Obesity Linked to More Aggressive Papillary Thyroid Carcinoma
It’s known that having obesity is a risk factor for a number of serious health conditions. More so, certain cancers such as papillary thyroid carcinoma, are specifically associated with a higher BMI.
Thyroid cancer cases are on the rise in the U.S. and papillary thyroid cancer is noted as driving those numbers. A new review published in the Archives of Surgery noted that patients presenting with higher or increasing BMI have a significantly increased risk of presenting with late stage papillary thyroid cancer (PTC). In fact, having obesity raises the risk for late-stage PTC and more aggressive forms of PTC.
The team at UCLA David Geffen School of Medicine reviewed 443 medical records. The average age of the patients was 48.2. Patients had a total thyroidectomy (removal of the thyroid gland) as their first procedure to either treat PTC or another type of thyroid cancer. For the study, patients were divided into 4 weight categories:
- Normal BMI (18.5-24.9)
- Overweight (25 – 29.9)
- Obese (30-39.9)
- Morbidly obese (greater than or equal to 40)
The researchers found that the higher the BMI the more likely that the patient had advanced stage disease when diagnosed.
Patients diagnosed as obese or morbidly obese were more likely to present with stage III or stage IV disease. These patients were also more likely to have aggressive tumor types.
In another study that reviewed the charts of 7300 patients, obesity was strongly linked with more aggressive papillary thyroid carcinoma but not with a greater likelihood of disease recurrence. Patients with obesity were more likely to have larger tumors (43 percent) compared to normal weight patients (31 percent) and overweight patients (34 percent). Multiple tumors were found in 15 percent of overweight patients, compared to 11 percent of normal weight patients and 10 percent of overweight patients.
Patients with obesity also skewed higher with stage III and stage IV presentations, compared to normal weight and overweight individuals. The groups did not differ with regards to regional lymph node staging, distant metastasis or recurrence rates.
Prior to these two studies, researchers had been clear on an association between obesity and risk of thyroid cancer but not with regards to association between obesity and aggressiveness of PTC or recurrence.
The researchers’ conclusion was that patients with obesity are at higher risk of developing aggressive thyroid cancers, and should therefore have screenings for thyroid cancer using sonography in addition to physical exams. Sonography is more likely to identify these cancers versus just physical examination which typically involves palpation of the thyroid gland in the neck. The medical community will still have to decide the appropriate frequency of sonography in patients with obesity, since guidelines will have to consider and help to dictate insurance coverage parameters.
Diagnosis and treatment of thyroid cancer
In early thyroid cancer there are usually no symptoms. The cancer is often found on a routine exam, when the doctor discovers a nodule while palpating the thyroid gland (in the neck below the Adam’s apple). Diagnosis is based on clinical findings, scans and blood tests. A doctor may decide to biopsy the nodule or simply to perform surgery. Surgery will depend on how extensive the tumor is, the type (biopsy will offer that information), the staging of the tumor. Radioactive iodine may be used as part of the treatment.
Thyroid surgery is considered safe even in patients diagnosed with obesity who present with advanced disease.
Treating your obesity can help to limit heart disease, diabetes, and many other chronic diseases. It may also help to reduce the risk of developing breast and prostate cancer, colon cancer and limit your risk of presenting with advanced or aggressive PTC.
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