Traditionally, thyroid cancer has required surgical removal. However, as medicine has evolved, radioactive iodine (RAI) therapy (“internal radiation therapy”) and chemotherapy have gradually “kicked in”, leading to a shift to a combination of surgery and other therapies. The treatment is a combination of surgery and other therapies. As a result, you may see a surgeon-led team of specialists from several departments, including pathology, anesthesia, imaging, otolaryngology, endocrinology, radiotherapy, and chemotherapy. This is called a multidisciplinary team (MDT).
What other professionals besides surgeons might you need help from?
If you need other complementary treatments after surgery, you may need an MDT.
- Specialists in radioactive iodine therapy: Thyroid cells have the ability to take up iodine, and this property can be used to treat differentiated thyroid cancer with radioactive iodine therapy.
- Experts in chemotherapy: After surgical resection, some patients may need chemotherapy, such as those with poorly differentiated or undifferentiated cancer, tumors that have invaded vital organs or tissues in the neck (e.g., trachea, esophagus, internal jugular arteries, etc.). Other patients may need chemotherapy before surgery to shrink the tumor appropriately before surgery because the tumor is too large and the risk of direct resection is high.
- Orthopedic and counseling specialists: If the surgical scarring in your neck bothers you, you may also need a specialist in cosmetic surgery and a counseling specialist.
Complex conditions require more integrated multidisciplinary treatment
If you have a complex condition, such as a large tumor, history of multiple surgeries, airway compression, vocal cord involvement, or multiple organs involved, these conditions are often difficult and risky to operate on and have more complications than the surgeon alone may be able to achieve the desired outcome. This is a time when multidisciplinary expert collaboration is even more necessary.
Before surgery, imaging and pathology specialists are asked to do a comprehensive evaluation of the tumor to determine the size, nature, extent of invasion, and anatomic relationships to help the surgeon develop the best surgical plan.
Intraoperative assistance from specialists in otolaryngology, thoracic surgery, etc. may be required. For example, a tumor invading the trachea or larynx may require a tracheotomy by an ENT specialist, while a thyroid tumor behind the sternum may require a thoracic surgeon to open the chest to assist in the surgery.
After the surgery, the care measures also need to be “decided” by specialists from various disciplines.
Today, most tertiary hospitals have an MDT model of care. But this model is mainly for complex and difficult cases, and your primary care physician will determine if you need a multidisciplinary team of specialists.
Co-written by Dr. Hongyi Jiang, Fudan University Cancer Hospital