Author: Endocrine Tumor Multidisciplinary Team, Dr. Li-Ying Juan, Nurse Shu-Chen Lee
Dr. Juan currently serves as a senior attending physician in the General Internal Medicine Department's Endocrinology Section at KFSYSCC. She is also the convener of the Endocrine Tumor Multidisciplinary Team. Her expertise includes diabetes, thyroid diseases, other metabolic diseases, and general internal diseases. She holds a Bachelor's degree in Medicine from the China Medical College. In 2000, she worked as a resident doctor in the Department of Internal Medicine at the Taipei Veterans General Hospital. In 2003, she became the Chief Physician of the Endocrinology and Metabolism Section in the same department and served as a research physician in 2004. She has been serving at KFSYSCC since 2007 and participates in the hospital's Multidisciplinary Endocrine Tumor and Nutrition Treatment Teams.
Shu-Chen Lee is an Advanced Practice Nurse and currently serves as an Advanced Practice Nurse in the Advanced Nursing Group of the Nursing Department at the Koo Foundation Sun Yat-Sen Cancer Center. Her expertise is in the care of patients with thyroid cancer. She graduated from Mackay Nursing School in 1983 and has been serving at this hospital since 1994.
Our Unique Approach to Treating Thyroid Cancer
Endocrine organs include the pituitary gland, thyroid, parathyroid, endocrine pancreas, adrenal glands, and gonads. These glands regulate growth, metabolism, reproduction, and aging in the human body by secreting hormones. If an endocrine organ is impaired, not only is that specific organ affected, but the whole body is as well, which can impact a patient's lifelong health. Endocrine diseases can be categorized into functional and tumorous diseases. Common functional issues, such as menopausal syndrome, thyroid dysfunction, and diabetes, are prevalent and well-known to the public. Endocrine tumors are less common, with malignant tumors even rarer. Such tumors often coincide with endocrine dysfunction, requiring skilled medical personnel for proper diagnosis and treatment.
The Koo Foundation Sun Yat-Sen Cancer Center specializes in oncology and has been established for over thirty years. Although malignant endocrine tumors are rare, the hospital, being a cancer-specialized institution, has cared for many patients. Thyroid cancer is the most common, followed by rare parathyroid and adrenal cancers. Every two to three years, several patients undergo treatment for these conditions at the hospital. As a result, KFSYSCC has significant experience in treating malignant endocrine tumors, especially in the care of thyroid cancer patients.
Thyroid cancer has the best prognosis and highest survival rate among all malignant tumors in the human body. Early-stage thyroid cancer can often be cured through surgery and, if needed, Iodine-131 treatment. For advanced stages, continuous Iodine-131 treatments can significantly improve survival rates. Since most thyroid cancers are detected in the early stages, the challenge post-treatment is ensuring a good quality of life due to the high long-term survival rate of the patients.
Two critical factors affecting the quality of life during thyroid cancer treatment are the following:
Avoiding damage to the recurrent laryngeal nerve and parathyroid during thyroid surgery. Damage to the recurrent laryngeal nerve can lead to vocal cord paralysis, speech issues, and swallowing difficulties. Previously, many patients feared thyroid surgery due to witnessing acquaintances who couldn't speak post-surgery. The reason being the damage to the recurrent laryngeal nerve. Accidental removal of the parathyroid gland during surgery can lead to permanent hypocalcemia, which can cause limb numbness and severe arrhythmias and fainting. This complication is significant and cannot be overlooked. Patients will need to take calcium and vitamin D for life. Surgeons need to be experienced and use tools like nerve monitoring systems to minimize the risks during thyroid surgery.
Preserving appropriate amounts of thyroid tissue without compromising cancer recurrence. The thyroid plays a crucial role in regulating metabolism and energy supply in the human body. Depending on the patient's condition, treatment may require total or partial thyroidectomy. However, making the right decision between the two is crucial for preventing cancer recurrence and lifelong thyroid dysfunction. Crafting the optimal treatment plan requires a doctor's expertise.
For recurrent or metastatic thyroid cancer, adopt the treatment method that has the least impact on patients. Approximately 30% of thyroid cancer patients will experience a recurrence in the regional cervical lymph nodes after treatment. Traditionally, most doctors would recommend re-operating to remove the recurrent lymph nodes; our institution's approach prioritizes assessing whether the patient's recurrence is suitable for "alcohol injection therapy", using alcohol to destroy the tumor cells within the lymph nodes. This method is as effective as surgical removal. This can minimize the patient's exposure to unnecessary surgery while effectively controlling the tumor. Additionally, for thyroid cancer that has metastasized to the bone, besides the traditional iodine-131 treatment, external radiation therapy on the metastatic bone is often required. However, radiation therapy, besides treating the metastatic part, also affects the organs nearby, causing damage to those organs (especially affecting the gonads, which would impair the patient's reproductive ability). To avoid this situation, "radiofrequency ablation" can be used to treat the metastatic site, also effectively controlling the tumor.
Paying careful attention to the three points above is a feature of our institution's thyroid cancer treatment, especially the treatment method mentioned in the third point, which is unique to our institution. What kind of patient is suitable for which treatment depends not only on the disease itself but also on factors such as the patient's living environment, physical and mental health, and family background. During team meetings, medical professionals from different specialties can provide their opinions, and after thorough discussion, a consensus is reached to ensure that patients receive the most suitable treatment plan.
Here we share two cases recorded by the endocrinology team, illustrating through these two patient stories how our team treats and cares for patients:
The first case: A 21-year-old woman with bright lipstick and shiny teeth came to the Koo Foundation Sun Yat-Sen Cancer Center in 2005 for thyroidectomy. The pathological examination results showed left-sided follicular thyroid carcinoma and a tiny papillary carcinoma on the right side. A few years later, she got married and had a boy the following year.
Cancer sometimes makes people feel depressed, so whenever there are significant life events like marriage or childbirth, the joy is indescribable.
However, as time went by, even after the patient underwent three iodine-131 treatments, her tumor markers gradually increased, revealing a metastasis in the left clavicle.
The primary doctor initiated a team meeting to discuss her condition. During the meeting, the surgeon expressed his view: the tumor's recurrence location is too close to nerves, making surgery unsuitable. The radiation oncologist thought of radiation therapy, but given she's only 30 and has a life ahead of her, future pregnancy would be affected. The nuclear medicine physician believed the tumor is slightly large, making iodine-131 treatment less effective. Eventually, the radiologist introduced a new idea: a technique called Radiofrequency Ablation (RFA), using thermal energy to eliminate the tumor. After an hour of passionate discussion, they decided to adopt this method to treat the left clavicle metastasis. In addition, the care manager and social workers fully assisted to ensure the smooth progress of the treatment. After the treatment, the patient's tumor markers significantly decreased, and the condition improved. Five years later, the patient had her second child, and up to today, the tumor remains under control.
The second case: A healthy 30-year-old man, sunny and passionate about photography and cycling, underwent a total thyroidectomy due to papillary thyroid cancer. However, a year later, a recurrence in a neck lymph node was discovered. The primary physician raised the discussion during a team meeting. In the meeting, the surgeon said surgery was an option, but considering the risks associated with surgery and anesthesia for just one small recurrent lymph node, was there another treatment method? The radiologist suggested: alcohol injection is typically used for liver cancer, so could we use this method for such a small lymph node in this patient? After everyone's discussion, they decided to use alcohol injection therapy, successfully controlling the condition. The patient, since his diagnosis, has survived for more than a decade. Not only has his condition remained stable during this time, but he also achieved a significant life event: getting married. Nowadays, he often enjoys leisurely cycling trips and photography during weekends, leading a happy life.
As recorded in the two stories above, beyond treating cancer, caring about patients' lives and their quality of life after cancer treatment is the key to successful treatment. We firmly believe that ‘cancer patients, in addition to being treated for their illness, also need to live their lives well'; 'curing cancer, but ruining life' is not what we want to see. Over the years, the endocrinology team has always adhered to the core value of 'caring for patients' rather than 'just treating diseases' to assist patients. This spirit will continue to be carried forward in the future."
