The Parathyroid glands are four pea-sized endocrine glands located in the neck and attached to the back of the thyroid gland. They are responsible for the production of parathyroid hormone (PTH) which has a key role in regulating the amount and the usage of calcium in the blood and within the bones. Parathyroid cancer is a slow growing and rare disease in which malignant cancer cells form in the tissues of a parathyroid gland. Most people with parathyroid cancer make too much PTH. That leads to too much calcium in the blood (called hypercalcemia)
There are chances that a patient suffering from parathyroid cancer may not experience any symptoms at all. Otherwise, the common symptoms observed are:
The symptoms mentioned are not unique to parathyroid cancer alone, therefore it is important to get a check-up done quickly to drive early detection.
It is understood that Parathyroid cancer occurs during middle-age amongst men and women. Although there are no known causes of Parathyroid cancer, the following risk factors may increase a person’s chance of developing the cancer:
A Parathyroid cancer can be classified into 3 stages specifically:
Localized stage: In the 1st stage, the cancer is present only in the parathyroid gland or nearby tissues.
Metastatic stage: In the 2nd stage, the cancer has spread to the other parts of the body and nearby tissues including lymph nodes, lungs or bone.
Recurrent stage: In this stage, the cancer can come back after it has been treated. A recurrent parathyroid cancer is most often in the tissues or lymph nodes in the neck. It can also come back in other parts of the body.
Diagnosis of Parathyroid Cancer may require the following tests and procedures:
Physical Exam & History: The doctor does a physical exam to check for any lumps around the neck which seem unusual. A detailed account of patient’s health habits and past illnesses and treatments are also carefully studied.
Blood Chemistry Studies: A blood sample from the patient is extracted to check high level of calcium levels which can indicate the presence of parathyroid cancer. A secondary test is also done to check the amount of parathyroid hormone which is released into the blood by the parathyroid glands.
CT-Scan: The computerized tomography test makes a series of detailed pictures of areas inside the body at different angles. A dye is injected into the vein or swallowed to the help the organs or tissues show up more clearly. The test is highly effective in detecting any abnormalities in the parathyroid gland. A SPECT scan (single photon emission computed tomography scan) is also conducted before or after the CT scan where a special camera is used to make a 3-D picture with help of a small amount of radioactive substance that gets injected into the vein.
Ultrasound exam: The procedure involves high-energy sound waves (ultrasound) which bounces off internal tissues or organs and makes echoes. The echoes form a picture of the parathyroid gland and how far the tumour has spread.
Angiogram: Under this a procedure is performed to check the blood vessels and the flow of blood. A dye is injected into the blood vessel. As the dye moves through the blood vessel, x-rays are taken to see the presence of tumour in the parathyroid gland.
Venous Sampling: A procedure in which sample of blood is taken from specific veins and checked to measure the amount of certain substances released into the blood by nearby organs and tissues. If imaging tests don’t show which parathyroid gland is overactive, blood samples may be taken from veins near each parathyroid gland to find which one is making excessive PTH (Parathyroid Hormone).
After conducting multiple tests and making a proper diagnosis, the consultants may decide to go with one or more possible treatment modalities. These include radiation therapy, chemotherapy, and surgery.
It is understood that a parathyroid tumour can cause high level of calcium in the blood (hypercalcaemia). The medication prescribed is used to reduce the calcium levels in the blood. Most of the drugs are only used for short periods until treatment to remove the tumour can be started. Otherwise, the various types of treatment are:
Under this, a surgical procedure is performed to remove the tumour in the parathyroid gland. Surgery is usually recommended when the tumour is larger than 3 centimetres. In such cases, the parathyroid gland and surrounding tissues are removed.
In order to treat benign parathyroid cancers, a surgery called parathroidectomy is performed. During the procedure, if the surgeon discovers that the tumour is benign during surgery, it is common to check the patient’s level of PTH in the blood during the operation. If required, the surgeon will then put back 1 of the normal parathyroid glands that had been removed earlier in the operation.
During radiation, high energy x-rays are used to destroy cancer cells.
Radiation therapy is usually recommended after surgery for parathyroid cancer. It helps in reducing the risk of recurrent parathyroid cancer. It is also considered an option where surgery is not possible.
The side effects of radiation therapy can include fatigue, mild skin reactions, upset stomach and loose bowel movements.
During this form of therapy, chemo-drugs are used to destroy the cancer cells. The drugs are injected into the body through the intravenous (IV) tube placed into a vein using a needle or in a capsule which requires to be swallowed orally. It is understood that chemotherapy rarely works at treating metastatic or recurrent parathyroid cancer. The side effects of chemotherapy include fatigue, risk of infection, nausea, vomiting, hair loss, loss of appetite and diarrhoea.