What’s New in Thyroid Cancer Research?

Important research into thyroid cancer is being done in many university hospitals, medical centers, and other institutions around the world. Each year, scientists learn more about what causes thyroid cancer, how to find it, and how to improve treatment.

The information below is an overview of the latest research into thyroid cancer, including genetics, detection and diagnosis, and treatments.

Genetics

Researchers have discovered the genetic causes of familial (inherited) medullary thyroid cancer. Because of this, it is now possible to identify family members who carry the abnormal RET gene that causes this type of cancer, and to remove the thyroid gland before cancer can develop there.

Understanding the abnormal genes that cause sporadic (not inherited) thyroid cancer has also led to better treatments. In fact, treatments that target some of these gene changes are already being used, and more are being developed (see below).

Detection and diagnosis

Many thyroid lumps turn out not to be cancer. But doctors can’t always tell which ones are likely to be cancer based on exams and commonly used tests, such as an ultrasound of the neck. Even some thyroid biopsies (in which small pieces of the lump are removed and looked at under a microscope) can’t always tell if a lump is cancer or not. Because of this, some people might end up having their thyroid removed even if they don’t have thyroid cancer.

Researchers are now studying newer tests that look at the gene patterns inside the cells removed during a biopsy. They want to see if these tests can help determine if someone has thyroid cancer, and possibly even how that person’s cancer should be treated

Treatment

Most thyroid cancers can be treated successfully with surgery, along with radioactive iodine (RAI) therapy if needed. But more advanced cancers can be hard to treat, especially if they don’t respond to RAI therapy. Doctors and researchers are looking for new ways to treat thyroid cancer that are more effective and lead to fewer side effects.

Active surveillance for some low-risk thyroid cancers

Until fairly recently, the number of people diagnosed with thyroid cancer in the US had been rising rapidly. Much of this was because of the increased use of thyroid ultrasound, which can detect small thyroid nodules that might not otherwise have been found in the past.

Studies have suggested that some newly found, very small thyroid cancers (known as microcarcinomas) may not need to be treated right away. Instead, they can be safely watched and then treated only if they start to grow or show other concerning signs.

This might now be an option for some people with these cancers. Ongoing clinical trials are looking to better define which tumors can be safely watched this way.

Non-surgical treatments to destroy thyroid tumors

Surgery is a common treatment for thyroid cancer, and it’s often very effective. But it can also lead to lifelong side effects, particularly when the entire thyroid is removed. Researchers are now looking at other ways to destroy thyroid tumors while leaving most of the healthy gland intact. This could lead to fewer long-term side effects.

Techniques that destroy (ablate) small areas of tissue are more often used to treat benign (non-cancerous) thyroid nodules. Some of these approaches are now being studied for use on small thyroid cancers as well, although they’re still considered experimental at this time.

For example, researchers are studying if microwave ablation (MWA) or radiofrequency ablation (RFA) can offer similar results to surgery in the treatment of small papillary thyroid cancers. In these techniques, a thin probe is inserted through the skin into the tumor to heat and destroy it.

Radioactive iodine (RAI) therapy

Researchers are looking for ways to make RAI effective against more thyroid cancers.

For example, in some thyroid cancers, the cells have changes in the BRAF gene, which may make them less likely to respond to RAI therapy. Researchers are studying whether new drugs that target the BRAF pathway can be used to make thyroid cancer cells more likely to take up radioactive iodine. These types of drugs might be useful for people who have advanced cancer that is no longer responding to RAI therapy.

Newer medicines to treat thyroid cancer

In the past, advanced thyroid cancers that weren’t responding to RAI treatment were often treated with chemotherapy (chemo). Unfortunately, most thyroid cancers don’t respond well to chemo. But newer types of medicines have become available in recent years, and others are now being studied.

Targeted therapy drugs

In recent years, doctors have started using newer, targeted drugs to treat thyroid cancer. Unlike standard chemo drugs, which work by attacking rapidly growing cells (including cancer cells), targeted drugs attack specific parts of cancer cells.

Targeted drugs for thyroid cancer attack some of the gene and protein changes inside the cancer cells. These changes are what make thyroid cancer cells different from normal cells.

Targeted drugs have become an important part of treatment for many advanced thyroid cancers, as they generally work better than chemo drugs. New targeted drugs are also being developed and tested.

Immunotherapy

Immunotherapy is the use of medicines to help the body’s own immune system find and attack cancer cells. This approach has become an important part of the treatment of many types of cancer. It might also be helpful in treating some thyroid cancers.

For example, immunotherapy medicines known as checkpoint inhibitors can often help boost the immune system response against cancer cells anywhere in the body. These drugs might be useful for people whose thyroid cancer cells have certain changes, such as having many gene mutations.

These and other types of immunotherapy are being studied to see how they might assist in treating other thyroid cancers.