Let's Finish Cancer: Thyroid Nodules, Cancer + Treatments
Let’s Finish Cancer Thyroid Nodules Cancer Treatments: Transcript
Mary Renouf
Well, hello everyone, and welcome to our show. Let's finish cancer, where we bring you the brightest cancer experts and compassionate cancer navigators. Our goal is to make you stronger at a time. You might feel that your weakest and to empower you to make the best decisions for you and your family.
You'll hear about the latest in technology and treatment options, stories of our patients and our survivors, doctors that see you as more than a cancer diagnosis and a whole person approach to cancer care. We want to be on your journey with you, and we know that at times it can be bumpy, but we're here for you and we want to help you forward.
I'm your host, Mary runoff and here with me today is Doctor Melanie Goldfarb, a fellowship trained endocrine surgeon and oncologist who specializes in minimal access surgery for thyroid, parathyroid and adrenal tumors, and is also one of the first physicians on the West Coast to offer. Radiofrequency ablation for thyroid nodules today.
She's joining us to discuss the thyroid nodules, thyroid cancer and the different treatments. Available before we start, I want our listeners to know that the information provided during this program is for educational purposes only. Should always consult a healthcare provider if you have any questions regarding a medical condition or treatment.
So, let's get started by welcoming Dr. Goldfarb. Well, Doctor GI like to give everybody an easy start and that is to just tell our listeners a little bit about yourself and your role with Providence.
Dr. Melanie Goldfarb
Thanks so much, Mary. So my name is Melanie Goldfarb and I am an endocrine surgeon. And for those of you that don't know what that is, it means that I am a general surgeon that also did a fellowship in endocrine surgery where I specialize in tumors of the thyroid, parathyroid and adrenal glands. And at Providence St. John's, I am the director of the Center for Endocrine Tumors and Disorders.
Mary Renouf
That's exciting. I like that you kind of started us with the basics, which is super helpful. But I do think that a lot of people get confused about what the thyroid does, right, like we've heard a lot of different things. But tell us what the thyroid's main function is.
Dr. Melanie Goldfarb
Sure. So the thyroid is an important organ of your body that produces your thyroid hormone and what thyroid hormone does is it helps. Regulate things like your metabolism, your temperature, your heart, your neurocognitive. So it really affects almost all areas of your body in some fashion, which means if you have abnormalities in your thyroid, you're going to. Usually feel it in some way.
Mary Renouf
I think I hear that a lot when people say, oh, I can't figure out why I'm cold all the time or why my hair is falling out and they are always you always hear that. Have you checked your thyroid?
Dr. Melanie Goldfarb
So I'm going to ask you, how does one check the thyroid? Really easy question, Mary. So you check your thyroid by doing labs. So it's a really easy blood test called your TSH. And in general, and I'm not going to say 100% of the time, but in general, if that number is within the normal limits, your thyroid is working well now there obviously are some nuances. To that but. That's for 98% of us, all we. Need to know.
Mary Renouf
Well, this is super helpful, but we are talking about cancer. So I do want to talk a little bit about how we know we have thyroid cancer.
Dr. Melanie Goldfarb
So thyroid cancer is actually something that rarely produces any symptoms. And I know that sounds really scary, but with that. Thyroid cancer is a very slow growing disease compared to a lot of other cancers. So it's OK if we, I'm gonna say catch it when we catch it. Sometimes you will have a lump in your neck and that's generally the only symptom you may have. If it's gotten big enough. But other than that, your thyroid is still producing. It's normal. Hormones. The cancer doesn't affect the hormones, so you don't get any symptoms from.
Mary Renouf
So would you? I wouldn't know then that I had it probably, unless I came in to you and was experiencing those symptoms. And you said, oh, it could be your thyroid. I'm. I'm thinking I go to my primary care physician. They check my thyroid. And then how do I? Get to you. How do I get from my primary care to you?
Dr. Melanie Goldfarb
Exactly. And that's a really great question. So most of the time. It's either because your doctor felt something. You looked in the mirror and you saw something, or many times people are getting scans for other reasons. So carotid ultrasound is a really big one. Getting a lung CT or even occasionally even a chest X-ray. And they're gonna pick up these incidental things on their thyroid. Some primary care physicians. We'll just send them to people directly to me. Most of the other time they're going to order an ultrasound of your neck and see if there's anything really there before you get to me.
Mary Renouf
And So what is it that they're seeing? Is it, are we calling it a tumor is? It a nodule is. It what is it that they're seeing?
Dr. Melanie Goldfarb
Great. So those some of those words are synonymous. So a tumor can be either benign or malignant. So tumor is just a general term for abnormal growth and used to your abnormal growth can be a cancer or your abnormal growth can not be a cancer. And So what they'll see on ultrasound is a nodule or a tumor. Same word and based on what it looks like on ultrasound, it'll either be really suspicious for being a cancer. Pretty much, you know, we know that it's benign or somewhere in the middle and that's when they'll either see me or get sent for a biopsy. But that really is usually. Our next step?
Mary Renouf
Well, since we're talking about thyroid cancer and you know you, you did kind of scare us, right? Like you don't typically know it's but. You did say. It's a slow grower. How common is it? Right. And then once we hear how common it is, then talk to me about what happens once I get diagnosed.
Dr. Melanie Goldfarb
Sure. Perfect. So, thyroid cancer, it's not that it's super common, but there are certain age groups where it is the most common cancer. So surprisingly in the young adult age group, which means in the under 40 age group and not pediatric. So ages about 15 to 40. It is now the number one. Cancer in the United. States and it has now overtaken breast cancer actually for females in their 30s in middle age women, though it is the most common age where you will get diagnosed with thyroid cancer, but it's still semi rare. So only about two to 3% of people will develop it in their lifetime. As opposed to where you hear about breast cancer, where one in eight women develop. It in their lifetime.
Mary Renouf
I I'm I'm a little bit lost or maybe I'm just terrified. So if it's becoming so much more common or like you were saying in these these different age groups, these different points in your life, is it really that we're starting to see it more because it's happening more or are we starting to detect it more often? Like how does? It become.
Dr. Melanie Goldfarb
This prevalent, I think that we know some of those answers and we don't know. Others. So there we are picking up more of it because we're doing screenings or imaging for other reasons. But there's been a bunch of studies out there that show that that is not. That doesn't explain everything. So it is for some reason we don't know. Also becoming a little bit more common and it's not that it's super common in young adults. It's just in that age group where cancer is less common, this is. Most common.
Mary Renouf
So what are the the symptoms then for it to be cancerous versus just a general thyroid issue because some thyroid issues you can just treat with medication? Right.
Dr. Melanie Goldfarb
Right. So if you have a hormone problem, meaning your thyroid is working too much or working too little, then you're going to treat that with medicine. However, if you have a growth, which is that tumor nodule, cancer, whatever, that's where medicine doesn't help, you have to either. Decide to leave it there or decide to remove it surgically. Or in the case of benign nodules, we actually have a new in office procedure called radiofrequency ablation to shrink the 9 nodules.
Mary Renouf
We're definitely going to dig into that, but I have a few more questions before we get there. That's like going. To be like the whole second-half. Talk to me a little bit about other risk factors, obviously talked about age and you did say women, right? But is it hereditary? Is it based on race or, you know, is it ethnicity at? All a fact. Sure.
Dr. Melanie Goldfarb
So there are very few risk factors for the run-of-the-mill thyroid cancer, really the only one is radiation. So for certain cancer survivors that got radiated to their thyroid area and their neck area for their other cancer treatment, that's a really big risk factor. Or if you were in Fukushima or Chernobyl or something. Like that? That's that's a big risk factor. OK, but. That's really it. There are. There's a rare type of thyroid cancer called medullary thyroid cancer that is hereditary, and there are some other genetic syndromes that thyroid cancer can be a part of, but those are very rare and don't really apply to most of us. Which I know is scary because you want to say, hey, I'm this, this and this. And therefore I'm either at high risk or low risk, but we don't. Have that.
Mary Renouf
And I kind of want to back up to the last question too, because I know that I really dug into it. But if, say, I have a thyroid condition for. Hormones or whatever AM. I more likely to get thyroid cancer. Or is it completely not related?
Dr. Melanie Goldfarb
That's a very good question that we are still studying a little bit. In general, if your thyroid is over working. You are less likely to have cancer in it, but you can see. Under working thyroid or the most common, maybe you've heard the term Hashimoto's, which is what we call most under working thyroids. There are some studies out there that say you have an increased chance of if you have nodules of those being cancers and there are others even that say that you have a decreased chance of those nodules being cancer. So I think the jury's still out. I don't think it affects it super much and it's more maybe someday there'll be an association that we talk about.
Mary Renouf
Well, before we go into how we treat it, talk to me a little bit about the survivability. Like is does it matter how early it's detected? Does it matter if it's spread? What? What are you looking for when I come in and I've been diagnosed, what's kind of that next step for whether I feel comfortable that I am going to pull through this.
Dr. Melanie Goldfarb
So this is like my favorite question because one of the things I love about my specialty is that I really get to cure most people, and I really can. Just give them a really good prognosis so most of thyroid cancer is very treatable and people live long, healthy lives that I tell my cancer patients in general that you have to think to yourself as a cancer patient. So you get follow up and all the other things that cancer survivors need, but you need to live your life like you don't have. Answer because it won't impact you know how long you're gonna survive. Now, obviously there are some people out there that have more aggressive cancers that that's not. As good of a statement for them. But even people with super aggressive or cancer that spread, they still, I would say have better survivability than most other cancers out there.
Mary Renouf
So I used to work in sports and anytime my athletes were challenging, I would say look, don't give me a hard time. You play sports, you're not carrying cancer. And now I feel like I have this whole new respect for for you today because you're kind of curing cancer. I mean, like you just said, people are coming to you and they have a good survivability. It does have to feel good. I mean, you're right. Like when you go into oncology, it has to be a challenging field, but you're in one that has pretty good odds.
Dr. Melanie Goldfarb
Yeah. So, so that is one of the things I really like about my specialty is people come in, they're really freaked out. You know, just the word cancer really scares a lot of people. And we and what cancer that I treat, I can really, I'm going to say do good. By patients and really get them to move on with their life.
Mary Renouf
Well, that's exciting. Let's talk about treatment. So, OK, I come to you. I've got cancer. You you've seen me. We've taken a look. You know what? My, what? My, what? My situation? Is. What are my options?
Dr. Melanie Goldfarb
Thyroid cancer is really a surgical disease, is what we call it. There is no chemotherapy. There is no radiation therapy. There is. You don't no immunotherapy. You really just gotta get it out. So you're. Most of the time, going to have surgery, which includes removing either half of your thyroid or your entire thyroid, and if it's in the lymph nodes, then we'll take out the lymph nodes in that in that area.
How much surgery we do depends on the features of your cancer and you know whether it's really small, very contained, or whether it's already spread to the lymph. Nodes and stuff like that. These days, if you have a really small cancer and you're a little older, we sometimes offer you active surveillance, kind of like what they do for prostate cancer, which means we don't take it out and we just watch you with serial imaging and ultrasounds. To make sure it doesn't grow.
Mary Renouf
This might seem like a really dumb question, but don't I need my thyroid? I mean, you said you might take half of it, I take it out, don't I need it?
Dr. Melanie Goldfarb
Well, So what you need is your thyroid hormone. You don't need your actual thyroid in itself. So if we take out your whole thyroid, or even sometimes when we take out half your thyroid, we can replace the thyroid hormone that your body normally makes. Something that's made in the lab and I explained because people are like, why aren't I gonna get fat? Aren't I gonna lose my hair? All this stuff, you know you hear about? And I say no. We're gonna keep you at the same level.
So it's kind of like insulin for diabetics. You're not gonna have side effects from insulin. You're not. They have, you know, issues with it, but you have to take it so that your body can function normally. So you don't have side effects from it. And hopefully you won't skip a beat.
Mary Renouf
Well, this is the most exciting part of our conversation to me, so I got to read up and I got to see the videos. But you are one of the first physicians to treat thyroid nodules with the treatment called radiofrequency ablation talk to me about what that means. That's very exciting.
Dr. Melanie Goldfarb
Yeah. Thanks, Mary. It's it was pretty cool. It took me. I'm I'm gonna say a long time to go through all the. I don't know paperwork to be able to start this at the hospital, but historically if somebody has a big nodule so somebody has like a lump in their neck, you, you, everybody has seen people that you're like, what is that the only way to fix it or to make it smaller is to take it out and. As much as I'm a surgeon and I love to operate, you know not everybody wants surgery and it it doesn't make sense for everybody.
So I'm I'm now able to offer a non surgical treatment for these big benign nodules to help improve either symptoms like swallowing or just the cosmetic aspects of having a a big. All right. And this is not something new. Experimental. I'm going to say they've been doing it in Europe and Asia for 1015 years. So there's a lot of great long term data. It's not a new technology. It just took a while to make it to the US and to California.
Mary Renouf
So when you say ablation in my head, an ablation is usually either like a big scraping or a burning like what does it actually mean?
Dr. Melanie Goldfarb
So burning is A is a good word. I I explain it to patients in late terms is I'm gonna cook your thyroid tum. So I'm going to I'm going to take this little this little tiny probe or like a big needle and I'm going to. Really, under 3D ultrasound guidance, cook and nuke. You could say this benign growth in your neck, and then when it's dead, your body is gonna reabsorb a lot of it.
Mary Renouf
You're going to cook it.
Dr. Melanie Goldfarb
Hmm.
Mary Renouf
I like that. I like that. OK, so then what does that mean? Right? You do the ablation. How long does the procedure take? What's the heel situation? How long till I'm back functioning?
Dr. Melanie Goldfarb
Yeah. So really great questions. So the procedure itself will take anywhere from maybe 20 to 45 minutes depending on how big your nodule is. So how much, how much area I have to kill. You go right home and you put a bunch of ice on it that day because it can get a it can get a lot of swelling, but otherwise you can do your thing.
There's no scar, there's no hole, and slowly over the course of time, the nodule is going to get smaller, so you might not see the full size shrinkage. For 12 months. But many people already start to see the effect at one month, and if not by three.
Mary Renouf
So I get, I get what you're doing when we know for sure that it's cancerous, but you did mention earlier that you can have the 9 nodules. So what happens if it's the nine? Do I need to treat it? And if I don't treat it, could it become cancerous?
Dr. Melanie Goldfarb
Awesome question. So in general, a benign nodule is not going to turn into a cancer. So if we've proven that it's benign, meaning it looks benign. On my ultrasound, we've stuck a needle in it. And then we've and the needle biopsy shows that it's been. Line I don't have to worry that it's going to turn into cancer down the road. OK, whether you need to do anything about the benign nodules many times is really up to the patient. If they're not ginormous and or not giving symptoms, there is no reason that you need to do anything and we just follow it. Periodically for a certain period of time. However, if you are having symptoms or if it's big enough, I might recommend that you do something about it.
Mary Renouf
So I just want to clarify it. Ginormous is a medical term, yes.
Dr. Melanie Goldfarb
It's a great medical term. It's in our medical textbook, so. Like.
Mary Renouf
It I like it, I use it often, so so let's go back to the radio frequency ablation talk to me a little bit about the benefits of doing this over other options that you have. I mean you, you kind of give me a little bit, but let's dig in just a little bit more.
Dr. Melanie Goldfarb
Yeah. So this is a really great question because not there is no one side fits. All treatment for benign nodules. And that's what I really like is you. We kind of talk to the patient and we figure out what's the best thing for them. And I don't have to push one thing or the other because I do both surgery and our FA and watching it so I. I'm. I'm not gonna lose. So that's why I I think that's great.
So benefits of surgery. So let's say you have a four. Centimeter benign thyroid nodule. That's whatever. You can see it, you. Don't. Really like how it looks so you can do surgery and it's gonna be outdone. Never have to think about it again. So the nodule is gonna be gone. So your lump is gonna be gone. It's not gonna grow back. You know very definitive, very quick results. The downside is you have to have anesthesia to have surgery. You may have a little bit of a scar though. Most people heal up really nice and you may have to take thyroid hormone afterwards, cause I took. Out half your thyroid.
On the flip side, you can do the radio frequency where you won't have to take thyroid hormone. You definitely won't have a scar. You won't have anesthesia, but it's gonna take time. Maybe up to 12 months to get the full effect. And the nodule is not going to go away, so it could potentially grow back slowly over time. So it really just it's a weighing of your personal preferences.
Mary Renouf
Well, that's really interesting because I was going to ask you, you talked about survivability, but what about like, I don't know, I guess if we're talking about cancer, we should use the word remission or something like am I. Did you beat my cancer? And now it could come back because you just mentioned that you could see another.
Dr. Melanie Goldfarb
Growth. Right. OK. So let's let's separate. So radio frequency is just for benign stuff for the most part, whereas for cancer, I'm we're not doing that because we don't know what it does to cancer. So we're just gonna take it out. However, yeah, so. So split that up, but you're right in terms of saying thyroid cancer is an.
Mary Renouf
Got it.
Dr. Melanie Goldfarb
Beyond excellent survivability, so the one thing we talk about with patients is what's the risk of it coming back. So for thyroid cancer, I rarely even stage patients like you talk about stage 1234 like you do for other cancers. And we more talk about what's the risk of it recurring, which is a more meaningful. Set of information for thyroid cancer.
Mary Renouf
Patients so benign, we have the options. We can watch it, we can do the ablation, we could surgically remove it cancerous. We're surgically removing it. Exactly. Got it. OK. So I know you talked a little bit about how we get it, but are there things I can do to, you know, lower my risk, right? Like when we talk about lung cancer, let's not smoke when we talk about, you know what I mean? Like, is there anything I can do to make sure I don't get it or at least decrease my odds?
Dr. Melanie Goldfarb
I wish there was a magic potion or some really yummy chocolate or glass of wine that we could. Drink to do that, but. Unfortunately, no. I mean, there's all these like thyroid, healthy diets out there on the Internet and but there's really no research or there's nothing that shows it was anything that would that would change that I that would really change our cancer risks.
Mary Renouf
So this is going to come to you out of left field, but I have a couple of women in my family who have thyroid issues right now and they're convinced. No, I'm not saying. I'm not saying anybody's name on there or anything. They're convinced because they did keto, right? They didn't have this problem before they did keto. They lost a bunch of weight. Are you guys hearing anything about diet related situations or are you seeing anything like that?
Dr. Melanie Goldfarb
So I would say that for thyroid and this is not my official area of expertise, but for thyroid hormone related problems, wacky diets, taking weird supplements, including a lot of iodine, and there are things like that that can make your thyroid hormones go. Out of whack.
So they they are not crazy. I don't know if anybody's done a study specifically with Keto, but if you have a big change in stuff like that, you can. Alter your horn.
Mary Renouf
Well, you know, you did mention women, and you did mention kind of this age group. And again, I don't want to go into like kind of this existential theoretical situation or. Not but. You talk hormones, right then people like me instantly go to great. I was on birth control for like 20 some odd years of my life. Is there a correlation there have? You guys seen any studies on that?
Dr. Melanie Goldfarb
So people have looked at that because, yeah, like young women, birth control, it's kind of like our our, whatever our vitamins. But no, I mean nobody's seen anything like that, you know. There are some. Because it's more common in women. There is a lot of speculation that estrogen and certain hormones should have something to do with thyroid cancer, but the. There really hasn't been great studies that have shown any of that and definitely no risk from birth.
Mary Renouf
All right. Well, that's good to know. You guys heard it here. I also, I don't want to sound like I'm not already very grateful for the amazing work you're doing, especially since you were like, the first doctor you know in our area. But are there any other new innovations or treatments that are coming out for thyroid cancer or specifically for these cancerous pieces?
Dr. Melanie Goldfarb
Uh, so that's always like the most fun conversation and information to share. There are drugs that are being developed in the pipeline, not for low risk cancer, but for, you know, the. Really bad thyroid. Sensors that are really aggressive. So for those small population, there are a bunch of drugs in the. Pipeline for it. UM and probably what? I think it's still a while away, but what our goal would be is let's say somebody has a small thyroid cancer, can we do any tests on it to figure out which ones we can leave alone and not take out and which ones we can? Like that have to come out because they're gonna do something bad.
So I think we already have molecular tests that we use on when we do a biopsy to help tell us a little bit of this information, but we still have a ways to go. So I really think that's where the field is going to go down the road is. Hey, we can leave your cancer in there. It's not going to do anything versus we need to take it. Out because overtime. It's going to spread.
Mary Renouf
Well, you know, we're. We're almost out of time, but I always like to ask people, is there anything we haven't talked about today that you think is really important or you want somebody to take away from this conversation?
Dr. Melanie Goldfarb
Thanks Mary. I would say let's do what are the takeaways more than other questions. So takeaways from the conversation are you're generally not going to have symptoms from your thyroid cancer. It's OK if we pick it up when. We pick it up. You're going to do really well from your thyroid cancer, and if you have benign tumors or benign nodules that are bothering you, we now have another treatment that is non-surgical in the office to offer you to shrink these nodules.
Mary Renouf
Is there, I mean, you did mention that you had to get, like more training and you had to go through kind of hoops to get it going on here. Are there other physicians that are doing what you're doing? Is it still fairly new or is it pretty, pretty standard now?
Dr. Melanie Goldfarb
It's not standard. There are other physicians that are doing it and more are, you know, coming down the pipeline and it really. It really just depends on your institutions set up in terms of who or when it's gonna get started. Part of the challenge is it's not always covered by insurance yet. And so I think that's why it's not as rampant. And you also don't want somebody doing the procedure that doesn't. Really treat thyroid nodule and thyroid cancer patients on a regular basis, both in terms of knowing. And recommending for you. Is this appropriate? Is it not? Is it the best thing for you as well as the actual technicality of doing it? You want somebody who's going to be doing this or something like it on a regular basis.
Mary Renouf
Well, you have been a fountain of information and I'm super excited to have you on the show and I'm pretty sure I'm gonna ask you to come back and we'll dig into a different topic because you are like very easy conversion. To have, but I do want to thank you Doctor Goldfarb for joining us today on let's finish cancer. We look forward to continuing the conversation on whole person approach to cancer care with more experts from Providence and our future episodes.
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