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Definition
Hurthle (HEERT-luh) cell cancer is a rare form of cancer affecting the butterfly-shaped thyroid gland in the front part of the lower neck. The thyroid secretes hormones that are essential for regulating your body's metabolism.
Among new cases of thyroid cancer, less than 5 percent are Hurthle cell cancers. The condition is also called Hurthle cell carcinoma or sometimes oxyphil cell carcinoma.
Hurthle cell cancer can be aggressive, and surgery to remove the thyroid gland is the most common treatment. Most people with Hurthle cell cancer have a good prognosis, but the outlook for Hurthle cell cancer is better the earlier that a diagnosis occurs.
Symptoms
Signs and symptoms of Hurthle cell cancer may include:
- A fast-growing lump (nodule) in your neck, just below your Adam's apple (the most common and often the only clinical sign)
- Pain in your neck or throat, with pain sometimes extending to your ears
- Hoarseness or other changes in your voice
- Shortness of breath
- Swallowing difficulty
- A continuous cough that's not caused by a respiratory tract infection
These signs and symptoms don't necessarily mean you have Hurthle cell cancer. They may be indications of other medical conditions — such as an infection of the thyroid gland or a noncancerous enlargement of the thyroid (goiter).
When to see a doctor
If you have any signs or symptoms associated with Hurthle cell cancer, contact your doctor. An evaluation by your doctor and appropriate diagnostic tests can determine whether these signs or symptoms are caused by Hurthle cell cancer or another medical condition.
Causes
The precise cause of Hurthle cell cancer isn't known, although researchers believe the disease is associated with alterations in DNA, including some related to the aging process.
DNA is the genetic material that contains the instructions for every biochemical process in your body. When DNA is altered or damaged, these genes may not function properly, causing cells to grow out of control and eventually form a mass (tumor) of cancerous (malignant) cells. A possible cause of such DNA damage is exposure to radiation.
Risk factors
The following factors may raise your likelihood of developing Hurthle cell cancer:
- Being female
- Older age
- Radiation treatments to the head and neck
Complications
Possible complications of Hurthle cell cancer and other thyroid tumors include:
- Difficulty swallowing and breathing. This can occur if the tumor grows and presses on the esophagus and trachea.
- Spread of the cancer. If Hurthle cell cancer isn't treated appropriately, or if treatment begins late, the cancer can spread (metastasize) to other tissues and organs, making therapy more difficult and diminishing the chances of recovery.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, if Hurthle cell cancer is suspected, you may be referred to a doctor who specializes in treating thyroid disorders (endocrinologist) or a doctor who specializes in treating cancer (oncologist).
Because appointments can be brief, it's often helpful to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For Hurthle cell cancer, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- What treatments are available, and which do you recommend?
- What's my prognosis?
- What types of side effects can I expect from treatment?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any dietary or activity restrictions that I need to follow?
- Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to discuss points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or occasional?
- Have they gotten worse?
- Do you have any family history of cancer? What type?
- Have you ever had cancer? What type and how was it treated?
- Have you ever received radiation treatments to the head or neck area?
Tests and diagnosis
If your doctor suspects Hurthle cell cancer, the first steps will be to obtain your medical history and conduct a physical exam. Your doctor will examine your neck, checking the size of your thyroid and seeing whether lymph nodes in the neck are swollen. Your doctor will also likely order blood tests to check your thyroid function.
To help make a definite diagnosis, your doctor may recommend one or more of the following tests:
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Ultrasound scan. This painless imaging technique, also called a sonogram, uses high-frequency sound waves to outline the neck anatomy and detect a thyroid tumor. While ultrasound is very good at identifying the presence of a tumor, this test can't determine whether a growth or nodule is malignant or benign.
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Fine-needle aspiration biopsy. This test may determine whether a tumor or nodule is cancerous or noncancerous. In this procedure, the doctor passes a fine needle through the skin of your neck. The needle is attached to a syringe. Your doctor may use ultrasound imaging to help direct the needle into the tumor. Cellular material is then withdrawn through the needle (aspirated) and into the syringe. The process is repeated to obtain cells from several regions of the growth.
Fine-needle aspiration can be performed in your doctor's office or at an ambulatory surgical center. Because the needle is very thin (much thinner than a needle used to withdraw blood from your arm), it causes only slight discomfort. Your doctor may apply a local anesthetic to the area to reduce or eliminate the chance of pain. Some people experience a small amount of temporary bleeding, bruising or swelling at the site where the needle was inserted.
The results of the biopsy may be inconclusive, in which case the test may need to be repeated or surgical removal of the nodule may be necessary to confirm whether cancer is present. Most tumors turn out to be benign.
You won't need to do much preparation for either of these tests. No fasting is required. In most cases, you won't need to stop taking any medications.
Other diagnostic tests also may be used, including:
- Magnetic resonance imaging (MRI)
- Computerized tomography (CT) scan
- Positron emission tomography (PET) scan
Treatments and drugs
Most people with Hurthle cell cancer have a good prognosis and excellent long-term survival after treatment.
Possible treatments for Hurthle cell cancer include:
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Surgery. Surgery is the best treatment for Hurthle cell cancer. During this operation all or nearly all of the thyroid gland is removed. This procedure is called a near-total thyroidectomy. The surgeon leaves tiny edges of thyroid tissue near the adjacent parathyroid glands to lower the likelihood of parathyroid injury. These small parathyroid glands regulate your body's calcium level. Surrounding lymph nodes may be removed if there's suspicion that the cancer has spread to them.
The greatest risk associated with the operation is unintended injury to the recurrent laryngeal nerve, which could cause temporary or permanent hoarseness or a loss of your voice. Other complications include damage to the parathyroid, excessive bleeding and infection. You'll probably need to stay in the hospital for a day or two after the operation to ensure that post-surgical bleeding hasn't occurred and that you're able to breathe normally.
- Thyroid hormone medication. After surgery for Hurthle cell cancer, your doctor will prescribe the synthetic drug levothyroxine (Levoxyl, Synthroid, Levothroid), which replaces the hormones no longer being produced because of the absence of the thyroid. You'll need to take these synthetic hormones for the rest of your life. These medications are safe, and blood tests help determine the correct dose.
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Radioactive iodine therapy. Radiation therapy using a capsule containing radioactive iodine 131 is often prescribed following surgery for Hurthle cell cancer. It can be used to destroy any microscopic thyroid tissue remaining after the operation, using a modest dose of radiation in a procedure called remnant ablation. At times, a higher dose of radioiodine can be used to eliminate any malignant cells that have spread to other parts of the body, such as the lungs and bones.
In rare cases, radioiodine therapy can cause temporary side effects including sore throat, dry mouth, decrease in taste sensations, neck tenderness and nausea. Doctors avoid this form of treatment in pregnant and breast-feeding women because of risks to the fetus and newborn. After receiving radioiodine therapy, women are advised to wait at least six months before attempting to conceive, and men are advised to wait several months before attempting conception.
- External beam radiation. This approach delivers radiation treatment to destroy malignant cells. It's sometimes an option for people in whom radioiodine therapy hasn't been successful. It uses a special X-ray machine called a linear accelerator to deliver radiation to cancer cells. This treatment can target specific areas of cancer, minimizing damage to nearby healthy tissue. Side effects may include fatigue and a temporary reddening and sensitivity of the skin.
Although it's often useful for other types of cancer, currently available chemotherapy isn't an effective treatment for Hurthle cell cancer.
Alternative medicine
Although many alternative or nontraditional treatments — from vitamins to herbs — are sometimes promoted for use in treating cancer, none has been proved helpful in the management of Hurthle cell cancer or other types of thyroid cancer. If you have questions about a specific alternative treatment, talk with your doctor about the potential risks and benefits of the treatment.
Prevention
There are few specific measures you can take to prevent Hurthle cell cancer. However, you may be able to lower your risk by reducing your exposure to radiation from X-rays and other sources whenever possible.
Coping and support
A diagnosis of Hurthle cell cancer can be challenging and frightening. Even when a full recovery is likely, you may worry about a recurrence of the disease. But no matter what your concerns or prognosis, you're not alone. Here are some strategies and resources that may make dealing with this cancer easier:
- Know what to expect. Find out everything you can about Hurthle cell cancer in order to make treatment decisions. Ask your doctor to tell you about your cancer, as well as your treatment options and their side effects. The more you know, the more confident you'll be when it comes to making decisions about your care. Look for information in your local library and on reliable Web sites. The National Cancer Institute (NCI) answers questions from the public. You can reach the NCI at 800-4-CANCER (800-422-6237). Or contact the American Cancer Society (ACS) at 800-227-2345.
- Maintain a strong support system. Friends and family can be your best allies as you face cancer. They often want to help, so take them up on offers to make meals or provide transportation. Sometimes the concern and understanding of a formal support group of cancer survivors can offer a unique type of emotional support and encouragement. You may also find you develop deep and lasting bonds with people who are going through the same things you are. There are also support groups for the families of cancer survivors.
- Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able to work full time, for example, but you may be able to work at least half time. In fact, many people find that continuing to work can be helpful.
- Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or limit what you do.
Last Updated: 2009-12-23
