Papillary thyroid cancer: symptoms, tests, treatment and outlook

The thyroid is a small gland in the front, lower part of the neck that makes hormones helping with things like digestion, muscles and heart. Thyroid cancer is cancer found in this gland. Cancer Research UK explains that the type of thyroid cancer depends on the type of cell it started in, and that papillary is the most common. Others include follicular, medullary and anaplastic, which are handled differently.

The NHS says how serious thyroid cancer is depends on the type, how big it is, whether it has spread and your general health. Cancer Research UK says survival is generally very good for papillary and follicular cancers, but that it depends on the type and stage, so your own outlook is best discussed with your specialist.

The NHS lists the symptoms of thyroid cancer, and stresses that these are very common and can be caused by many other conditions.

• A lump in the front, lower part of the neck, usually hard, slowly growing and painless.

• A hoarse voice, a sore throat, or a cough.

• Difficulty swallowing or breathing.

• Pain in the front of the neck, or a feeling of something pressing against the neck.

• Less commonly, flushing, softer poos or diarrhoea, and weight loss.

The NHS advises seeing a GP if you have a new lump in the neck or an existing lump that is getting bigger, a hoarse voice, sore throat or cough for more than 3 weeks, or pain or pressure in the front of the neck. It says to ask for an urgent GP appointment or get help from NHS 111 if you are having difficulty swallowing or breathing.

If you already have a swollen thyroid (goitre) or nodules, the NHS says to get checked by a GP if symptoms change, get worse or do not feel normal for you. The GP may feel your neck and arrange blood tests, and may give you an urgent referral, which does not definitely mean you have cancer.

The NHS says anyone can get thyroid cancer and it is not always clear what causes it. You may be more likely to get it if you are a woman who has not been through the menopause, have a condition affecting the thyroid such as a goitre, Hashimoto's disease or non-cancerous nodules, have a close relative who has had thyroid cancer, were exposed to a lot of radiation or had radiotherapy in the past, especially as a child, or have had certain other cancers such as breast, oesophageal, testicular cancer or non-Hodgkin lymphoma.

Cancer Research UK adds age, being very overweight and some non-cancerous thyroid conditions to the risk factors. The NHS notes you cannot always prevent it, but keeping a healthy weight, cutting down on alcohol and not smoking can lower your chance of cancers generally.

The NHS says that if the GP refers you to a specialist you may have blood tests, an ultrasound scan of the neck and a biopsy, where a small sample is taken from the thyroid gland with a needle to be checked for cancer. You may not have all of these. It should take about 2 weeks to get results.

If thyroid cancer is confirmed, further tests help work out the size and how far it has spread. The NHS lists CT, MRI or PET scans and a test where a thin flexible tube with a camera is passed through the nose to check the vocal cords. Cancer Research UK explains that staging uses the TNM system, which looks at the size of the cancer, whether it has spread to lymph nodes and whether it has spread to other parts of the body, and that the number staging for papillary and follicular thyroid cancer is the same.

The NHS says the treatment depends on the size and type of thyroid cancer, whether it has spread and your general health. It will usually include surgery and may also include hormone therapy, radioactive iodine treatment, targeted medicines, radiotherapy or chemotherapy.

The NHS says you will have regular check-ups during and after treatment, and may have tests and scans. If you have symptoms or side effects you are worried about, you do not need to wait for the next check-up. A clinical nurse specialist is usually your main point of contact. Support is available from charities such as the Butterfly Thyroid Cancer Trust, Macmillan Cancer Support and Cancer Research UK, which the NHS lists in its help and support page.

On the NHS the route is a GP appointment, urgent referral where cancer is suspected, ultrasound and needle biopsy, then a multidisciplinary team that recommends treatment. Some people choose a private endocrine surgeon or ENT specialist for a quicker first appointment or a second opinion. Whichever route you use, it is worth asking which surgeon and team will manage each stage of care.