Until recently, decades passed with little progress in improving the
survival rates of parathyroid cancer patients. But our
specialized, multidisciplinary team led by Naifa L. Busaidy, M.D., and Nancy D. Perrier, M.D., is bringing parathyroid
cancer patients new hope.
We sat down with them to understand this rare disease and how MD Anderson is advancing parathyroid cancer treatment. Here’s what they shared.
What is a parathyroid?
We all have four parathyroids located in our necks. These endocrine
glands are only the size of a sunflower seed, but they control the
body’s calcium by producing a regulatory hormone.
When a parathyroid becomes overactive and produces too much of this
hormone, it’s called hyperparathyroidism. The most common endocrine
disorder, hyperparathyroidism can result in tumor growth in the neck.
Most parathyroid tumors are benign, but some patients have a genetic
mutation that leads to the development of parathyroid cancer.
If hyperparathyroidism progresses to cancer, it’s important that
it’s caught and treated early, when treatment is most effective.
That’s why it’s so important for patients with hyperparathyroidism to
be monitored by skilled specialists, such as by our team.
What are common parathyroid cancer symptoms?
When monitoring hyperparathyroidism, we’re suspicious that it’s
progressed to cancer if the patient’s calcium and parathyroid hormone
levels are high. We’re also concerned if diagnostic imaging, such as a
CT scan, ultrasound or a specialized sestamibi parathyroid scan, shows
unusual features of the parathyroid gland, such as the glands
appearing bigger than normal or calcified. In this case, we also check
for a lump on the patient’s neck. In addition, we closely monitor
patients who have a family history of kidney tumors or jaw tumors
since they can be at higher risk, as well as carriers of the MEN1,
CDC73 and P53 gene mutations.
Patients may notice bodily changes, such as excessive urination,
excessive thirst, fatigue and bone pain. If you experience these
symptoms, seek care from an experienced team to ensure an accurate diagnosis.
Why is an accurate diagnosis so important for parathyroid
A correct diagnosis is necessary to develop an effective treatment plan.
Because parathyroid cancer is so rare, pathologists are often
unfamiliar with the disease when making a diagnosis. Your care team
should be able to make a diagnosis by evaluating your diagnostic
imaging, calcium levels and parathyroid hormone levels.
If you don’t feel comfortable with the choices laid out by your care
team or feel they don’t have enough experience treating parathyroid
cancer, get a second opinion. It may save your life.
Why is parathyroid cancer difficult to treat?
Malignant parathyroid tumors are often misdiagnosed as benign and
treated improperly. Surgery is currently the gold standard for
treating malignant parathyroid cancer. It’s best to completely remove
the tumor during the initial surgery, so it’s important that your
medical team have a suspicion of parathyroid cancer beforehand.
Sometimes, the cancer returns when most but not all of the tumor is
removed because cancer cells remain in the body. There’s then a higher
risk of death due to complications associated with recurrence.
How common is a parathyroid cancer recurrence?
Most people with parathyroid cancer have a recurrence — either in
the same area of initial diagnosis or because the cancer spreads.
Unfortunately, recurrence can be fatal. When the tumor comes back
locally, it can be difficult to surgically remove because it often
attaches to other vital structures like the esophagus, the breathing
tube or the major blood vessels in the neck. Some then spread to the
lungs, bones or liver. If the surgeon can’t remove all of the
parathyroid tumor, the patient’s calcium levels won’t be regulated.
The patient may then develop hypercalcemia, which can lead to fatigue,
dehydration, increased infection and harm to the kidneys. Although we
can relieve pain and discomfort with palliative care, the patient’s
unregulated, high calcium levels eventually lead to death.
What parathyroid cancer research is underway?
We’re learning more about parathyroid cancer with six protocols that
are currently enrolling patients. Two protocols are examining
parathyroid tissue and hoping to predict recurrence through tumor
staining. A third study is reviewing diagnostic imaging to more
effectively diagnose parathyroid cancer. Fourth, we’re exploring immunotherapy as a treatment option. Fifth, with
precision medicine, we’re evaluating molecular profiles of parathyroid
tumors and sequencing patients’ genes to identify drugs that may
specifically target the mutations. Lastly, we’re studying how
circulating tumor cells can help us better monitor parathyroid cancer
patients to better predict if a patient’s tumor will recur and, for
those who need treatment, how the tumor will respond. By learning more
about this disease, we hope to develop newer, better parathyroid
cancer treatment options.
Anything else you’d like to share?
Without our patients, none of our new research would be possible.
Because of patients like you who are reading this, we’re able to find
new treatments. So thank you.
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