 men) this year. For unknown reasons, thyroid cancers occur about three times more often in women than in men. Thyroid cancer can occur at any age, but the risk peaks earlier for women, most often in their 40s or 50s when diagnosed, compared to men, who are usually in their 60s or 70s. Studies have shown that thyroid cancer is now the fastest growing cancer among women.
You might not know you have a lump
Lumps on the thyroid gland, or thyroid nodules, often go unnoticed and are quite common. For example, a thyroid nodule can be found incidentally because you had an imaging test for an entirely different medical issue, or they can be discovered by your doctor during a routine yearly physical. Thyroid nodules are so common that they are found in up to 60% of U.S. and European populations.An annual incidence rate of 0.1% in the U.S. suggests that 300,000 new thyroid nodules are detected in the U.S. each year.
In addition to your doctor performing a neck exam to check for nodules, you can also perform a self-examination on yourself at home. To properly perform a neck exam, you can look at yourself in the mirror from the side, with your head tilted slightly up, and swallow. The thyroid moves with swallowing, so you will want to check and see if there is a lump when swallowing. Additional symptoms to take note of include the feeling of something in your throat when swallowing, difficulty swallowing, chronic cough, difficulty breathing, and new onset of hoarseness.
How can you tell which lumps have cancer?
To determine what the lump is, a tissue sample is needed either by cutting it out entirely through surgery or via a small needle biopsy called a fine needle aspiration or FNA. You wouldn’t want to put yourself through the cost and dangers of unnecessary surgery, since more than 90% of thyroid nodule lumps are actually benign. On the other hand, you don’t want to be living with a cancer that could’ve been treated.
The best way to tackle this is by visiting an FNA specialist and having a biopsy performed that is easy, fast, accurate (in the right doctor’s hands), cost-effective, and less risky. They perform these biopsies for lumps found all over the body including lymph nodes, salivary glands, tongue, breasts, soft palate, head and neck, eyelids, back, legs, and arms.
Some FNA physicians are also pathologists
When FNA specialists also act as pathologists they not only perform the biopsy, but they are also the doctor who looks at your tissue under a microscope to make the diagnosis. These doctors can even look under the microscope during a procedure to make sure there is enough tissue to make an accurate diagnosis, eliminating the burden of having you return for an additional biopsy. In addition, this kind of quick analysis helps doctors determine if other types of tests are needed for the patient.
Indeterminate thyroid nodules
Have you been told your thyroid nodule is “indeterminate” or “inconclusive” and you need a thyroidectomy? Thousands of unnecessary thyroid surgeries are commonly performed, and only 40% of these cases turn out to be malignant. Patients are unaware there are molecular tests that can help classify indeterminate thyroid nodules instead of going straight to surgery. Your thyroid nodule may be benign, and a Genomic Sequencing Classifier (GSC) test like Afirma is a safe alternative to surgery. Many insurance plans cover thyroid molecular tests, such as the GSC, which can only be performed by pathologists.
Outlook and Treatment
The chance of being diagnosed with thyroid cancer has risen in recent years and it is the most rapidly increasing cancer in the U.S., tripling in the past three decades. Much of this rise appears to be the result of the increased use of ultrasound, which can detect small thyroid nodules that might not otherwise have been found in the past.
Even though the diagnosis of cancer is terrifying, the prognosis for most patients with well differentiated cancers, such as papillary and follicular thyroid cancer, is usually excellent. If the thyroid cancer has not spread to distant parts of the body at the time it is diagnosed, most cases can be cured. The goal of treatment is usually to remove or destroy as much of the cancer as possible and to keep it from growing, spreading, or returning for as long as possible, and to relieve painful symptoms.
About Celina Nadelman, MD
Dr. Celina Nadelman, M.D., is one of very few doctors in the U.S. to uniquely serve as both a board certified pathologist and cytopathologist as well as a fine needle aspiration (FNA) specialist. In addition to operating her own FNA clinic and in-office laboratory practice in Beverly Hills, California, Dr. Nadelman performs the same dual-role services at Los Angeles County’s Martin Luther King, Jr. Outpatient Center, and is also a clinical instructor at UCLA’s David Geffen School of Medicine Greater Los Angeles Training Cytotechnology Consortium.