Cancer: The Diagnosis
Guest: Dr. Denise Carneiro-Pla – Surgery
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Denise Carneiro-Pla who
is Assistant Professor of Endocrine Surgery at the medical university. Dr. Carneiro-Pla, I know you have a strong
interest in thyroid cancer and in the surgical resection of thyroid
cancer. First of all, how do you
diagnose that? When you go into an
operation where there’s an enlarged thyroid nodule, how do you know beforehand
that it might be cancer?
Denise Carneiro-Pla: Usually you come to
the surgeon because you have a thyroid nodule.
The thyroid nodule could be increasing in size or your voice can be
changing. There are things that you
could find during the physical examination that could be suspicious for thyroid
cancer. So, when you have a thyroid
nodule, what you need to do is have a biopsy done, which is done in the office
with a fine needle aspiration. With a
really thin needle, we suction a couple of cells and send them to the
pathologist, and they give the diagnosis.
diagnosis is cancer, you need to have a thyroidectomy. So, at that point, the great majority of the
time, we offer a thorough thyroidectomy.
It means that we take both sides of the thyroid and the isthmus, which
is right in the middle, connecting the two lobes. So, usually, we do a thorough
Linda Austin: How long does that
Denise Carneiro-Pla: It’s two and half,
Linda Austin: So it must be fairly
delicate surgery, I would imagine?
Denise Carneiro-Pla: The problem with
the thyroid and parathyroid is that you have the nerves, the recurrent
laryngeal nerves, right next to the thyroid and parathyroid, so those two
procedures are very delicate because you need to find a nerve and preserve it. If you don’t, you could have a voice change
postoperatively. It’s usually temporary,
but it could be permanent, in less than one percent of the time.
Linda Austin: How long does the patient
have to stay in the hospital after the surgery?
Denise Carneiro-Pla: Usually, patients
having a thyroidectomy stay overnight and, in the morning, if everything goes
fine, they’re discharged.
Linda Austin: Now, I would imagine that
it would depend on the stage of the cancer whether the patient has chemotherapy
or radiation afterwards. What happens
Denise Carneiro-Pla: Depending on the
type of cancer you have, if you have papillary cancer or follicular cancer, you
could have radioactive iodine, which is not really chemotherapy or
radiotherapy. You inject an isotope in
the blood at a certain time after surgery and this iodine that is radioactive
will kill the thyroid cells left behind after surgery. This is usually the treatment that you would
get as a postoperative treatment following thyroidectomy surgery. There are different types of thyroid cancer,
like medullary carcinoma, for which this treatment would not work, so your best
option is a thyroidectomy with no dissection.
you do radioactive iodine, you have to have your thyroid completely removed. Sometimes when you have a thyroid cancer, you
may only have one side of the thyroid removed, a lobectomy. This is a controversial. I tend to perform thyroidectomies in patients
when I know they have thyroid
cancer. But there are surgeons that perform
lobectomies for thyroid cancer and that’s not wrong. It just depends on what school of thought you
follow for thyroid management, peri-cancer management.
Linda Austin: Dr. Carneiro-Pla, thank
you so much for talking with us today.
Carneiro-Pla: Thank you.
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