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Thyroid Cancer Treatment in Delhi Gurgaon India – Best Cancer Specialist

thyroid-cancer

Thyroid is a butterfly-shaped endocrine gland located just below the larynx (voice box). It consists of 2 lobes that are present on either side of the trachea and are joined together by an isthmus present anterior to the trachea.

Most of the thyroid is made of follicular cells that form spherical sacs enveloping a colloid and secrete thyroid hormones – thyroxine and triiodothyronine, under the influence of thyroid stimulating hormone (TSH) secreted from the anterior pituitary. Thyroid hormones regulate body’s basal metabolic rate.

A few parafollicular or C-cells lie between the follicular cells in the thyroid gland and secrete calcitonin. Calcitonin is a hormone that helps in maintaining appropriate calcium level in the blood. Other, less common cells in the thyroid gland include lymphocytes, fibroblasts, and adipocytes.

Four parathyroid glands are present on the posterior surface of the two lobes of the thyroid gland. The parathyroid glands secrete parathormone that helps in maintaining an appropriate level of calcium, magnesium, and phosphate in the blood. Thyroid cancer is assessed to be the most frequently diagnosed endocrine cancer and twelfth most commonly diagnosed cancers in the United States (US).

Risk factors for Thyroid Cancer

Female gender

Thyroid cancer is 2 to 3 times more common in women. Reason for this gender disparity is unknown though.

Age

aging As with most other cancers, older age individuals remain at higher risk of developing thyroid cancer compared to young ones.

History of radiation exposure

Exposure-to-radiation Individuals with a history of radiation exposure to head and neck, especially at a younger age are at increased risk of developing thyroid cancer. The risk further increases with the increase in the radiation dose.

Dietary iodine intake

dietary-iodine-intake A diet with very high iodine content may increase the risk of papillary thyroid cancer whereas a diet deficient in iodine content may cause follicular thyroid cancer or other benign thyroid disorders like goiter. The risk of thyroid cancer further increases in the presence of other risk factors, such as radiation exposure.

Family history

Family-history Individual with a history of thyroid cancer in close relatives are considered to be at increased risk of developing thyroid cancer.

Genetic alterations

Genetic-Cancer-Predisposition-Syndromes Many inherited genetic alterations have been reported to be associated with a high incidence rate of thyroid cancer, for example (e.g.), multiple endocrine neoplasia type 2 (MEN2), familial papillary thyroid cancer, familial polyposis coli, Gardner syndrome, and Cowden disease.

Thyroid Cancer Signs and Symptoms

symptoms-of-thyroid-cancer

  • A lump or swelling in the neck.
  • Pain in the neck.
  • Difficulty in swallowing.
  • Hoarseness of voice.
  • Chronic cough that does not go away with treatment.

Thyroid Cancer Staging Investigations

If a person is suspected to have thyroid cancer due to the presence of signs and symptoms, certain investigations are required to confirm the diagnosis of the disease and determining the stage of the disease, which in turn helps in choosing an appropriate treatment option. They help in distinguishing between benign thyroid disease (a benign nodule, goiter, or Grave’s disease) and thyroid cancer.

Thyroid ultrasound

thyroid ultrasound This technique may be used to-

  • examine the thyroid tissue for any abnormality
  • distinguish between fluid-filled cysts (mostly benign) and solid tumor masses (mostly cancerous)
  • reveal certain features of the cancerous nodules like micro-calcifications, irregular borders, or abnormal vascular patterns
  • Nearby lymph nodes (both in the lateral and the central neck) can also be studied for any sign of cancer spread with the help of this test.
  • guide a biopsy needle to collect biopsy samples from the affected area. This test does not use any ionizing radiation and is considered safe.

Blood Tests

Blood tests are not used to diagnose thyroid cancer itself but these tests can reveal certain important information that can provide direction to the diagnostic workup of thyroid cancer. Following are commonly employed blood test for this purpose.

Thyroid Hormone Level

thyroid hormone level The level of thyroid hormones – thyroxine and tri-iodothyronine, may be utilized to assess the functioning of the thyroid gland. The thyroid hormone level is usually normal in most thyroid cancers but may be elevated in the case of hyperfunctioning thyroid cancer and may require further investigations.

Thyroid Stimulating Hormone (TSH) Level

The TSH is secreted by the anterior pituitary and its level in the blood is regulated through negative feedback mechanism by thyroid hormones. Thus, an elevated level of TSH indicates diminished thyroid functioning while a suppressed TSH level indicates hyperfunctioning thyroid (or thyroid nodule).

The hyperfunctioning thyroid nodules are rarely cancerous and can be easily detected with the help of a radioiodine scan. No further investigation is generally required unless a cold nodule (an area in the thyroid with lower radioactivity then surrounding) is present. Cold nodules can be cancerous and thus require further investigation.

Calcitonin Level

calcitonin level Calcitonin is a hormone secreted by C-cells of the thyroid gland. These cells give rise to MTC that is usually associated with elevated levels of calcitonin. Thus, elevated calcitonin levels may signal MTC and should be handled appropriately.

Calcitonin level estimation may also be helpful in the assessment of the efficacy of the treatment/surgery for MTC (which generally cause calcitonin level to decrease) and the progression/recurrence of the disease in patients with MTC (indicated by increased calcitonin level after the decrease caused by the treatment).

Thyroglobulin Level

thyroglobulin test Thyroglobulin is a protein made by thyroid cells and its level in the blood usually remains normal in most thyroid cancers. However, levels of thyroglobulin can be helpful in assessing the efficacy of the treatment/surgery (that should bring down the thyroglobulin level) and the progression/recurrence of the disease in patients with DTC (if thyroglobulin level increases, which was diminished after treatment).

Carcinoembryonic antigen (CEA)

carcinoembryonic antigen- CEA test CEA is a protein (tumor marker) that is found to be elevated in many patients with thyroid cancer (especially MTC). Monitoring of the CEA level can be helpful in assessing the efficacy of the treatment/surgery (that should bring down the elevated CEA level) and the progression/recurrence of the disease in MTC patients who had high CEA levels before treatment.

Radioiodine (I-131) Scan

radioiodine-I 131 scan In this test, radioiodine (I-131) is first administered to a patient. Iodine is essential for making thyroid hormones by follicular cells of the thyroid gland. Thus, radioiodine is absorbed by the thyroid follicular cells including the thyroid cancer cells (papillary, follicular, or Hürthle cell). This absorption of radioiodine occurs under the influence of TSH, and thus, a higher TSH level is usually achieved by injecting thyrotropin (recombinant TSH) to the patient before radioiodine dosing.

The whole body is then scanned for the presence of radioiodine with the help of a radioactivity detector. Abnormal areas in thyroid gland with low radioactivity compared to the surrounding are known as ‘cold nodules’, while the areas with high radioactivity than surrounding are known as ‘hot nodules’.

Cold nodules can be cancerous and require further investigation while hot nodules are usually benign. This test is mostly utilized to assess the efficacy of a treatment/surgery and the spread/recurrence of the disease in patients with DTC. If cancer cells are detected on radioiodine scan after surgical removal of the thyroid gland, it indicates spread of disease and disease sensitive to radioiodine therapy.

Thyroid FNAC

thyroid fine needle aspiration This is a confirmatory test and considered as gold standard in establishing the diagnosis of thyroid cancer. Biopsy sample(s) is generally collected from the suspected areas or cold nodules observed during the thyroid ultrasound or radioiodine scan, respectively. A fine needle aspiration (FNA) biopsy technique is generally utilized for the diagnosis of thyroid cancer.

Sometimes, biopsy sample(s) from lymph nodes in the central or lateral neck region is also collected for examination. The collected biopsy samples are examined under the microscope in a laboratory and can provide very useful information such as the type of thyroid cancer, the severity of cancerous changes involved (level of differentiation), and the presence of specific defective genes or proteins in the cancer cells.

Imaging Tests

These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.

  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Positron emission tomography (PET) scan
  • Bone Scan

Staging of Thyroid Cancer

Differentiated Thyroid Cancer

Apart from the TNM scoring, age at diagnosis is also considered for assigning an overall stage to DTCs.

Stage I

Age at Diagnosis <55 years – Any T Any N M0

Cancer of any size that might or might not has spread to nearby lymph nodes but no spread to distant body parts.

Age at Diagnosis >/=55 years – T1-2 N0 M0

Cancer </=4 cm in size that is confined to the thyroid gland. No spread to nearby lymph nodes or distant body parts.

Stage II

Age at Diagnosis <55 years – Any T Any N M1

Cancer of any size that might or might not has spread to nearby lymph nodes but has spread to distant body parts.

Age at Diagnosis >/=55 years – T1-2 N1 M0

Cancer </=4 cm in size that is confined to the thyroid gland. Cancer has spread to nearby lymph nodes but has not spread to distant body parts. T3a-3b Any N M0 Cancer >4 cm in size that is confined to the thyroid gland or it may have invaded into the strap muscles around the thyroid gland. Cancer might or might not has spread to nearby lymph nodes but has not spread to distant body parts.

Stage III

Age at Diagnosis >/=55 years – T4a Any N M0

Cancer of any size that has invaded into the nearby tissues of the neck like the larynx (voice box), trachea (windpipe), esophagus (food pipe), or the recurrent laryngeal nerve. Cancer might or might not have spread to nearby lymph nodes but has not spread to distant body parts.

Stage IVA

Age at Diagnosis >/=55 years – T4b Any N M0

Cancer of any size that has invaded into the important nearby structures like the spine or large blood vessels. Cancer might or might not have spread to nearby lymph nodes but has not spread to distant body parts.

Stage IVB

Age at Diagnosis >/=55 years – Any T Any N M1

Cancer of any size that might or might not have spread to nearby lymph nodes but have spread to distant body parts like distant lymph nodes, lungs, bones, etc.

Medullary Thyroid Carcinoma (MTC)

Age at diagnosis is not considered for the staging of MTCs

Stage I

T1-2 N0 M0

Cancer </=4 cm in size that is confined to the thyroid gland. No spread to nearby lymph nodes or distant body parts.

Stage II

T2-3 N0 M0

Cancer </=4 cm in size that is confined to the thyroid gland or cancer >4 cm in size that has invaded into the strap muscles around the thyroid gland. No spread to nearby lymph nodes or distant body parts.

Stage III

T1-3 N1a M0

Cancer </= 4 cm in size that is confined to the thyroid gland or cancer >4 cm in size that has invaded into the strap muscles around the thyroid gland. Cancer has spread to nearby lymph nodes in the neck region but has not spread to distant body parts.

Stage IVA

T4a Any N M0

Cancer of any size that has invaded into the nearby tissues of the neck like the larynx (voice box), trachea (windpipe), esophagus (food-pipe), or the recurrent laryngeal nerve. Cancer might or might not has spread to nearby lymph nodes but has not spread to distant body parts.

T1-3 N1b M0

Cancer </= 4 cm in size that is confined to the thyroid gland or cancer >4 cm in size that has invaded into the strap muscles around the thyroid gland. Cancer has spread to nearby lymph nodes in the neck (cervical or jugular nodes) but has not spread to distant body parts.

Stage IVB

T4b Any N M0

Cancer of any size that has invaded into the important nearby structures like the spine or large blood vessels. Cancer might or might not has spread to nearby lymph nodes but has not spread to distant body parts.

Stage IVC

Any T Any N M1

Cancer of any size that might or might not have spread to nearby lymph nodes but has spread to distant body parts like distant lymph nodes, lungs, bones, brain etc.

Anaplastic (Undifferentiated) Thyroid Cancer

Due to the aggressive nature of the anaplastic thyroid cancers, all such cancers are considered as stage IV disease.

Stage IVA

T1-3a N0 M0

Cancer of any size that is confined to the thyroid gland. No spread to nearby lymph nodes or distant body parts.

Stage IVB 

T1-3a N1 M0

Cancer of any size that is confined to the thyroid gland. Cancer has spread to nearby lymph nodes in the neck region but has not spread to distant body parts. T3b Any N M0 Cancer >4 cm in size that has invaded into the strap muscles around the thyroid gland. Cancer might or might not has spread to nearby lymph nodes but has not spread to distant body parts.

T4 Any N M0

Cancer of any size that has invaded into the nearby tissues of the neck like the larynx (voice box), trachea (windpipe), esophagus (food-pipe), recurrent laryngeal nerve, spine, or large blood vessels. Cancer might or might not has spread to nearby lymph nodes but has not spread to distant body parts.

Stage IVC

Any T Any N M1

Cancer of any size that might or might not have spread to nearby lymph nodes but has spread to distant body parts like distant lymph nodes, lungs, bones, brain etc.

Treatment of Thyroid Cancer

Based on the type of cells affected, level of differentiation, appearance of cells under the microscope, and disease prognosis, thyroid cancers are divided mainly into 3 types: Differentiated (including papillary, follicular and Hrthle cell), Medullary, and Anaplastic thyroid cancers. 

Following are the treatment options for these 3 types of thyroid cancer-

Treatment of Differentiated Thyroid Cancer (DTC)

These cancer cells appear similar to normal thyroid cells under the microscope and arise from follicular cells. These can be further divided into following 3 subtypes:

  1. Papillary Carcinoma: This is the most common type of thyroid cancer, representing about 80% of all cases. Papillary carcinoma tends to grow slowly and can be treated successfully in most of the cases. Some variants of papillary carcinoma include mixed papillary-follicular, columnar, tall cell, insular, and diffuse sclerosing carcinomas. These variants (except mixed papillary-follicular) are sometimes referred to as poorly differentiated carcinomas and they tend to grow and spread rapidly.
  2. Follicular Carcinoma: This is the second most common type of thyroid cancer, representing about 10% of all cases. Prognosis of follicular carcinoma is not as good as of papillary carcinoma but they can also be treated successfully in most cases.
  3. Hrthle (Hurthle) cell Carcinoma: This type of thyroid cancer is rare and is harder to recognize and treat. They have worse prognosis among all differentiated thyroid cancers.

Stage I-II DTCs

Stage I-II DTCs are generally treated with surgery (lobectomy or total thyroidectomy) with or without radioiodine therapy (depending on the size of tumor and extent of invasion) as the standard treatment.

Stage III DTCs

Stage III DTCs are generally treated with surgery (total thyroidectomy) along with radioiodine therapy (if the disease is iodine-sensitive) or external beam radiation therapy (EBRT) as the standard treatment.

Stage IV DTCs

Stage IV DTCs sensitive to iodine are generally treated with radioiodine therapy as the standard treatment. Stage IV DTCs that are not sensitive to iodine therapy can be treated with thyroid-suppression therapy, targeted therapy, or EBRT as per physician’s discretion. Surgery and EBRT may also be employed for palliation of symptoms of advanced disease.

Treatment of Medullary Thyroid Cancer (MTC)

These cancers arise from parafollicular cells (or C-cells) and account for about 4% of all thyroid cancers. They are also referred to as neuroendocrine tumors and generally secrete calcitonin. They do not have a good prognosis as they grow and spread rapidly. They are mainly divided into following 2 subtypes:

  1. Sporadic MTC: They accounts for about 80% of all MTCs. They are not generally inherited and mostly affect one lobe of the thyroid gland.
  2. Familial MTC: They comprises about 20% of all MTCs and are generally inherited. They are generally bilateral or multicentric in occurrence.

Stage I-II MTCs

Stage I-II MTCs are generally treated with surgery (total thyroidectomy) with or without EBRT as the standard treatment.

Stage III-IV MTCs

Stage III-IV MTCs are generally treated with surgery (total thyroidectomy) along with thyroid hormone therapy and EBRT or targeted therapy as the standard treatment. Palliative chemotherapy may also be employed for palliation of symptoms of advanced disease. Genetic testing is generally recommended in MTCs so that other family members can also be screened and treated, as appropriate.

Treatment of Anaplastic (Undifferentiated) Thyroid Cancer

These cancers also arise from follicular cells and is a rare form of thyroid cancer accounting for about 2% of all cases. Anaplastic cancer cells do not look like normal cells under the microscope and known as undifferentiated cells. These are the most aggressive form of thyroid cancer and are harder to treat.

Stage IV Anaplastic thyroid cancer

Anaplastic thyroid cancers are generally already widespread at the time of diagnosis. Rarely, when the disease is confined to locoregional area, surgery (total thyroidectomy) to remove the thyroid and regional lymph nodes can be performed. For extensive disease, EBRT and/or chemotherapy are generally employed as standard treatment.

Role of Surgery

surgery for thyroid cancer treatment

Surgery is the treatment of choice for most early-stage DTCs and MRCs and some cases of anaplastic thyroid cancers that have not spread to distant body parts and can be completely removed by a surgical procedure. The main objective of surgery is to remove the primary tumor tissue along with some affected lymph nodes (if detected by imaging tests or during the procedure). Following are some commonly employed surgical procedures for the treatment of thyroid cancer:

Lobectomy

In this surgical procedure, only the affected lobe of the thyroid gland is removed (generally along with the isthmus). This surgery is usually employed for low-risk, small DTCs (<1 cm) confined to one lobe of the thyroid gland without any lymph node involvement.

The advantage of this procedure is that the patient can retain one lobe of the thyroid gland and will not require thyroid hormone supplementation after surgery. Radioiodine therapy cannot be given after this surgery as most of the iodine will be absorbed by the remnant thyroid.

Total Thyroidectomy

In this surgical procedure, the entire thyroid gland is removed. Some of the suspected lymph nodes may also be removed during this procedure, especially in case of medullary or anaplastic thyroid cancers. Since all of the thyroid tissue is removed, thyroid supplementation is required after this surgery.

The advantage of this procedure is that radioiodine therapy can be employed for ablation of any remaining (or recurrent) disease. Surgery for thyroid cancer may be associated with the risk of complications, such as temporary or permanent hoarseness or loss of voice, damage to the parathyroid glands leading to low blood calcium level and associated symptoms, infection, excessive bleeding, blood clots in the neck, etc.

Role of Radioiodine (RAI) Therapy

radioiodine therapy for thyroid cancer In this technique, the therapeutic dose of radioiodine I-131 (much higher than that used for radioiodine scan) is administered to the patient. The iodine is taken up by the thyroid cancer cells (including the normal cells if any). The radiation from the iodine can destroy the thyroid cells that have concentrated the radioiodine, without much effect on the nearby healthy cells.

This treatment is usually employed for destroying any remaining thyroid cells after total thyroidectomy or iodine-sensitive advanced-stage disease. The radioiodine therapy can only work in the presence of a sufficiently high level of TSH, which is achieved by the administration of thyrotropin.

Radioiodine therapy may be associated with side-effects like nausea, vomiting, swelling or tenderness in the neck or salivary glands, dry mouth, low sperm count in males, and irregularity in menstrual cycles in females.

Thyroid Hormone Therapy

thyroid hormone therapy This treatment approach includes taking thyroid hormones at slightly higher dose than normal daily after surgical removal of the thyroid gland. This serves two purposes, first it provides necessary thyroid hormone supplementation for maintaining body’s normal metabolism, and secondly, it helps in reducing the growth of any remaining/recurrent thyroid cancer cells by decreasing the TSH level in blood.

It can also be combined with other treatment modalities such as EBRT or chemotherapy for the treatment of some locally advanced or metastatic thyroid cancers. Side-effects of prolonged thyroid hormone therapy may include rapid or irregular heartbeat and osteoporosis.

Radiation Therapy

radiation therapy Radiation therapy uses high-energy x-rays or other high-energy radiations which are directed to the affected area to kill cancerous cells. EBRT is generally used when radioiodine therapy cannot be used for the treatment, for example, in the case of MTCs, anaplastic thyroid cancers, and iodine resistant advanced stage DTCs.

Sometimes, EBRT is used as palliative therapy to relieve pain, bleeding, and obstructive symptoms associated with the advanced-stage disease.

Targeted Therapy for Thyroid Cancer

targeted therapy for thyroid cancer Targeted drugs are designed to target a specific gene or protein characteristic of the thyroid cancer cells. Following is the list of various targeted drugs that are currently approved or have shown potential for the treatment of thyroid cancer:

Lenvatinib

lenvatinib Lenvatinib is an orally active, small-molecule inhibitor of vascular endothelial growth factor receptor (VEGFR) 1 to 3, platelet-derived growth factor receptor (PDGFR) alpha, RET, stem cell factor receptor (KIT) and fibroblast growth factor receptor (FGFR) 1 to 4 kinases. These kinases have been implicated to promote angiogenesis, growth, and progression of thyroid cancer cells.

Lenvatinib is the preferred targeted agent and has been approved by US FDA for the treatment of patients with locally recurrent or metastatic, progressive differentiated thyroid cancer (DTC [including papillary, follicular, and poorly differentiated subtypes]) that is not responding to radioactive iodine treatment. It has been reported that patients whose tumors contain a RAS mutation have significantly better clinical outcome compared to those who lack this mutation.

Sorafenib

sorafenib Sorafenib is an orally active, small-molecule inhibitor of multiple kinases including VEGFR 1 to 3, PDGFR beta, KIT, RET/PTC, and less potently, BRAF.

Sorafenib has been approved by the US FDA for the treatment of patients with locally recurrent or metastatic, progressive Differentiated Thyroid Cancer that is not responding to radioactive iodine treatment. It has been reported that the presence/absence of a BRAF or RAS mutation is not predictive of clinical outcome.

Sunitinib

sunitinib Sunitinib is an orally active, small-molecule inhibitor of multiple kinases including PDGFR alpha, PDGFR beta, VEGFR 1 to 3, KIT, RET/PTC subtypes 1 and 3, and others.

Various clinical trials have shown the efficacy of sunitinib in the treatment of patients with MTC. Although not approved for the treatment of DTC, it can be used in the case of progressive and/or symptomatic metastatic disease when no appropriate clinical trial or preferred TKI agents are available.

Pazopanib

pazopanib Pazopanib is an orally active, small-molecule inhibitor of multiple kinases including VEGFR 1 to 3, PDGFR alpha and beta, and KIT; but it does not have significant inhibitory activity against the RET, RET/PTC, or BRAF kinases. Thus, it seems to exert its anti-thyroid cancer effect primarily via inhibiting the formation of new blood vessels.

Similar to sunitinib, it can be used in the case of progressive and/or symptomatic metastatic disease when no appropriate clinical trial or preferred TKI agents are available.

Vandetanib

vandetanib Vandetanib is an orally active, small-molecule inhibitor of multiple kinases including VEGFR, RET/PTC, epidermal growth factor receptor (EGFR), and others.

It is considered the preferred treatment option and has been approved by US FDA for patients with unresectable, locally advanced or metastatic MTC that is either symptomatic or progressive. It helps in controlling the progression of cancer; however, overall survival advantage is not yet proved in the clinical trials.

Cabozantinib

cabozantinib Cabozantinib is an orally active, small-molecule inhibitor that targets VEGFR 1 to 3, RET/PTC, KIT, c-MET and others. Similar to vandetanib, it is considered the preferred treatment option and has been approved by US FDA for patients with unresectable, locally advanced or metastatic Medullary Thyroid Cancer that is either symptomatic or progressive. Cabozantinib can also be employed for the treatment of patients with radioiodine-refractory DTC who have progressed on previous anti-VEGFR therapy.

Efatutazone

Efatutazone is an orally active agonist of peroxisome proliferator-activated (PPAR)-gamma receptor. In combination with paclitaxel (chemotherapeutic drug), it could be helpful in the treatment of patients with advanced-stage Anaplastic Thyroid Cancer unresponsive to standard therapy.

Dabrafenib & Trametinib combination treatment

Dabrafenib is a BRAF kinase inhibitor and Trametinib is a mitogen-activated extracellular signal-regulated kinase (MEK)-1 and -2 inhibitor. ATCs frequently have mutations in the BRAF V600E gene and other mutations that lead to the activation of the mitogen-activated protein kinase (MAPK) and other proteins.

These proteins promote cellular growth and proliferation. The combination of dabrafenib and Trametinib has been approved by US FDA for the treatment of patients with locally advanced or metastatic ATC that possess BRAF V600E mutation and for whom no other satisfactory locoregional treatment is currently available.

Solumetinib

Selumetinib is an orally active, small-molecule, selective inhibitor of MEK 1 and MEK 2. It has been reported to increase the radio-iodine uptake by thyroid cancer cells. Thus, it is deemed to be efficacious in the treatment of patients with radioiodine-refractory thyroid cancer. Mainly, patients with NRAS mutation positive thyroid cancer were reported to derive the benefit of selumetinib treatment.

Vemurafenib

vemurafenib Vemurafenib is an orally active, small-molecule, selective inhibitor of BRAF serine-threonine kinase including BRAF V600E and other kinases that are involved in abnormal cellular proliferation and metastasis.

It has shown some activity for the treatment of patients with progressive radioiodine-refractory BRAF V600-mutant thyroid cancer who have previously received treatment with antiangiogenic kinase inhibitors including sorafenib. Patients with any component of squamous differentiation within the primary or secondary papillary thyroid cancer lesion may confront disease progression with this drug. Thus, caution should be taken in such patients.

Role of Chemotherapy

chemotherapy for thyroid cancer Chemotherapy may be employed for the treatment of anaplastic thyroid cancers or for some advanced-stage MTCs that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with EBRT to accelerate the benefit achievement.

Best Thyroid Cancer Specialist in Delhi

Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of around 10 years of treating thyroid cancer patients. He has treated thyroid cancer patients with Chemotherapy and Targeted Therapy. He is currently practicing at Manipal Hospital, Dwarka.

Diagnostic modalities available at our hospital include Thyroid FNAC/Biopsy, Throglobulin Test, Calcitonin levels, Thyroid Hormone Levels, CEA, Whole Body PET CT, etc. Other treatment facilities for Colon Cancer available are Lobectomy, Hemithyroidectomy, Total Thyroidectomy, Radiation Therapy, etc.

Call +91 9686813020 for appointment.

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