En español | You know it's important to check your skin for unusual moles that could be melanoma and, if you're a woman, to check your breasts for lumps that could signal breast cancer. But did you know you should also see a doctor if you notice any unusual swelling in your neck?
That's a classic symptom of thyroid cancer, says Jonathon Russell, M.D., director of the Multi-Disciplinary Thyroid Tumor Center at Johns Hopkins Medicine.
About 45,000 Americans are diagnosed with thyroid cancer every year, according to the Centers for Disease Control and Prevention (CDC).
Thyroid cancer can occur at any age, but the risk peaks for women when they're in their 40s or 50s, while most men are diagnosed in their 60s or 70s, according to the American Cancer Society. Women are three times more likely than men to develop thyroid cancer.
Until recently, thyroid cancer was the most rapidly increasing cancer in the U.S., largely due to better detection.
Many cases discovered accidentally
Many thyroid tumors today are discovered unexpectedly when a patient is being checked for another problem, says Douglas Ross, M.D., codirector of Thyroid Associates at Massachusetts General Hospital. A tumor may be spotted during an imaging test such as a chest or neck CT, a carotid Doppler study or a neck MRI. “The imaging has gotten so much better that we're picking up cancers decades earlier than we used to,” Ross says.
Thyroid cancer is mostly curable, with an overall five-year survival rate of about 98 percent, according to the American Society of Clinical Oncology.
However, an individual patient's survival rate depends on what kind of thyroid cancer they have — some types are aggressive — and how early the cancer is detected, Russell says. That's why it's a good idea to be familiar with the possible symptoms of thyroid cancer, and to tell a doctor if you have any. Here are four of the most common.
1. A lump or swelling in your neck
A lump, nodule or swelling near the base of your neck that you can feel or see in the mirror is the most common symptom of thyroid cancer. Not all lumps are cancer, however. Studies show up to half of all people over the age of 60 have some type of thyroid nodule, and only a small number of them turn out to be cancerous tumors. So while it's important to get a lump checked out, there's no need to panic if you have one.
2. Trouble swallowing
A tumor on the back of the thyroid can sometimes press on the esophagus and make swallowing difficult. Some patients say it feels like something is stuck in their throat; others describe a tightness that makes it difficult to swallow. It's usually solid foods like breads and meats that are hard to swallow — not liquids, Russell says. “Liquids not going down the right way is probably something else,” he says.
3. Hoarseness that persists
Occasional temporary voice changes are usually not a cause for concern, Russell says. But if your voice becomes very hoarse or breathy for no reason, and it stays that way, a large tumor may be affecting your vocal cords. “A severe change in your voice when you're not sick is a sign you should see a doctor right away,” Russell says.
4. Chronic cough or shortness of breath
In rare situations, a tumor may grow so large that it presses on your esophagus, causing shortness of breath or a chronic cough. That may be a sign you have a more aggressive form of thyroid cancer that “has started to invade other structures,” Ross says.
Getting a diagnosis
These symptoms can also be signs of many other health conditions, so it's important to see a medical provider who can make a diagnosis. You can start with your primary care provider, but you will probably be referred to an endocrinologist or to an ear, nose and throat (ENT) specialist.
That specialist will likely conduct a thyroid function blood test and order imaging, such as an ultrasound or a neck CT scan. Depending on those results and the characteristics of the nodule, your doctor may recommend a needle biopsy to make a definitive diagnosis.
Even if a nodule is malignant, thyroid cancer is highly treatable with surgery and, if necessary, radiation and chemotherapy. And the latest treatment guidance says small tumors found early may not need to be removed immediately. Many doctors will let the patient decide if they want to have surgery right away or take a wait-and-watch approach to see if the tumor progresses. “The goal is to personalize the care of a cancer that is unlikely to kill you,” Russell says.
Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation's top consumer publications. Her work has appeared in Reader's Digest, Real Simple, Prevention, The Washington Post and The New York Times.