Marcia S. Brose, MD, PhD: All About Thyroid Cancer

 Dr. Marcia Brose sits down with Selma Schimmel in The Group Room where she gives a Thyroid 101 — starting with the function of the gland, the signs, symptoms and the lack of any real treatments for advanced thyroid cancer until recently.

This interview was filmed at the American Society of Clinical Oncology Annual Meeting in Chicago 2013.

Marcia S. Brose, MD, PhD is an Asst. Professor at the Abramson Cancer Center at the University of Pennsylvania.

Advocacy and educational support provided at ASCO 2013, in part, by:

TGR ASCO 2013 Sponsor

VIDEO TRANSCRIPT

 

This is Selma Schimmel and you are looking live at the great city of Chicago which is once again playing host to the American Society of Clinical Oncology: ASCO.  This is ASCO’s 49th annual meeting and this year’s theme could not be more appropriate, Building Bridges to Conquer Cancer.  More than 30,000 of the world’s foremost cancer specialists are here and so is The Group Room making our 15th appearance at ASCO, and one of our very best.  Joining me now is Dr. Marcia Brose: Assistant Professor at the Abramson Cancer Center at the University of Pennsylvania.  Welcome, Dr. Brose.

 

Marcia S. Brose, MD, PhD, Asst. Professor, Abramson Cancer Center, University of Pennsylvania:

                 

Thank you for having me.

 

Selma Schimmel:

                 

Explain a bit about the function of the thyroid.  And, what are some of the common symptoms of thyroid cancer?

 

Marcia S. Brose, MD, PhD:

 

So, the thyroid is a gland.  It’s a butterfly shaped gland right here at the base of the neck, and the main function is it really regulates sort of the metabolic environment of the body.  And, it secretes a hormone called thyroid hormone.  It does that by making a hormone that actually has iodine in it, it’s one of the few parts of the body that actually uses iodine.  This gland normally is fine and actually, when people have thyroid cancer, it doesn’t usually affect the functioning of the gland.  So, many times the thing that comes to awareness for the patient or is brought to the attention of a doctor is that a nodule or a mass might be felt.  And so there’s a lot of effort to encourage people to not just do their breast exams but also to check your neck.  Patients might feel a nodule at the base or a little bump that they don’t, you know, wasn’t there before.  I’ve had friends actually who felt it because when they kept swallowing they felt like a little scratchy thing in the back of their throat and that sometimes might have been a nodule sort of going inside.  So, difficulty swallowing, voice changes, those could also be symptoms of early thyroid cancer.

 

Selma Schimmel:

                 

Who is at risk?

 

Marcia S. Brose, MD, PhD:

                 

I think that the patients at a risk are more commonly women to men, a 3:1 ratio, and it’s much more common under the age of 45.  The patients who have it who are women and under 45 actually have a better chance of doing well long term.  They are treated originally with some surgery and then radioactive iodine.  There are known risk factors- for instance, it’s known that people who were in the area of Chernobyl or Fukushima are going to be more at risk because thyroid cancer is one of the first cancers actually that shows up after a nuclear accident.  Some patients who have had a lot of radiation to their face… back in the old days they actually used to give radiation treatments for people who had acne and believe it or not, they had it as well.  Of course we’ve stopped doing that but sometimes I’ll still find an older patient.  So, thankfully we don’t do that anymore but you might have somebody who had either breast cancer or perhaps lymphoma and had a lot of radiation in that area, they are also at higher risk.

 

Selma Schimmel:

 

How is it diagnosed?

 

Marcia S. Brose, MD, PhD:

 

Once a mass has been picked up the workup would include an ultrasound of the neck.  Occasionally it’s picked up incidentally, there may not be any symptoms and a patient will be having a CAT-scan or an MRI for something else.  And in that case what happens is that, it’s noticed that they have a nodule and then after the nodule is noticed the gold standard is actually a fine needle aspirate.  So, and usually it’s done with ultrasound guided.  The best are done with a pathologist who is in the room who can actually check for the quality of the sample and then it’s usually the cells on the fine needle aspirate.

 

Selma Schimmel:

 

Dr. Brose, as you mentioned, many of these patients are seen in their endocrinologist’s office.  When is it time to make the transition to a medical oncologist’s office?

 

Marcia S. Brose, MD, PhD:

 

It’s a very important point, because many times these patients don’t even know what is available.  So now what we’re really recommending and trying to tell all the endocrinologists and all the patients out there that as soon as your doctor notices that your tumor is no longer taking up radioactive iodine you should get yourself to a center that knows how to treat thyroid cancer.  And I’ll point out that not all oncologists at this point are up and knowledgeable about it, so do your research- try to find out and make sure that your oncologist has learned about how to treat thyroid cancer.  And get yourself to their office because it may not be that you need to start chemotherapy right away but you need to actually establish a relationship with them so he can get to know you and the pace of your disease so that he can start treatment when it’s ready.

 

Selma Schimmel:


Where does thyroid cancer metastasize to?

 

Marcia S. Brose, MD, PhD:

 

When it comes back it might recur over and over again in the neck and that cannot be just, obviously the thyroid is gone at that point, but it might recur in spots in the neck but then it also, the highest place it will spread to once it leaves the neck is the lungs.  So, the primary spots are lungs, lymph node, bones, and even brain.

 

Selma Schimmel:

                 

Dr. Brose, for patients whose disease progresses, what problems do they experience?

 

Marcia S. Brose, MD, PhD:

                 

The first thing that you should know is actually, once somebody becomes radioactive iodine refractory their overall survival is only 2.5 to 3.5 years.  Even though they may have had it for 15 years or they could have had it 1year, from that point when they can’t have any therapy, their survival is… So already you can imagine psychologically what that’s going to mean.  Then, on top of that, they might have complications related to the slow and continuous, unrelenting progression in all of the sites that we just spoke of.  So when they have progression in their lungs they might have admissions to a hospital for pneumonia, they might have problems because their airways get blocked off and they have trouble breathing, they might have trouble with fluid accumulating in the lungs.  So, all of these things have often pain associated with it, hospitalizations, procedures; it’s a rough ride, and I think that they consider it kind of a bumpy ride.  They go in and out having multiple therapies as needed.

 

Selma Schimmel:

                 

One is going to require systemic therapy.   What are the treatments that are available?  And, where are we in the progress we’re making?  And actually, I know with this ASCO meeting there was some important data that got presented.

 

Marcia S. Brose, MD, PhD:

                   

Very.  So, historically, after somebody has had thyroid cancer, if it comes back, first and foremost, they sometimes will respond to additional treatments of radioactive iodine.  We don’t do anything until after that’s already been exhausted, after it’s all been used up.  But if they’ve had radioactive iodine and either they grew anyway or they’ve had radioactive iodine and they have not taken it up into the gland, in the skin afterwards, then we know that that’s not going to work anymore.  So, at that point we would call them radioactive iodine refractory, radioactive iodine non-avid; all of those go to say, basically the bottom line, radioactive iodine is done.  Some patients, it’s done from the beginning; they have an uptake skin and their tumors don’t pick it up.  So, some patients may have had tumors for 20 years, some people may have been diagnosed a year ago.  It’s a very large variety of people who would end up in that group that iodine is not working, and at that point we have had historically nothing to treat them with.  The only chemo that was FDA approved was doxorubicin in 1974. Before, we had CAT scans to monitor them and the trials were very small.  In this day and age doxorubicin would never have received FDA approval, and for that reason for the last 20 years at least people have not been giving it routinely.  Also, these patients are healthier than most- they have really good functioning status, they have great quality of life, and because of that giving them doxorubicin, when you know it’s not going to work, didn’t make any sense.  So, really ipso facto, you know, in reality we have no treatment and for that reason, as I said, it’s even another challenge for these patients.  They had cancer but they weren’t even referred to an oncologist and in a way that’s even sadder to some degree because the support of the cancer community is usually linked around an oncologist’s office.  So these patients were really, I think they felt a lot of them, abandoned and isolated, no hope, just go home and if you have a problem we’ll deal with it as it comes up.

 

Selma Schimmel:

 

You seem like such a warm and really passionate about your area of expertise.  Patients are very lucky to have you.

 

Marcia S. Brose, MD, PhD:

 

Oh, that’s nice.  Thank you.

 

Selma Schimmel:

 

There’s a real gentleness about you, like you really must take time to listen to what your patients say.

 

Marcia S. Brose, MD, PhD:

 

Well, when you’re treating a rare cancer an interesting thing is there are not many of them, and I will say that they’ve taught me.  I wouldn’t be the expert in thyroid cancer if I didn’t have patients who have taught me what it’s like and what matters, because we had to actually address their concerns.  And there wasn’t another doctor who was going to teach it to me.  It was the patients.

 

Selma Schimmel:

 

Dr. Marcia Brose: Assistant Professor at the Abramson Cancer Center at the University of Pennsylvania.  Thank you, Dr. Brose.

 

Marcia S. Brose, MD, PhD:

 

Thank you for having me.

 

Selma Schimmel:

 

Pleasure.

 

 

END OF VIDEO

 

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