Parathyroid Cancer

21.03.2024

PARATHYROID CANCER DIAGNOSIS AND TREATMENT

Parathyroid cancer is a rare type of tumor that occurs in the parathyroid glands. Parathyroid glands are small glands located near the thyroid glands in the neck and are responsible for regulating the calcium level in the body. Parathyroid cancer occurs as a result of uncontrolled growth of these glands and the formation of abnormal cells. Parathyroid cancer is often associated with a condition called hyperparathyroidism. Hyperparathyroidism is a condition that causes the parathyroid glands to produce excessive amounts of parathyroid hormone. Parathormone increases the calcium level in the body and enables calcium to be released from the bones. This can lead to bone weakness and high blood calcium levels. When parathyroid cancer is diagnosed, it is important for the patient to be treated because this type of cancer can be aggressive and lead to complications. Treatment options may include surgery, radiotherapy and chemotherapy. Parathyroid cancer can be controlled with early diagnosis and appropriate treatment. Therefore, regular health check-ups and being sensitive to symptoms are important.

WHAT ARE THE RISK FACTORS?

The exact cause of parathyroid cancer is not yet known, but potential risk factors may include:

Genetic Factors: Family history may increase the risk of parathyroid cancer. People with a family history may have a higher risk of developing this cancer.

Radiation Exposure: Radiation exposure may increase the risk of parathyroid cancer. The risk may be higher in people who received radiation therapy to the head and neck area, especially during childhood.

MEN Syndromes: Genetic diseases called multiple endocrine neoplasia (MEN) syndromes may increase the risk of parathyroid cancer. These syndromes may include parathyroid cancer as well as other endocrine system problems, such as thyroid cancer and tumors in the adrenal glands.

Hyperparathyroidism: Hyperparathyroidism is a condition that causes the parathyroid glands to produce excessive parathyroid hormone. Long-term hyperparathyroidism may increase the risk of parathyroid cancer.

Age: Parathyroid cancer usually occurs in middle-aged or older adults. It occurs rarely in young ages.

Gender: Parathyroid cancer is slightly more common in women.

These factors may increase the risk of parathyroid cancer, but there is no guarantee that anyone will develop this cancer even if they have these risk factors. In case of any doubt or concern, it is important to consult a healthcare professional. In addition, regular health checks and early diagnosis play an important role in detecting rare types of cancer such as parathyroid cancer.

Image 1: Parathyroid glands secrete parathyroid hormone (PTH) and regulate calcium mechanisms in the body.

HOW DOES IT OCCUR?

The mechanisms of development of parathyroid cancer are still not fully understood, but research is ongoing on some possible factors and processes. Genetic mutations may be an important factor that may play a role in the development of this cancer. Genetic diseases, especially multiple endocrine neoplasia (MEN) syndromes, may increase the risk of parathyroid cancer. Additionally, long-term hyperparathyroidism can lead to overactivity of the parathyroid glands and abnormal cell growth, triggering the development of cancer. However, more research is required and the exact mechanisms of parathyroid cancer have not yet been conclusively determined.

WHAT ARE THE SYMPTOMS?

Parathyroid cancer may sometimes not show symptoms, or the symptoms may be similar to other parathyroid diseases. However, symptoms of parathyroid cancer may include:

Increase in Blood Calcium Levels: Parathyroid cancer can lead to increased blood calcium levels. This is called hypercalcemia and can cause symptoms such as fatigue, nausea, vomiting, constipation, and increased urination frequency.

Bone Pain and Weakness: High parathormone levels can increase calcium removal from bones, causing bones to weaken. This can increase the risk of bone pain and fractures.

Urinary Tract Stone Formation: High calcium levels can lead to the formation of stones in the kidneys, which can cause kidney pain and urinary tract problems.

Muscle Weakness: Muscle weakness, muscle twitching or muscle contractions may be among the symptoms of parathyroid cancer.

Fatigue and Weakness: High levels of calcium in the blood can affect the body, causing weakness, fatigue and a general feeling of restlessness.

Swelling in the Throat: Parathyroid cancer can cause a swelling or lump sensation in the neck area.

An important point to note is that these symptoms are not limited to parathyroid cancer. Similar symptoms may indicate other health problems. It is therefore important to consult a physician in case of any concerning symptoms. Even if a rare condition such as parathyroid cancer is considered, early diagnosis and treatment are critical to control the effects of the disease.

HOW IS IT DIAGNOSED?

Parathyroid cancer is diagnosed using a series of clinical and laboratory tests. In the first stage, the patient's symptoms and physical examination are evaluated. Blood tests measure calcium and parathormone levels in the blood. High calcium and parathyroid hormone levels may be a sign of parathyroid cancer. In addition, the condition of the parathyroid glands is evaluated with imaging tests such as neck ultrasound or computed tomography (CT). Definitive diagnosis is usually made with a surgical biopsy. A tissue sample taken from the parathyroid gland is examined under a microscope and a diagnosis is made if cancer cells are present. The diagnostic process is usually done in collaboration with an endocrinologist, surgeon and pathologist.

WHAT ARE THE PATHOLOGICAL TYPES?

Parathyroid cancer can be divided into different pathological types, and the identification and classification of these types can have an impact on the treatment and course of the disease. Pathological types of parathyroid cancer may be:

Adenocarcinoma: Adenocarcinoma, the most common pathological type of parathyroid cancer, is a type in which cancer cells form gland-like structures.

Sclerozan Type: In this type of cancer, cancer cells are found in fibrotic or sclerotic tissue, meaning the cancer tissue hardens.

Onkositik Type: This type of cancer is dominated by oncocytic cells and is characterized by large and granular cells.

Anaplastic Type: This type of cancer is typically a more aggressive form that grows and spreads rapidly.

Since cases of parathyroid cancer are rare, identifying pathological types is important in determining treatment options and prognosis of the disease. The type of disease can affect the treatment approach and the patient's chance of survival. Therefore, tissue examination by a pathologist is important to correctly classify the type of disease. Targeted treatment methods are used in the treatment of parathyroid cancer, and it is important to target certain receptors in these treatments. In particular, some receptors found in parathyroid cancer cells are targeted. These include parathormone receptor, calcitonin receptor and vascular endothelial growth factor (VEGF) receptors. The parathyroid hormone receptor is a receptor used to control the growth and calcium levels of parathyroid cancer cells, and targeting it may help inhibit the growth of cancer cells. The calcitonin receptor may be another target that helps limit the growth of cancer. Since VEGF receptors help the tumor promote new blood flow to blood vessels and therefore support tumor growth and metastasis, targeting these receptors could be used as a strategy to control tumor growth. Targeting these receptors may contribute to the development of new and promising approaches to the treatment of parathyroid cancer.

Image 2: PTH secreted by the parathyroid gland is very important for bone health and regulating the calcium level in the blood.

HOW IS TUMOR STAGING DONE?

Staging of parathyroid cancer is a system used to determine the spread and severity of cancer. This staging process evaluates the size of the cancer, its spread to lymph nodes, and its ability to metastasize to distant organs. Staging systems used for parathyroid cancer often play an important role in determining the extent of cancer and treatment options.

Parathyroid cancer staging is done as follows:

Stage 1: At this stage, the cancer is limited to the parathyroid gland only and has not spread to surrounding tissues or lymph nodes.

Stage 2: The cancer has spread from the parathyroid gland to surrounding tissues but has not metastasized to distant organs.

Stage 3: The cancer has spread to the large vessels in the neck, surrounding tissues and lymph nodes, but has not metastasized to distant organs.

Stage 4: At this stage, the cancer has metastasized to distant organs. The organs that metastasize are usually the lungs, bones, or other distant sites.

Staging is done based on radiological imaging, biopsy results, and information obtained during surgery. Staging of parathyroid cancer patients is important in determining the treatment plan and prognosis of the disease. Staging results are taken into account when determining an appropriate treatment approach for each patient.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Treatment for parathyroid cancer may vary depending on the stage of the cancer and the patient's general health condition. Here are the treatment approaches according to different stages of parathyroid cancer:

Stages 1 and 2: Parathyroid cancer is often treated with surgery in these early stages. During the surgery, cancerous parathyroid glands, surrounding tissues and lymph nodes are carefully removed. After surgery, the patient's calcium levels are checked regularly and supplements are given if necessary.

Stage 3: At this stage, if the cancer has spread to surrounding tissues or large vessels, surgical treatment may still be an option. However, because the cancer is more widespread at this stage, the surgical procedure may be more complex. Radiotherapy may also be required after surgery.

Stage 4: If parathyroid cancer has metastasized to distant organs, treatment may require a more aggressive approach. Surgical intervention is usually inadequate at this stage and systemic treatments such as radiotherapy or chemotherapy can be used. Treatment is adapted to the organs where the cancer has metastasized.

The treatment plan may vary depending on the patient's unique situation and the type and stage of the cancer. A multidisciplinary approach is used to treat parathyroid cancer, meaning endocrinologists, surgeons, radiation oncologists, and other specialists come together. A special treatment plan is created for each patient and the patient is followed up regularly. After treatment, it is important to monitor patients regularly and check their calcium levels.

Image 3: Parathyroid cancer is diagnosed as a result of abnormally high calcium levels, high PTH levels and surgery for the mass in the parathyroid glands.

WHAT ARE THE SYSTEMIC DRUGS USED IN TREATMENT

Methods used in the treatment of parathyroid cancer include options such as chemotherapy, hormonal drugs, smart drug treatments and immunotherapy. Here is information about some of these treatment methods:

Chemotherapy: Mitotane: It is a chemotherapeutic drug used in the treatment of parathyroid cancer. It may help slow tumor growth.

Calcitonin Drugs: It is used to regulate calcitonin levels and is preferred in parathyroid cancers.

Smart Drug Therapies: Sorafenib is a targeted therapy drug used to treat parathyroid cancer. It works to block new blood flow to the tumor's blood vessels by targeting VEGF receptors.

Immunotherapy: The role of immune checkpoint inhibitors in the treatment of parathyroid cancer is still being investigated. Drugs that target programmed cell death proteins (PD-1 or PD-L1) can help the immune system recognize and attack cancer cells.

These medications and treatment methods may vary depending on the specific conditions of parathyroid cancer patients and the stage of the cancer. The treatment plan is determined by a multidisciplinary healthcare team based on the patient's specific condition. Treatment options and medications suitable for each patient are carefully evaluated by doctors and the patient is followed up regularly.

HOW SHOULD FOLLOW-UP BE DONE AFTER RECOVERY?

Follow-up after parathyroid cancer treatment is very important to monitor the patient's health and detect recurrence or complications early. After recovery, patients should be followed regularly by endocrinologists and oncology doctors. The monitoring process includes regular measurement of calcium and parathyroid hormone levels. Calcium and vitamin D supplements may be prescribed if necessary to reduce the risk of cancer recurrence and maintain the patient's overall health. Various medical tests, such as imaging tests and biochemical tests, may also be performed. The follow-up process is customized depending on the patient's unique situation, response to treatment, and the stage of the cancer. Regular follow-up plays a critical role in closely monitoring the patient's health status and adjusting treatment when necessary, thus helping patients achieve the best results.