Parathyroid cancer surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Surgery is the mainstay of treatment for parathyroid cancer.
Surgery
- Surgery is the most common treatment for parathyroid cancer that is in the parathyroid glands or has spread to other parts of the body. Because parathyroid cancer grows very slowly, cancer that has spread to other parts of the body may be removed by surgery in order to cure the patient or control the effects of the disease for a long time. Before surgery, treatment is given to control hypercalcemia.
- Significant palliation may result from the resection of even very small tumor deposits in the neck, lymph nodes, lungs, or liver.
- The following surgical procedures may be used:
- En bloc resection: Surgery to remove the entire parathyroid gland and the capsule around it. Sometimes lymph nodes, half of the thyroid gland on the same side of the body as the cancer, and muscles, tissues, and a nerve in the neck are also removed.
- Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors cannot be completely removed.
- Metastasectomy: Surgery to remove any cancer that has spread to distant organs such as the lung.
- Surgery for parathyroid cancer sometimes damages nerves of the vocal cords. There are treatments to help with speech problems caused by this nerve damage.
- Preoperative suspicion and intraoperative recognition of parathyroid carcinoma is critical to achieve a favorable outcome, which involves en bloc resection of the tumor with all potential areas of invasion at the initial operation.
- One analysis of the literature indicated an overall 8% evidence of local recurrence after an en bloc resection compared with a 51% incidence after a standard parathyroidectomy.
- En bloc excision during the initial procedure for parathyroid cancer may involve resection of the recurrent laryngeal nerve because the nerve is at risk for invasion by any residual tumor and subsequent loss of function.
- The increased potential for long-term local control achieved by en bloc excision outweighs the complication of postoperative vocal cord paralysis, which can be improved with techniques such as Teflon injection into the paralyzed cord.
- Cervical lymph node dissection should be performed only for enlarged or firm nodes, particularly those found in the level VI paratracheal nodes and levels III and IV internal jugular nodes.[1]
Complications of Surgery
- Hoarseness of voice due to vocal cord injury
- Scarring
- Infections
- Hypocalcemia
References
- ↑ Parathyroid cancer. Cancer.gov (2015). http://www.cancer.gov/types/parathyroid/hp Accessed on December 29, 2015