Parathyroid Cancer

Treatment Options

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of tumor. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctors can help you review all treatment options. 

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

The most common treatment options for parathyroid cancer are surgery, radiation therapy, and treatment of hypercalcemia. Chemotherapy may also be recommended. Treatment will include efforts to both eliminate the tumor and control the amount of calcium in the patient’s bloodstream.

Descriptions of these common treatment options are listed below. Treatment options and recommendations depend on several factors, including the type and stage of the tumor, possible side effects, and the patient’s preferences and overall health. 

Treating hypercalcemia

There are a number of medications used to reduce calcium levels in the blood, including calcitonin (Calcimar, Cibacalcin, Miacalcin), plicamycin (Mithramycin), gallium nitrate (Ganite), bisphosphonates (Aredia, Bonefos, Loron), or zoledronic acid (Zometa). Most of these drugs are only used for short periods of time until treatment to remove the tumor can be started.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation.

Surgery is the primary treatment for a parathyroid tumor, regardless of whether the tumor is benign or cancerous. A surgical oncologist is a doctor who specializes in treating a tumor using surgery.

It is difficult to determine before surgery if a parathyroid tumor is benign or malignant. Therefore, the surgeon needs to remove the entire gland and any tissue that looks abnormal. In addition, because parathyroid tissue is very likely to implant in the surgical bed (area where tissue was removed during surgery), it is important for the surgeon to remove the tumor, any abnormal tissue, and a clean margin (tissue around the tumor that is disease-free). The doctor may also recommend radiation therapy (see below) after surgery to the affected area of the neck.

Surgery for a benign parathyroid tumor is called a parathyroidectomy. Talk with your surgeon about the role of minimally invasive surgery for a single gland tumor that is strongly believed to be benign.

Surgery for parathyroid cancer is more extensive and includes the complete removal of the parathyroid gland as well as surrounding tissues such as the nearby thyroid gland, adjoining fatty tissues, lymph nodes, and if possible, the surrounding muscles. 

If a surgeon finds the tumor is benign during surgery, it is common to check the patient’s level of parathyroid hormone in the blood during the operation. If necessary, the surgeon will then re-implant one of the normal parathyroid glands that had been removed earlier in the operation. However, if the tumor is cancerous, re-implantation should not be done to avoid putting cancer cells back into the body. 

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Occasionally, radiation therapy may be recommended after surgery for parathyroid cancer. Radiation therapy may help reduce the risks of parathyroid cancer recurring in the neck, but it is difficult to evaluate whether this treatment is beneficial because this type of cancer is so rare.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.  

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Chemotherapy is rarely effective at treating metastatic or recurrent parathyroid cancers. More clinical trials are needed.

The medications used to treat tumors are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. 

Palliative/supportive care

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem, so it is addressed as quickly as possible. 

Recurrent parathyroid tumor

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the tumor will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the tumor returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if it does return. 

If the tumor does return after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

The first sign of recurrence after treatment may be high blood calcium levels. Therefore, tests to watch for a recurrence include blood tests for PTH and calcium level changes, as well as ultrasounds of the neck .

If a recurrence is detected, the cycle of testing will begin again to learn as much as possible about the tumor. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor.

People with recurrent disease often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. 

Metastatic parathyroid cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. 

Your health care team may recommend a treatment plan that includes a combination of surgery, chemotherapy, and radiation therapy. Supportive care will also be important to help relieve symptoms and side effects.

For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Palliative care given toward the end of a person’s life is called hospice care. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families.

Coping with Side Effects

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for a parathyroid tumor are described in detail within the Treatment section.Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with a parathyroid tumor. 

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies.

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care.

After Treatment

After treatment for parathyroid cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. This should include tests to monitor your blood for elevated PTH and calcium levels . Follow-up care should also include imaging scans (such as an ultrasound of the neck) to watch for signs that the cancer has recurred. When parathyroid cancer does recur, it typically reappears between two and five years after the initial surgery, although there is always a risk of recurrence.

People recovering from parathyroid cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level.

Latest Research

Doctors are working to learn more about parathyroid cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Better treatment for hypercalcemia. Researchers are exploring new medications to reduce calcium levels in the blood.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current parathyroid cancer treatments in order to improve patients’ comfort and quality of life.

Genetics. Research is underway to learn more about why this type of tumor can run in certain families.