- What Is the Parathyroid?
- What Is Parathyroid Cancer?
- Who Is at Risk for Parathyroid Cancer?
- Signs and Symptoms of Parathyroid Cancer
- How Is Parathyroid Cancer Diagnosed?
- Stages of Parathyroid Cancer
- Treatment for Parathyroid Cancer
The parathyroid is a gland found in the neck near the thyroid. It consists of four pea-sized organs and produces the parathyroid hormone (PTH). The body depends on PTH to regulate calcium in the blood.
An overactive parathyroid gland can make too much PTH, which causes a condition called "hyperparathyroidism." Extra PTH in the body causes calcium that is stored in the bone to be released into the bloodstream and the intestines (gut) to absorb more calcium from the food we eat. In turn, it causes a second condition known as "hypercalcemia," or too much calcium in the blood, which can be life-threatening.
In some cases, hyperparathyroidism is due to benign (non-cancerous) cells that is attach to the surface of the parathyroid gland, causing it to become overactive. Parathyroid cancer occurs when malignant (cancerous) cells form in the tissues of the parathyroid gland.
Two disorders passed from parent to child that may increase the risk of parathyroid cancer are:
- Multiple Endocrine Neoplasia (MEN) Type 1 Syndrome
- Familial Isolated Hyperparathyroidism (FIHP)
Other risk factors include:
- Past treatment with radiation therapy for acne, infected tonsils, thymus or lymph nodes
- Any exposure to ionizing radiation in the neck region
Most symptoms of parathyroid cancer are caused by hypercalcemia, and include:
- Feeling very tired
- Nausea and vomiting
- Loss of appetite
- Weight loss (without trying to lose weight)
- Increased thirst (more than usual)
- Increased urination
- Trouble thinking clearly
Other symptoms directly related to parathyroid cancer include:
- Pain in the abdomen (belly), back or side that does not go away
- Bone pain
- Broken bone(s)
- Lump in the neck
- Hoarse voice or change in tone
- Trouble swallowing
**These signs and symptoms should immediately be reported to your physician.**
Various laboratory and diagnostic testing is used to diagnose parathyroidal cancer.
- calcium level
- parathyroid hormone test
- Sestamibi scan (radionuclide scan used to find out if a parathyroid gland is overactive)
- CT or CAT scan
- Ultrasound exam
- Angiogram (procedure to look for blood vessels and measure the flow of blood)
- Venous sampling (procedure in which a sample of blood is taken from a vein near the parathyroid gland to measure the amounts of PTH)
There is no staging process for parathyroid cancer. Parathyroid cancer is either localized or metastatic. CT or MRI scans may be used to determine if parathyroid cancer is found only in the parathyroid gland or if it has spread to nearby organs (lung, liver, bone, sac around the heart, pancreas or lymph nodes).
Controlling hyperparathyroidism and hypercalcemia are important first steps in treating parathyroid cancer. In addition, four standard treatment options include surgery, radiation therapy, chemotherapy and supportive drug therapy.
Surgically removing cancer in the parathyroid gland can cure patients. However, prior to surgery, steps must be taken to control hyperparathyroidism and hypercalcemia. Surgical procedures include:
- En bloc resection (also may include the removal of lymph nodes, tissues from the thyroid or muscles and nerves from the neck on the same side as the affected area)
- Tumor debulking
Surgery may damage nerves of the vocal cords, causing permanent changes in the voice. However, treatments are available to help with speech problems resulting from nerve damage.
Internal or external radiation therapy is administered according to the extent of parathyroid cancer. It may be recommended prior to surgery, after surgery or in combination with chemotherapy.
Chemotherapy may be recommended as a single agent or in combination with other drugs.
Supportive Drug Therapy
Some treatment options may be recommended to support the body in fighting hyperparathyroidism, including:
- Intravenous (IV) fluids
- Drugs that stop the parathyroid gland from making parathyroid hormone
- Drugs that cause the body to make more urine
- Drugs that stop the body from absorbing calcium from the food we eat