Parathyroid Cancer

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What is Parathyroid Cancer ?

About the parathyroid glands

The parathyroid glands are four small glands located in the neck or upper mediastinum (chest) near the thyroid gland. They are part of the endocrine system. The endocrine system regulates the hormones in the body. Like all parts of the endocrine system, the parathyroid glands play an important role in the body. These glands make parathyroid hormone (PTH), which regulates the levels of calcium and phosphorus in the blood.

About parathyroid cancer

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). A parathyroid tumor usually develops in one of the four parathyroid glands.

A parathyroid tumor, whether it is benign or malignant, can cause significant effects because the amount of calcium in the blood rises, resulting in a serious condition called hypercalcemia.

This section covers tumors found in the parathyroid. Learn more about tumors that begin in thethyroid gland in a separate section.

Risk Factors

A risk factor is anything that increases a person’s chance of developing a tumor. Although risk factors often influence the development of a tumor, most do not directly cause the tumor. Some people with several risk factors never develop a tumor, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.                     

There are no known causes for most parathyroid tumors. However, the following risk factor may increase a person’s chance of developing a parathyroid tumor:

Family history. A history of parathyroid tumors in a family may raise a person’s risk of developing a parathyroid tumor. A hereditary (inherited) condition known as multiple endocrine neoplasia may raise an individual’s risk for benign parathyroid tumors. For more information,read multiple endocrine neoplasia type 1 and multiple endocrine neoplasia type 2. No genetic factors have been linked to parathyroid cancer. 

There are no known risk factors for people who do not have a family history of parathyroid tumors.

Symptoms and Signs

A person with a parathyroid tumor may experience the following symptoms or signs. Sometimes, a person with a parathyroid tumor does not show any of these symptoms. The doctor may diagnose a problem if a blood test shows an increased level of calcium in the blood, a condition called hypercalcemia. The symptoms listed below may also be caused by a medical condition that is not a tumor. If you are concerned about a symptom or sign on this list, please talk with your doctor.

Bone pain

Kidney problems, including pain in the upper back and excessive urination

Stomach pain

History of gastroduodenal (stomach and/or small intestines) ulcers

Weakness

Difficulty speaking

Vomiting

Depression

Fatigue

Confusion

A lump in the neck

Insomnia (trouble sleeping)

Malaise (general feeling of discomfort or illness)

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

If a tumor is diagnosed, relieving symptoms and side effects remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

Diagnosis

Doctors use many tests to diagnose a tumor, find out if it is cancerous, and if so, determine whether it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of tumors, a biopsy (the removal of a small amount of tissue for examination under a microscope) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether a cancerous tumor has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of tumor suspected

Severity of symptoms

Previous test results

In addition to a physical examination, the following tests may be used to diagnose a parathyroid tumor:

Surgery. Removing the entire tumor during an operation is the most common way to diagnose both benign and malignant parathyroid tumors. The tumor is then analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Rarely a biopsy may be done before surgery. In these cases, the doctor usually performs a fine needle aspiration, which removes a sample of fluid and cells from the tumor with a very thin, hollow needle.

Blood/urine tests. Many types of blood or urine tests may be done. The most common test is a serum calcium test. Elevated serum calcium levels can indicate the presence of a parathyroid tumor or hyperplasia (over-active cells) on one or more glands. Another common laboratory test looks for elevated levels of the parathyroid hormone (PTH) and phosphorus levels in the blood. Doctors may suspect parathyroid cancer if these blood tests find a very high level of calcium and/or PTH.

Sestamibi/SPECT scan. A sestamibi/SPECT scan may be ordered if laboratory tests show an elevated level of PTH. A sestamibi/SPECT scan is a procedure in which a specific protein, called sestamibi, is mixed with a radioactive material and injected into the patient’s vein. A parathyroid tumor will absorb the material, and the tumor will be visible on an x-ray of the neck. SPECT stands for single proton emission computerized tomography.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. For tumors in or around the thyroid gland, an ultrasound is very useful.  However, it has limitations if the tumor is located lower in the neck or upper chest.

Computed tomography (CT or CAT) scan. A CT scan creates a two-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. The three-dimensional CT scan for parathyroid tumor localization is a “timed infusion” of contrast and, when combined with a sestamibi/SPECT scan (see above), is considered the “gold standard” in parathyroid imaging today.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Stages

Staging is a way of describing where the tumor is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (chance of recovery). There are different stage descriptions for different types of cancer. For parathyroid cancer, the cancer is typically described as localized, metastatic, or recurrent.

Localized. This means the cancer is only found in the parathyroid gland and has not spread to nearby tissues or organs.

Metastatic. The cancer has spread to lymph nodes in the area or to other parts of the body, such as the lungs. Lymph nodes are small, bean-shaped organs that help fight infection. Parathyroid cancer rarely spreads to lymph nodes.

Recurrent. Recurrent cancer is cancer that comes back after treatment. It may come back in the original location or in another part of the body. If there is a recurrence, the cancer may need to be staged again (called re-staging).

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