Parathyroid Carcinoma is a very rare form of cancer, but it could be very aggressive if not diagnosed on time. As the name suggests it occurs in one or more of the parathyroid glands that are located in the neck near the thyroid glands, and the patients generally come with a bone fracture, weakness, swelling in neck and hoarse voice. Parathyroid cancer leads to increased secretion of parathyroid hormone (PTH), produced by Parathyroid glands and which helps the body to regulate calcium and phosphorous levels in the blood. It can be treated by surgery followed by radiation therapy and managing hypercalcemia or too much calcium in the blood.
Dr. Anuradha Murthy, Senior Consultant, Histopathologist, Metropolis Healthcare Ltd helps us understand how the carcinoma develops in the body, its causes and the treatment.
What Are Parathyroid Glands And How They Begin To Malfunction
Parathyroid glands are four paired glands situated on either side of the thyroid gland in the neck, but can occasionally be displaced during the embryonic stage, says Dr. Murthy. These glands can be within the thyroid or in mediastinal, a part of the chest. So what happens when parathyroid glands begin to malfunction and produce excess hormone?
When parathyroid glands start to make too much PTH, it leads to a condition called hyperparathyroidism. Hyperthyroidism is related to thyroid dysfunction and can occur when a benign or non-cancerous tumor called an adenoma forms on one of the parathyroid glands. Parathyroid adenoma is enlargement of one or more parathyroid glands or diffused enlargement of all four glands which is called parathyroid hyperplasia.
What Is Hypercalcemia And Why It Needs To Be Taken Seriously?
Because of the excess amount of PTH, the calcium stored in our bones moves to blood and intestines to absorb more calcium from the food we eat and it leads to a condition called hypercalcemia.
Hypercalcemia needs to be taken seriously as it may be behind several conditions such as fractures, being immobilized, kidney disease, calculi, sarcoidosis, hyperparathyroidism, hyperthyroidism, etc. It is a useful test to add to annual medical check-up tests.
How Does Parathyroid Cancer Develop?
Parathyroid cancer can develop gradually without getting noticed. Multiple endocrine neoplasia (MEN) - Type I or IIA and patients with hyperthyroid jaw tumor are at increased risk of getting this disease.
Multiple endocrine neoplasia typically involves tumors (neoplasia) in at least two endocrine glands. Tumors can also develop in other organs and tissues. These growths can be non-cancerous (benign) or cancerous (malignant).
Is The Cancer Rare Or Common?
Parathyroid cancer is rare and occurs in large series. They do not constitute more than a few cases seen every year. In contrast to the relatively frequently encountered adenomas and hyperplasias that are benign.
Hyperplasias are basically an increase in the amount of organic tissue that results from cell proliferation. It may lead to the gross enlargement of an organ and it shouldn’t be confused with benign neoplasia or benign tumor. However, these benign lesions require prompt attention to control hypercalcemia, which can be life threatening.
Symptoms of Parathyroid Cancer
Parathyroid cancer causes increased secretion of parathyroid hormone (PTH) with increased calcium, bone resorption which may lead bone mass to decrease and puts one at high risk of fractures.
Its symptoms are:
- Lytic lesions in bone. Lystic lesions are the areas where bones have been destroyed
- Swelling in the neck
- Hoarseness of voice
- Malaise or general feeling of being slightly ill or unhappy without a reason
Diagnosis of Parathyroid Cancer
- Considering the disease is an endocrine malignancy, its diagnosis is a multidisciplinary effort.
- It involves an experienced endocrinologist and radiologist involving sonology CT scan and sestamibi SPECT scan along with excellent laboratory support
- It should including pre/intraoperative monitoring of Serum calcium and PTH levels along with Frozen section
- The oncosurgeon will ensure complete exploration and optimal clearance and histo-pathology will confirm the diagnosis, the chief features being tumour necrosis , capsular, vascular and neural invasion along with lymph node involvement .
What Are The Stages Of Parathyroid Cancer?
Currently no staging guidelines are available for Parathyroid cancer and they are described as localized or metastatic.
What Is The Line Of Treatment For Such A Cancer?
- Post-operative radiation
- Current unravelling may provide insights and novel targets to treat this rare tumour.
Parathyroid Cancers though very rare can affect the bone density of patients. A lot depends on the timely diagnosis by an experienced endocrinologist, skills of radiologist and efficiency of oncosurgeon who have to work in tandem. This a very rare kind of cancer and novel ways to treat this deadly tumour are being found by experts. Its symptoms be it swelling in neck, fracture, change in voice, weakness must not be ignored.
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