Sometimes, thyroid cancer becomes advanced or recurs (comes back) after being treated. It usually returns in the lymph nodes in the neck. Most of these types of tumors grow slowly, and some don’t grow at all.

Our specialists take care of many patients in this situation. We’re experienced in finding the treatment that will be most effective for you. We can also help you decide whether it’s important to start treatment right away, or if it’s safe for you to wait before doing anything more.

Part of what makes MSK so good at finding the most effective thyroid cancer treatment or clinical trial for you is that we use a tumor sequencing test called MSK-IMPACT™.  Results of this test allow us to quickly find out whether your thyroid tumor carries mutations that mean your cancer likely to respond to particular medicines.

Treatments for Advanced Thyroid Cancer

Surgery

Surgery can be a good choice for thyroid cancer that has come back. Success depends in part on the size of your tumor and where it’s located. Our team can remove lymph nodes in the neck if the cancer has come back there.

We may ask our head and neck cancer experts to be involved if cancer is close to a very important or sensitive part of your neck. These specialists know how to preserve voice quality and the function of the parathyroid gland in the neck.

We may recommend that you get radioactive iodine treatment after this additional surgery.

Radiation Therapy

We may recommend radiation therapy if:

• the recurrent tumors don’t get better with radioactive iodine treatment
• the cancer is only in one part of your body

For recurrent thyroid cancer we recommend external-beam radiation therapy. This approach involves high doses of radiation. You’ll get this therapy as an outpatient (meaning you won’t stay overnight at MSK) five days a week for five to six weeks.

We give external-beam radiation one of two ways:

• Proton therapy targets tumors with charged particles called protons. Proton therapy kills cancer cells through a process similar to that used in x-ray radiation: by damaging their DNA. However, the unique physical properties of protons allow them to deliver the dose at a specific depth in the body. With proton therapy, all energy has been released when it reaches the tumor site, so there is no dose beyond that point. This lowers the impact to normal tissues surrounding the tumor and reduces the risk of side effects.
• Intensity-modulated radiation therapy (IMRT) uses computer images to show the size and shape of the tumor. We aim thin, precise beams of radiation at the tumor from many angles. IMRT targets tumors with great precision, causing less damage to healthy tissue than other types of radiation therapy tend to do.

Chemoradiation

Chemoradiation combines chemotherapy with radiation. It can be given in the form of proton therapy or IMRT.

Our doctors may recommend chemoradiation for people who:

• have thyroid cancer that surgeons can’t remove
• have thyroid cancer left over after surgery

Medicines for Your Bones

Rank ligand inhibitors (sometimes called bisphosphonates) are medicines that help prevent bone loss, lower the risk of bone fractures, and lessen pain.

These medicines can also block thyroid cancer from spreading to your bones. We may recommend that you take rank ligand inhibitors if your thyroid cancer has spread to your bones.