Treatment of Parathyroid Cancer
1. Surgery
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery is the main treatment for a parathyroid tumor, whether the tumor is benign or cancerous. A surgical oncologist is a doctor who specializes in treating a tumor using surgery. Because parathyroid cancer is so rare and it cannot be cured if it has recurred, surgery with a surgical oncologist who has extensive expertise in thyroid and parathyroid surgery is strongly encouraged whenever parathyroid cancer is suspected.
It is difficult to know before surgery whether a parathyroid tumor is benign or malignant. Parathyroid cancer is the likely diagnosis whenever a patient has profound hypercalcemia, defined as a calcium level greater than 13 mg/dL, or a large parathyroid tumor, defined as larger than 3 centimeters. If this is the case, the parathyroid gland and surrounding structures should be removed. Those surrounding structures should include the same side of the thyroid gland, fatty tissue and lymph nodes surrounding the parathyroid tumor, and the overlying muscle of the center of the neck, called the sternothyroid muscle. The typical surgery for a benign parathyroid tumor is not the same as the surgery for a parathyroid cancer. The doctor may also recommend radiation therapy after surgery to the affected area of the neck (see below).
Surgery for a benign parathyroid tumor is called a parathyroidectomy. Talk with your surgeon about whether minimally invasive surgery for a benign tumor in a single gland is an option for you.
If a surgeon finds the tumor is benign during surgery, it is common to check the patient’s level of PTH in the blood during the operation. If necessary, the surgeon will then put back 1 of the normal parathyroid glands that had been removed earlier in the operation. However, if the tumor is cancerous, the gland should not be put back to avoid any chance of putting cancer cells back into the body.
Before surgery, talk with your surgeon about what to expect, how long recovery will take, and the possible short- and long-term side effects. Learn more about the basics of cancer surgery.
2. Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, which is your treatment plan, usually consists of a specific number of treatments given over a set period of time. This may also be called a schedule.
Occasionally, radiation therapy may be recommended after surgery for parathyroid cancer. Radiation therapy may help reduce the risk of parathyroid cancer recurring in the neck, but it is difficult to evaluate whether this treatment is beneficial because this type of cancer is so rare.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Talk with your doctor about how side effects can be relieved or managed during treatment. Most side effects go away soon after treatment has finished. Learn more about the basics of radiation therapy.
3. Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.
Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.
Chemotherapy rarely works at treating metastatic or recurrent parathyroid cancer. More clinical trials are needed.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.