Parathyroid Cancer Treatment (PDQ®): Treatment - Patient Information [NCI]
General Information About Parathyroid Cancer
Parathyroid cancer is a rare disease in which malignant (cancer) cells form in the tissues of a parathyroid gland.
The parathyroid glands are four pea-sized organs found in the neck near the thyroid gland. The parathyroid glands make parathyroid hormone (PTH or parathormone). PTH helps the body use and store calcium to keep the calcium in the blood at normal levels.
Anatomy of the thyroid and parathyroid glands. The thyroid gland lies at the base of the throat near the trachea. It is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The parathyroid glands are four pea-sized organs found in the neck near the thyroid. The thyroid and parathyroid glands make hormones.
A parathyroid gland may become overactive and make too much PTH, a condition called hyperparathyroidism. Hyperparathyroidism can occur when a benign tumor (noncancer), called an adenoma, forms on one of the parathyroid glands, and causes it to grow and become overactive. Sometimes hyperparathyroidism can be caused by parathyroid cancer, but this is very rare.
The extra PTH causes:
- The calcium stored in the bones to move into the blood.
- The intestines to absorb more calcium from the food we eat.
This condition is called hypercalcemia (too much calcium in the blood).
The hypercalcemia caused by hyperparathyroidism is more serious and life-threatening than parathyroid cancer itself and treating hypercalcemia is as important as treating the cancer.
Having certain inherited disorders can increase the risk of developing parathyroid cancer.
Anything that increases the chance of getting a disease is called a risk factor. Risk factors for parathyroid cancer include the following rare disorders that are inherited (passed down from parent to child):
- Familial isolated hyperparathyroidism (FIHP).
- Multiple endocrine neoplasia type 1 (MEN1) syndrome.
Treatment with radiation therapy may increase the risk of developing a parathyroid adenoma.
Signs and symptoms of parathyroid cancer include weakness, feeling tired, and a lump in the neck.
Most parathyroid cancer signs and symptoms are caused by the hypercalcemia that develops. Signs and symptoms of hypercalcemia include the following:
- Weakness.
- Feeling very tired.
- Nausea and vomiting.
- Loss of appetite.
- Weight loss for no known reason.
- Being much more thirsty than usual.
- Urinating much more than usual.
- Constipation.
- Trouble thinking clearly.
Other signs and symptoms of parathyroid cancer include the following:
- Pain in the abdomen, side, or back that doesn't go away.
- Pain in the bones.
- A broken bone.
- A lump in the neck.
- Change in voice such as hoarseness.
- Trouble swallowing.
Other conditions may cause the same signs and symptoms as parathyroid cancer. Check with your doctor if you have any of these problems.
Tests that examine the neck and blood are used to diagnose parathyroid cancer.
Once blood tests are done and hyperparathyroidism is diagnosed, imaging tests may be done to help find which of the parathyroid glands is overactive. Sometimes the parathyroid glands are hard to find and imaging tests are done to find exactly where they are.
Parathyroid cancer may be hard to diagnose because the cells of a benign parathyroid adenoma and a malignant parathyroid cancer look alike. The patient's symptoms, blood levels of calcium and parathyroid hormone, and characteristics of the tumor are also used to make a diagnosis.
The following tests and procedures may be used:
- Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. To diagnose parathyroid cancer, the sample of blood is checked for its calcium level.
- Parathyroid hormone test: A procedure in which a blood sample is checked to measure the amount of parathyroid hormone released into the blood by the parathyroid glands. A higher than normal amount of parathyroid hormone can be a sign of disease.
- Sestamibi scan: A type of radionuclide scan used to find an overactive parathyroid gland. A very small amount of a radioactive substance called technetium 99 is injected into a vein and travels through the bloodstream to the parathyroid gland. The radioactive substance will collect in the overactive gland and show up brightly on a special camera that detects radioactivity.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck. - SPECT scan (single photon emission computed tomography scan): A procedure to find malignant tumor cells in the neck. A small amount of a radioactive substance is injected into a vein or inhaled through the nose. As the substance travels through the blood, a camera rotates around the body and takes pictures of the neck. A computer uses the pictures to make a 3-dimensional (3-D) image of the neck. There will be increased blood flow and more activity in areas where cancer cells are growing. These areas will show up brighter in the picture.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- Angiogram: A procedure to look at blood vessels and the flow of blood. A contrast dye is injected into the blood vessel. As the contrast dye moves through the blood vessel, x-rays are taken to see if there are any blockages.
- Venous sampling: A procedure in which a sample of blood is taken from specific veins and checked to measure the amounts of certain substances released into the blood by nearby organs and tissues. If imaging tests do not show which parathyroid gland is overactive, blood samples may be taken from veins near each parathyroid gland to find which one is making too much PTH.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on the following:
- Whether the calcium level in the blood can be controlled.
- The stage of the cancer.
- Whether the tumor and the capsule around the tumor can be completely removed by surgery.
- The patient's general health.
Stages of Parathyroid Cancer
After parathyroid cancer has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.
The process used to find out if cancer has spread to other parts of the body is called staging. There is no standard staging system for parathyroid cancer. The following imaging tests may be used to find out if the cancer has spread to other parts of the body such as the lungs, liver, bone, heart, pancreas, or lymph nodes:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck. - MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if parathyroid cancer spreads to the lung, the cancer cells in the lung are actually parathyroid cancer cells. The disease is metastatic parathyroid cancer, not lung cancer.
Parathyroid cancer is described as either localized or metastatic.
- Localized parathyroid cancer is found in a parathyroid gland and may have spread to nearby tissues.
- Metastatic parathyroid cancer has spread to other parts of the body, such as the lungs, liver, bone, sac around the heart, pancreas, or lymph nodes.
Parathyroid cancer can recur (come back) after it has been treated.
The cancer may come back in the tissues or lymph nodes of the neck or in other parts of the body. More than half of patients have a recurrence. The parathyroid cancer usually recurs between 2 and 5 years after the first surgery, but can recur up to 20 years later. It usually comes back in the tissues or lymph nodes of the neck. High blood calcium levels that appear after treatment may be the first sign of recurrence.
Treatment Option Overview
There are different types of treatment for patients with parathyroid cancer.
Different types of treatment are available for patients with parathyroid cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Treatment includes control of hypercalcemia (too much calcium in the blood) in patients who have an overactive parathyroid gland.
In order to reduce the amount of parathyroid hormone that is being made and control the level of calcium in the blood, as much of the tumor as possible is removed in surgery. For patients who cannot have surgery, medication may be used.
Four types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is the most common treatment for parathyroid cancer that is in the parathyroid glands or has spread to other parts of the body. Because parathyroid cancer grows very slowly, cancer that has spread to other parts of the body may be removed by surgery in order to cure the patient or control the effects of the disease for a long time. Before surgery, treatment is given to control hypercalcemia.
The following surgical procedures may be used:
- En bloc resection: Surgery to remove the entire parathyroid gland and the capsule around it. Sometimes lymph nodes, half of the thyroid gland on the same side of the body as the cancer, and muscles, tissues, and a nerve in the neck are also removed.
- Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors cannot be completely removed.
- Metastasectomy: Surgery to remove any cancer that has spread to distant organs such as the lung.
Surgery for parathyroid cancer sometimes damages nerves of the vocal cords. There are treatments to help with speech problems caused by this nerve damage.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient's head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat parathyroid cancer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Supportive care
Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care for hypercalcemia caused by parathyroid cancer may include the following:
- Intravenous (IV) fluids.
- Drugs that increase how much urine the body makes.
- Drugs that stop the body from absorbing calcium from the food we eat.
- Drugs that stop the parathyroid gland from making parathyroid hormone.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI website.
Treatment for parathyroid cancer may cause side effects.
For information about side effects caused by treatment for cancer, visit our Side Effects page.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
Parathyroid cancer often recurs. Patients should have regular check-ups for the rest of their lives, to find and treat recurrences early.