Thyroid Cancer Is On The Rise

By Dr. Shane Morita
Interviewed by Melissa Moniz
Wednesday - May 12, 2010
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Dr. Shane Morita
Endocrine and Oncologic Surgeon

Where did you receive your schooling and training?

I was born and raised in Hilo and went to high school there. I then went to college in Colorado. I returned home to attend medical school at the University of Hawaii John A. Burns School of Medicine. I then moved to California, where I completed a general surgery residency at Harbor-UCLA Medical Center/David Geffen School of Medicine at UCLA. I came back home to work at North Hawaii Community Hospital in Kamuela to be closer to my father, who was ill. I then moved to Maryland, where I underwent specialized training in both surgical oncology and endocrine surgery. After my time in Maryland, I was fortunate enough to receive an opportunity to return to Hawaii and work at Queen’s and UH.


 

What types of endocrine diseases require surgery?

Some disorders of the endocrine system that require surgery include thyroid cancer, hyper-parathyroidism, as well as tumors affecting the adrenal glands, pancreas and gastrointestinal tract.

Is surgery often required to determine if the nodule is benign or cancerous?

Surgery is not always required to determine if a nodule is malignant. Needle biopsies can be helpful in letting the surgeon know if a tumor is cancerous. Imaging studies such as CT scans can provide clues that the tumor may be malignant based on its characteristics or if there is evidence of spread to other organs.

Dr. Morita examines patient Tarsian Bokuku

What are the symptoms? Is it usually visible or it is painful?

With regard to thyroid nodules and cancer, most patients do not have symptoms. Symptoms that may be present include difficulty swallowing, a pressure sensation in the neck or even hoarseness. It can be detected as a neck lump on physical examination by the patient or the physician. It is usually not visible or painful. I receive many referrals for incidentally discovered nodules of the thyroid because of CT scans that are being done for other purposes.

Is thyroid cancer genetic?

Thyroid cancer can be associated with mutated genes that are inherited or acquired. If hereditary, it can be seen with other diseases of the endocrine system including hyperparathyroidism and pheochromocytoma. Recently, some genetic mutations are garnering more attention because of evidence that they may on occasion predict a more aggressive course. This has been a major focus of my research.

What type of changes happens after having the thyroid gland removed?

The thyroid gland is actually very important for many things. It drives our metabolism and the way our body processes energy. So if someone doesn’t have a thyroid gland, they need to take thyroid hormone replacement. If patients do not have enough functioning thyroid hormone, they may feel fatigued and gain weight.


Is thyroid cancer on the rise?

Yes. Actually, in 2009, more than 37,000 patients were diagnosed with thyroid cancer in the U.S. Its incidence is rising faster than any other cancer in females. There’s been a lot of publicity about the increase, and there is controversy as to why this is happening. There’s been some thought that it may be due to all the imaging that’s being done for other reasons. So the field is really wide open as far as determining why this is happening. It’s really an epidemic.

Is thyroid cancer an aggressive cancer?

In general, thyroid cancer is not aggressive, but there are certain sub-types that do have very bad prog-noses, such as anaplastic thyroid carcinoma. It comprises only 1 percent of all thyroid cancers, but has the worst survival; most people will not survive past 12 months.

Is thyroid cancer treated primarily with surgery?

Most patients with thyroid cancer have differentiated thyroid cancer (papillary or follicular), which is usually initially treated with surgery. Patients can then undergo radioactive iodine therapy to kill any remaining thyroid cells. Patients also are placed on thyroid hormone to help discourage the growth of any remnant cancerous cells.

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