Parathyroid Cancer

  • Dana-Farber/Brigham and Women's Cancer Care

    Parathyroid cancer is a rare cancer that forms in tissues of one or more of the parathyroid glands (four pea-sized glands in the neck that make parathyroid hormone, which helps the body store and use calcium). Learn about parathyroid cancer and find information on how we support and care for people with parathyroid cancer before, during, and after treatment.

Treatment 

The Head and Neck Oncology Program is dedicated exclusively to treating patients with head and neck cancers, which include cancers of the throat, larynx, nose, sinuses, and mouth.

Our specialists evaluate and treat all types and stages, from early lesions to the rarest and most challenging cases.  We also specialize in the treatment of all forms and stages of salivary gland and thyroid cancer.

As a patient, you will be seen by highly experienced clinicians from numerous specialties, including head and neck surgery, medical and radiation oncology, dentistry, oral surgery, reconstructive surgery, nutrition services, social work, speech, voice, and swallowing therapy.

Beginning with the initial consultation, your team of specialists will work with you to create a comprehensive treatment plan tailored to your type of cancer, as well as your lifestyle and personal needs, to achieve the best possible outcome.

Providers meet regularly to discuss new developments in clinical and basic research. The close relationships between world-class researchers and medical clinicians ensure that the latest research findings are translated into new, effective treatment approaches as quickly as possible.

Learn more about treatment and support for patients with head and neck cancers 

Our clinicians are experts in treating all types of head and neck cancers, including: 

  • Hypopharyngeal cancer
  • Laryngeal cancer
  • Nasopharyngeal cancer
  • Oral cancer
  • Oral cavity cancer
  • Oropharyngeal cancer
  • Paranasal sinus and nasal cavity cancer
  • Pharyngeal cancer
  • Laryngeal cancer
  • Lip cancer
  • Ear and Temporal Bone cancer
  • Skull Base cancer
  • Head and Neck Sarcomas
  • Mandible and jaw cancer
  • Adult craniopharyngioma
  • Unknown primary cancer
  • Merkel cell carcinoma
  • Head and Neck Melanoma
  • Salivary gland cancer
  • Parotid gland cancer
  • Acinic cell cancer
  • Adenoidcystic carcinoma
  • Mucoepidermoid cancer
  • Adenocarcinoma cancer
  • Papillary thyroid cancer
  • Follicular thyroid cancer
  • Anaplastic thyroid cancer
  • Medullary thyroid cancer
  • Hurthle cell cancer

Contact us 

New patients 

If you have never been seen before at Dana-Farber/Brigham and Women’s Cancer Center, please call 877-442-3324 or use this online form to make an appointment.

For all other inquiries, please call 617-632-3090

Referring physicians: 617-632-6869

Fax: 617-632-4448

Mailing address
Head and Neck Oncology Center
Dana-Farber Cancer Institute
450 Brookline Ave.
Boston, MA 02115-5450

Information for: Patients | Healthcare Professionals

General Information About Parathyroid Cancer

Parathyroid cancer is a rare disease in which malignant (cancer) cells form in the tissues of a parathyroid gland.

The parathyroid glands are four pea-sized organs found in the neck near the thyroid gland. The parathyroid glands make parathyroid hormone (PTH or parathormone). PTH helps the body use and store calcium to keep the calcium in the blood at normal levels.

Anatomy of the thyroid and parathyroid glands; drawing shows the thyroid gland at the base of the throat near the trachea. An inset shows the front and back views. The front view shows that the thyroid is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The back view shows the four pea-sized parathyroid glands. The larynx is also shown.
Anatomy of the thyroid and parathyroid glands. The thyroid gland lies at the base of the throat near the trachea. It is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The parathyroid glands are four pea-sized organs found in the neck near the thyroid. The thyroid and parathyroid glands make hormones.

A parathyroid gland may become overactive and make too much PTH, a condition called hyperparathyroidism. Hyperparathyroidism can occur when a benign tumor (noncancer), called an adenoma, forms on one of the parathyroid glands, and causes it to grow and become overactive. Sometimes hyperparathyroidism can be caused by parathyroid cancer, but this is very rare.

The extra PTH causes:

  • The calcium stored in the bones to move into the blood.
  • The intestines to absorb more calcium from the food we eat.

This condition is called hypercalcemia (too much calcium in the blood).

The hypercalcemia caused by hyperparathyroidism is more serious and life-threatening than parathyroid cancer itself and treating hypercalcemia is as important as treating the cancer.

Having certain inherited disorders can increase the risk of developing parathyroid cancer.

Anything that increases the chance of getting a disease is called a risk factor. Risk factors for parathyroid cancer include the following rare disorders that are inherited (passed down from parent to child):

  • Familial isolated hyperparathyroidism (FIHP).
  • Multiple endocrine neoplasia type 1 (MEN1) syndrome.

Treatment with radiation therapy may increase the risk of developing a parathyroid adenoma.

Possible signs of parathyroid cancer include weakness, feeling tired, and a lump in the neck.

Most parathyroid cancer symptoms are caused by the hypercalcemia that develops. Symptoms of hypercalcemia include the following:

  • Weakness.
  • Feeling very tired.
  • Nausea and vomiting.
  • Loss of appetite.
  • Weight loss for no known reason.
  • Being much more thirsty than usual.
  • Urinating much more than usual.
  • Constipation.
  • Trouble thinking clearly.

Other symptoms of parathyroid cancer include the following:

  • Pain in the abdomen, side, or back that doesn't go away.
  • Pain in the bones.
  • A broken bone.
  • A lump in the neck.
  • Change in voice such as hoarseness.
  • Trouble swallowing.

Other conditions may cause the same symptoms as parathyroid cancer. Check with your doctor if you have any of these problems.

Tests that examine the neck and blood are used to detect (find) and diagnose parathyroid cancer.

Once blood tests are done and hyperparathyroidism is diagnosed, imaging tests may be done to help find which of the parathyroid glands is overactive. Sometimes the parathyroid glands are hard to find and imaging tests are done to find exactly where they are.

Parathyroid cancer may be hard to diagnose because the cells of a benign parathyroid adenoma and a malignant parathyroid cancer look alike. The patient's symptoms, blood levels of calcium and parathyroid hormone, and characteristics of the tumor are also used to make a diagnosis.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. To diagnose parathyroid cancer, the sample of blood is checked for its calcium level.
  • Parathyroid hormone test: A procedure in which a blood sample is checked to measure the amount of parathyroid hormone released into the blood by the parathyroid glands. A higher than normal amount of parathyroid hormone can be a sign of disease.
  • Sestamibi scan: A type of radionuclide scan used to find an overactive parathyroid gland. A small amount of a radioactive substance called technetium 99 is injected into a vein and travels through the bloodstream to the parathyroid gland. The radioactive substance will collect in the overactive gland and show up brightly on a special camera that detects radioactivity.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • SPECT scan (single photon emission computed tomography scan): A procedure that uses a special camera linked to a computer to make a 3-dimensional (3-D) picture. A very small amount of a radioactive substance is injected into a vein. As the substance travels through the blood, the camera rotates around the neck and takes pictures. Blood flow and metabolism are higher than normal in areas where cancer cells are growing. These areas will show up brighter in the picture. This procedure may be done just before or after a CT scan.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Angiogram: A procedure to look at blood vessels and the flow of blood. A contrast dye is injected into the blood vessel. As the contrast dye moves through the blood vessel, x-rays are taken to see if there are any blockages.
  • Venous sampling: A procedure in which a sample of blood is taken from specific veins and checked to measure the amounts of certain substances released into the blood by nearby organs and tissues. If imaging tests do not show which parathyroid gland is overactive, blood samples may be taken from veins near each parathyroid gland to find which one is making too much PTH.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • Whether the calcium level in the blood can be controlled.
  • The stage of the cancer.
  • Whether the tumor and the capsule around the tumor can be completely removed by surgery.
  • The patient's general health.

Stages of Parathyroid Cancer

After parathyroid cancer has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

The process used to find out if cancer has spread to other parts of the body is called staging. The following imaging tests may be used to determine if cancer has spread to other parts of the body such as the lungs, liver, bone, heart, pancreas, or lymph nodes:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if parathyroid cancer spreads to the lung, the cancer cells in the lung are actually parathyroid cancer cells. The disease is metastatic parathyroid cancer, not lung cancer.

There is no standard staging process for parathyroid cancer.

Parathyroid cancer is described as either localized or metastatic:

  • Localized parathyroid cancer is found in a parathyroid gland and may have spread to nearby tissues.
  • Metastatic parathyroid cancer has spread to other parts of the body, such as the lungs, liver, bone, sac around the heart, pancreas, or lymph nodes.

Recurrent Parathyroid Cancer

Recurrentparathyroid cancer is cancer that has recurred (come back) after it has been treated. More than half of patients have a recurrence. The parathyroid cancer usually recurs between 2 and 5 years after the first surgery, but can recur up to 20 years later. It usually comes back in the tissues or lymph nodes of the neck. High bloodcalcium levels that appear after treatment may be the first sign of recurrence.

Treatment Option Overview

There are different types of treatment for patients with parathyroid cancer.

Different types of treatment are available for patients with parathyroid cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Treatment includes control of hypercalcemia (too much calcium in the blood) in patients who have an overactive parathyroid gland.

In order to reduce the amount of parathyroid hormone that is being made and control the level of calcium in the blood, as much of the tumor as possible is removed in surgery. For patients who cannot have surgery, medication may be used.

Four types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) 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.

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: Surgery to remove as much of the tumor as possible. Sometimes, not all of the tumor can be 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.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Supportive care

Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care for hypercalcemia caused by parathyroid cancer may include the following:

  • Intravenous (IV) fluids.
  • Drugs that increase how much urine the body makes.
  • Drugs that stop the body from absorbing calcium from the food we eat.
  • Drugs that stop the parathyroid gland from making parathyroid hormone.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI Web site.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Parathyroid cancer often recurs. Patients should have regular check-ups for the rest of their lives, to find and treat recurrences early.

Treatment Options for Parathyroid Cancer

Localized Parathyroid Cancer

Treatment of localizedparathyroid cancer may include the following:

  • Surgery (en bloc resection).
  • Surgery followed by radiation therapy.
  • Radiation therapy.
  • Supportive care to treat hypercalcemia (too much calcium in the blood).

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized parathyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Metastatic Parathyroid Cancer

Treatment of metastaticparathyroid cancer may include the following:

  • Surgery (metastasectomy) to remove cancer from the places where it has spread.
  • Surgery followed by radiation therapy.
  • Radiation therapy.
  • Chemotherapy.
  • Supportive care to treat hypercalcemia (too much calcium in the blood).

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with metastatic parathyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Recurrent Parathyroid Cancer

Treatment of recurrentparathyroid cancer may include the following:

  • Surgery (metastasectomy) to remove cancer from the places where it has recurred.
  • Surgery (tumor debulking).
  • Surgery followed by radiation therapy.
  • Radiation therapy.
  • Chemotherapy.
  • Supportive care to treat hypercalcemia (too much calcium in the blood).

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent parathyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

To Learn More About Parathyroid Cancer

For more information from the National Cancer Institute about parathyroid cancer, see the Parathyroid Cancer Home Page.

For general cancer information and other resources from the National Cancer Institute, see the following:


This information is provided by the National Cancer Institute.

This information was last updated on November 8, 2013.


General Information About Parathyroid Cancer

Parathyroid adenomas represent a common endocrine problem, whereas parathyroid carcinomas are very rare tumors. With an estimated incidence of 0.015 per 100,000 population and an estimated prevalence of .005% in the United States, parathyroid cancer is one of the rarest of all human cancers.[1][2] In Europe, the United States, and Japan, parathyroid carcinoma has been estimated to cause hyperparathyroidism (HPT) in .017% to 5.2% of the cases; however, many series report this entity to account for less than 1% of patients with primary HPT.[1][3][4][5] The median age in most series is between 45 and 51 years.[1] The ratio of affected women to men is 1:1 in contrast to primary HPT in which there is a significant female predominance (ratio of 3–4:1).[5]

The etiology of parathyroid carcinoma is unknown; however, an increased risk of parathyroid cancer has been associated with multiple endocrine neoplasia 1 and with autosomal dominant familial isolated hyperparathyroidism.[6][7][8] Parathyroid cancer has also been associated with external radiation exposure; however, most reports describe an association between radiation and the more common parathyroid adenoma.[1][5]

Parathyroid cancer typically runs an indolent, albeit tenacious, course because the tumor has a rather low malignant potential. At initial presentation, very few patients with parathyroid carcinoma have metastases either to regional lymph nodes (<5%) or distant sites (<2%).[1] In the National Cancer Database series of 286 patients, only 16 (5.6%) had lymph node metastases noted at the time of initial surgery.[2] A higher proportion of parathyroid cancers locally invade the thyroid gland, overlying strap muscles, recurrent laryngeal nerve, trachea, or esophagus. Some patients are not identified preoperatively or intraoperatively as having parathyroid carcinoma and undergo parathyroid procedures devised to treat parathyroid adenoma. Only after review of the postsurgical pathology, or when these patients experience local or distant recurrence, is a correct diagnosis of parathyroid carcinoma made.[1] Parathyroid carcinoma tends to be localized in the inferior parathyroid glands; one series reported that the primary tumor originating in the inferior parathyroid glands was found in 15 of 19 cases involving local invasion.[9][10]

Approximately 40% to 60% of patients experience a postsurgical recurrence, typically in the range of 2 to 5 years after the initial resection.[11][12] In most cases, hypercalcemia precedes physical evidence of recurrent disease. The location of recurrence is typically regional, either in the tissues of the neck or in cervical lymph nodes, and accounts for approximately two thirds of recurrent cases.[13] Often, local recurrences in the neck are difficult to identify because they may be small and multifocal, and they may involve scar tissue from a previous surgical procedure. Use of ultrasonography, sestamibi-thallium scanning, and positron emission tomography may help to identify difficult-to-detect recurrent disease.[14][15][16] In older studies, distant metastases were reported to occur in 25% of patients, primarily in the lungs but also in the bone and liver.[13][17] More recent series indicate that the incidence of recurrence may be higher, possibly because of more accurate pathologic diagnoses that exclude patients with atypical adenomas.[1] Because of its low malignant potential, the morbidity and mortality associated with parathyroid cancer primarily result from the metabolic consequences of the disease and not directly from malignant growth.[9][17] In the National Cancer Database series of 286 patients, the 10-year survival rate was reported to be approximately 49%.[2] A smaller series has reported a 10-year survival rate of 77%, which might be related to improvements in supportive medical care and in the prevention of fatal hypercalcemia.[9]

Operatively, parathyroid cancers may be distinguished from adenomas by their firm, stony-hard consistency and lobulation; adenomas tend to be soft, round, or oval in shape, and of a reddish-brown color.[5] In most series, the median maximal diameter of parathyroid carcinoma is between 3.0 cm and 3.5 cm compared with approximately 1.5 cm for benign adenomas.[1] In approximately 50% of the patients, the malignant tumor is surrounded by a dense, fibrous, grayish-white capsule that infiltrates adjacent tissues.[5] Histopathologically, as with other endocrine neoplasms, the distinction between benign and malignant parathyroid tumors is difficult to make.[1][5][18] The extent to which capsular and vascular invasion appears to be unequivocally correlated with tumor recurrences and metastases makes a strong case for these findings to be considered the sole pathognomonic markers of malignancy.[18][19]

Parathyroid cancers are hyperfunctional unlike other endocrine tumors that become less hormonally active when malignant.[1] The clinical features of parathyroid carcinoma are caused primarily by the effects of excessive secretion of parathormone (PTH) by the tumor rather than by the infiltration of vital organs by tumor cells. Serum PTH levels may be 3 to 10 times above the upper limit of normal for the assay employed; this marked elevation is uncommon in primary HPT where serum PTH concentrations are typically less than twice that of normal.[5] Accordingly, signs and symptoms of hypercalcemia typically dominate the clinical picture and may include typical hyperparathyroid bone disease and features of renal involvement, such as nephrolithiasis or nephrocalcinosis.[1] Renal colic is a frequent presenting complaint of patients with parathyroid carcinoma.[5] In a study involving 43 cases, the prevalence of nephrolithiasis and the prevalence of renal insufficiency were reported to be 56% and 84%, respectively.[20]

The prevalence of bone disease is much greater in patients with parathyroid carcinoma than it is in patients with parathyroid adenoma with 70% or fewer patients manifesting symptoms related to calcium absorption with osteoporosis and bone pain.[21][22] (Refer to the PDQ summary on Pain for more information.) In benign parathyroid disease, it is unusual to have both renal and bone symptomatology documented at the time of diagnosis.[23] These symptoms are present simultaneously at diagnosis in 50% or fewer patients with parathyroid cancer.[1] In contrast, simultaneous renal and overt skeletal involvement is distinctly unusual in primary HPT.[5]

Signs and symptoms of the hyperparathyroid state associated with parathyroid cancer that may be found at diagnosis include:[1][5]

  • Subcortical bone resorption.
  • Bone pain.
  • Pathological fractures.
  • Palpable neck mass.
  • Renal calculi.
  • Renal disease.
  • Renal colic.
  • Peptic ulcer.
  • Recurrent pancreatitis.
  • Fatigue.
  • Muscle weakness.
  • Weight loss.
  • Anorexia.
  • Polyuria.
  • Polydipsia.
  • Dehydration.
  • Nausea and vomiting.

(Refer to the PDQ summaries on Pain, Fatigue, Nutrition in Cancer Care [for weight-loss information], and Nausea and Vomiting, for information on some of the above symptoms.)

Certain clinical features may help to distinguish parathyroid carcinoma from parathyroid adenoma.

Parathyroid carcinoma should be suspected clinically if:[1][5][11][13]

  • Hypercalcemia is greater than 14 milligrams per deciliter.
  • Serum PTH levels are greater than twice that of normal.
  • A cervical mass is palpated in a hypercalcemic patient.
  • Hypercalcemia is associated with unilateral vocal cord paralysis.
  • Concomitant renal and skeletal disease are observed in a patient with a markedly elevated serum PTH.

The medical management of hypercalcemia, particularly in patients with unresectable disease or without measurable disease, is critical and must be the initial treatment goal in all patients with HPT. Conventional treatment with intravenous fluids, diuretics, and antiresorptive agents such as biphosphonates, gallium, or mithramycin may help control the hypercalcemia.[10] Calcimimetic agents that directly block secretion of the parathyroid hormone from the glands may offer an important new approach to medical therapy of primary HPT associated with parathyroid cancer.[24][25]

Surgery is the only effective therapy for parathyroid carcinoma.[1][5][18] 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.[10][12][26] 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.[27] 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]

Because of the fairly indolent biology of this cancer, the management of recurrent or metastatic disease is primarily surgical; significant palliation may result from the resection of even very small tumor deposits in the neck, lymph nodes, lungs, or liver.[2][20][23][28][29] Accessible distant metastases should be resected when possible.[5] Localization studies performed before the first operation or reoperation may include technetium Tc 99m sestamibi scan, single photon emission computed tomography, CT-MIBI image fusion, ultrasound, computed tomography (CT), selective angiogram, and selective venous sampling for PTH;[3] CT and magnetic resonance imaging are useful imaging adjuncts for the localization of distant metastases.[5][30]

Nonsurgical forms of therapy for parathyroid carcinoma generally have poor results.[1][5][9][18] Some investigators have advocated the use of adjuvant radiation therapy to decrease the local recurrence rate.[31][32] Patients with this disease should be monitored for life because they may be at a relatively high risk of multiple relapses over prolonged periods of time.[9] As stated previously, patients rarely die from the tumor itself; rather, they die from the metabolic complications of uncontrolled HPT.

References:

  1. Rahbari R, Kebebew E: Parathyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1473-9.

  2. Hundahl SA, Fleming ID, Fremgen AM, et al.: Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86 (3): 538-44, 1999.

  3. Fraker DL: Update on the management of parathyroid tumors. Curr Opin Oncol 12 (1): 41-8, 2000.

  4. Favia G, Lumachi F, Polistina F, et al.: Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg 22 (12): 1225-30, 1998.

  5. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.

  6. Mallette LE, Bilezikian JP, Ketcham AS, et al.: Parathyroid carcinoma in familial hyperparathyroidism. Am J Med 57 (4): 642-8, 1974.

  7. Dionisi S, Minisola S, Pepe J, et al.: Concurrent parathyroid adenomas and carcinoma in the setting of multiple endocrine neoplasia type 1: presentation as hypercalcemic crisis. Mayo Clin Proc 77 (8): 866-9, 2002.

  8. Wassif WS, Moniz CF, Friedman E, et al.: Familial isolated hyperparathyroidism: a distinct genetic entity with an increased risk of parathyroid cancer. J Clin Endocrinol Metab 77 (6): 1485-9, 1993.

  9. Busaidy NL, Jimenez C, Habra MA, et al.: Parathyroid carcinoma: a 22-year experience. Head Neck 26 (8): 716-26, 2004.

  10. Clayman GL, Gonzalez HE, El-Naggar A, et al.: Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100 (5): 900-5, 2004.

  11. Anderson BJ, Samaan NA, Vassilopoulou-Sellin R, et al.: Parathyroid carcinoma: features and difficulties in diagnosis and management. Surgery 94 (6): 906-15, 1983.

  12. Sandelin K, Auer G, Bondeson L, et al.: Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16 (4): 724-31, 1992 Jul-Aug.

  13. Obara T, Fujimoto Y: Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15 (6): 738-44, 1991 Nov-Dec.

  14. Lu G, Shih WJ, Xiu JY: Technetium-99m MIBI uptake in recurrent parathyroid carcinoma and brown tumors. J Nucl Med 36 (5): 811-3, 1995.

  15. Al-Sobhi S, Ashari LH, Ingemansson S: Detection of metastatic parathyroid carcinoma with Tc-99m sestamibi imaging. Clin Nucl Med 24 (1): 21-3, 1999.

  16. Neumann DR, Esselstyn CB, Kim EY: Recurrent postoperative parathyroid carcinoma: FDG-PET and sestamibi-SPECT findings. J Nucl Med 37 (12): 2000-1, 1996.

  17. Sandelin K, Tullgren O, Farnebo LO: Clinical course of metastatic parathyroid cancer. World J Surg 18 (4): 594-8; discussion 599, 1994 Jul-Aug.

  18. Iacobone M, Lumachi F, Favia G: Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88 (4): 223-8, 2004.

  19. Levin KE, Galante M, Clark OH: Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101 (6): 649-60, 1987.

  20. Wynne AG, van Heerden J, Carney JA, et al.: Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore) 71 (4): 197-205, 1992.

  21. Lafferty FW: Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests. Arch Intern Med 141 (13): 1761-6, 1981.

  22. Nikkilä MT, Saaristo JJ, Koivula TA: Clinical and biochemical features in primary hyperparathyroidism. Surgery 105 (2 Pt 1): 148-53, 1989.

  23. Vetto JT, Brennan MF, Woodruf J, et al.: Parathyroid carcinoma: diagnosis and clinical history. Surgery 114 (5): 882-92, 1993.

  24. Collins MT, Skarulis MC, Bilezikian JP, et al.: Treatment of hypercalcemia secondary to parathyroid carcinoma with a novel calcimimetic agent. J Clin Endocrinol Metab 83 (4): 1083-8, 1998.

  25. Strewler GJ: Medical approaches to primary hyperparathyroidism. Endocrinol Metab Clin North Am 29 (3): 523-39, vi, 2000.

  26. Cohn K, Silverman M, Corrado J, et al.: Parathyroid carcinoma: the Lahey Clinic experience. Surgery 98 (6): 1095-100, 1985.

  27. Koea JB, Shaw JH: Parathyroid cancer: biology and management. Surg Oncol 8 (3): 155-65, 1999.

  28. Obara T, Okamoto T, Ito Y, et al.: Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114 (6): 1040-8; discussion 1048-9, 1993.

  29. Sandelin K: Parathyroid carcinoma. Cancer Treat Res 89: 183-92, 1997.

  30. Pasieka JL: What's new in general surgery: endocrine surgery. J Am Coll Surg 199 (3): 437-45, 2004.

  31. Munson ND, Foote RL, Northcutt RC, et al.: Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer 98 (11): 2378-84, 2003.

  32. Chow E, Tsang RW, Brierley JD, et al.: Parathyroid carcinoma--the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 41 (3): 569-72, 1998.

Cellular Classification of Parathyroid Cancer

The histologic distinction between benign and malignant parathyroid tumors is difficult to make.[1] Although cell type is not known to be of prognostic significance, histologic cell types include chief cell, transitional clear cell, and mixed cell types. Standard criteria of malignancy often cannot be confirmed in retrospective reviews of patients with carcinoma. Macroscopic and microscopic infiltrations often do not correlate, and adhesion to surrounding structures does not necessarily imply malignancy. Features such as dense fibrous trabeculae, trabecular growth patterns, mitoses, and capsular invasions, which have been classically associated with carcinomas, have also been found in parathyroid adenomas.[2][3][4] Capsular and vascular invasion appears to correlate best with tumor recurrence.[3][5] In a study of 286 patients, pathologists described well-differentiated carcinomas in approximately 80% of the patients.[6]

An aneuploid DNA pattern is more common, and mean nuclear DNA content is greater in carcinomas than in adenomas; when present in a carcinoma, aneuploidy appears to be associated with a poorer prognosis.[7][8][9] Aneuploidy occurs too frequently in parathyroid adenomas to be significant in differentiating benign from malignant parathyroid lesions.[9][10][11] In general, the clinical course and the gross pathology observed at surgery are as important as the histology to define a lesion as a parathyroid carcinoma.[12]

References:

  1. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.

  2. Schantz A, Castleman B: Parathyroid carcinoma. A study of 70 cases. Cancer 31 (3): 600-5, 1973.

  3. Levin KE, Galante M, Clark OH: Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101 (6): 649-60, 1987.

  4. Bondeson L, Sandelin K, Grimelius L: Histopathological variables and DNA cytometry in parathyroid carcinoma. Am J Surg Pathol 17 (8): 820-9, 1993.

  5. Iacobone M, Lumachi F, Favia G: Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88 (4): 223-8, 2004.

  6. Hundahl SA, Fleming ID, Fremgen AM, et al.: Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86 (3): 538-44, 1999.

  7. Levin KE, Chew KL, Ljung BM, et al.: Deoxyribonucleic acid cytometry helps identify parathyroid carcinomas. J Clin Endocrinol Metab 67 (4): 779-84, 1988.

  8. Obara T, Fujimoto Y: Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15 (6): 738-44, 1991 Nov-Dec.

  9. Sandelin K, Auer G, Bondeson L, et al.: Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16 (4): 724-31, 1992 Jul-Aug.

  10. Mallette LE: DNA quantitation in the study of parathyroid lesions. A review. Am J Clin Pathol 98 (3): 305-11, 1992.

  11. Obara T, Okamoto T, Kanbe M, et al.: Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Semin Surg Oncol 13 (2): 134-41, 1997 Mar-Apr.

  12. Rahbari R, Kebebew E: Parathyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1473-9.

Stage Information for Parathyroid Cancer

Because of the low incidence of parathyroid carcinoma, an American Joint Committee on Cancer staging system has not yet been formulated and thus is not applicable to this malignancy. In addition, neither tumor size nor lymph node status appear to be important prognostic markers for this malignancy.[1]

Patients are considered to have either localized or metastatic disease.[2][3]

Localized Parathyroid Cancer

Localized parathyroid cancer is disease that involves the parathyroid gland with or without invasion of adjacent tissues.

Metastatic Parathyroid Cancer

Metastatic parathyroid cancer is disease that spreads beyond the tissues adjacent to the involved parathyroid gland(s). Parathyroid carcinoma most frequently metastasizes to regional lymph nodes and lungs, and it may involve other distant sites, such as liver, bone, pleura, pericardium, and pancreas.[4]

References:

  1. Hundahl SA, Fleming ID, Fremgen AM, et al.: Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86 (3): 538-44, 1999.

  2. Chow E, Tsang RW, Brierley JD, et al.: Parathyroid carcinoma--the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 41 (3): 569-72, 1998.

  3. Busaidy NL, Jimenez C, Habra MA, et al.: Parathyroid carcinoma: a 22-year experience. Head Neck 26 (8): 716-26, 2004.

  4. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.

Treatment Option Overview

The rarity of this tumor does not provide large published series of treatment experience or permit the systematic evaluation of combination therapies.[1][2] The relatively slow cell-doubling time for this tumor makes radical surgery a therapeutic option even for patients with metastatic disease. As stated previously, treatment and control of secondary hypercalcemia must be the initial treatment goal in all patients with hyperparathyroidism.

References:

  1. Rahbari R, Kebebew E: Parathyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1473-9.

  2. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.

Localized Parathyroid Cancer

Treatment options:[1][2][3][4]

  1. The initial operation should include an en bloc resection of the tumor that takes care to avoid rupture of the tumor capsule and to ensure that the margins are free of tumor. This procedure will involve a parathyroidectomy, typically an ipsilateral thyroidectomy (thyroid lobectomy), and possibly resection of adjacent cervical muscles, paratracheal tissues, and the recurrent laryngeal nerve, if involved. Lymphadenectomy, beyond that necessary to achieve an en bloc excision of the primary malignancy, is not indicated unless enlarged or firm nodes clinically indicate the presence of nodal disease. Local recurrence may be minimized by this en bloc resection approach. Preoperative medical management to lower elevated calcium levels and to correct other metabolic disturbances that are due to hyperparathyroidism is critical.
  2. Surgery followed by radiation therapy.[4][5][6]
  3. Radiation therapy.

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized parathyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

  1. Rahbari R, Kebebew E: Parathyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1473-9.

  2. Sandelin K, Auer G, Bondeson L, et al.: Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16 (4): 724-31, 1992 Jul-Aug.

  3. Koea JB, Shaw JH: Parathyroid cancer: biology and management. Surg Oncol 8 (3): 155-65, 1999.

  4. Clayman GL, Gonzalez HE, El-Naggar A, et al.: Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100 (5): 900-5, 2004.

  5. Munson ND, Foote RL, Northcutt RC, et al.: Parathyroid carcinoma: is there a role for adjuvant radiation therapy? Cancer 98 (11): 2378-84, 2003.

  6. Chow E, Tsang RW, Brierley JD, et al.: Parathyroid carcinoma--the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 41 (3): 569-72, 1998.

Metastatic Parathyroid Cancer

Metastatic disease can appear shortly after the initial diagnosis and operation or for up to 20 years later.[1] Because of the difficulty in making a histologic diagnosis, the appearance of recurrent or metastatic disease in a patient previously operated on for hypercalcemia can be the first indicator that the tumor was malignant.[2] Approximately 50% of the patients who experience recurrence will have distant metastases.[3] The most common site of distant metastasis is the lung.[4][5] Some patients experience years of survival even after the diagnosis of distant metastases.[5] Aggressive surgical resection has been associated with a 30% long-term survival in retrospective series.[3][6]

Treatment options:[1][3][4][5][6][7][8][9][10]

  1. Metastasectomy: Because parathyroid carcinoma can be slow growing, resection of distant metastases can be effective for palliation and occasional cure.
  2. Medical management of hypercalcemia.[5][10][11][12]
  3. Surgery plus radiation therapy.
  4. Radiation therapy.
  5. Chemotherapy. Anecdotal reports show that short-term remissions with chemotherapy are possible.[5][10]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with metastatic parathyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

  1. Wynne AG, van Heerden J, Carney JA, et al.: Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore) 71 (4): 197-205, 1992.

  2. Busaidy NL, Jimenez C, Habra MA, et al.: Parathyroid carcinoma: a 22-year experience. Head Neck 26 (8): 716-26, 2004.

  3. Sandelin K, Tullgren O, Farnebo LO: Clinical course of metastatic parathyroid cancer. World J Surg 18 (4): 594-8; discussion 599, 1994 Jul-Aug.

  4. Favia G, Lumachi F, Polistina F, et al.: Parathyroid carcinoma: sixteen new cases and suggestions for correct management. World J Surg 22 (12): 1225-30, 1998.

  5. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.

  6. Obara T, Okamoto T, Ito Y, et al.: Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114 (6): 1040-8; discussion 1048-9, 1993.

  7. Vetto JT, Brennan MF, Woodruf J, et al.: Parathyroid carcinoma: diagnosis and clinical history. Surgery 114 (5): 882-92, 1993.

  8. Sandelin K: Parathyroid carcinoma. Cancer Treat Res 89: 183-92, 1997.

  9. Iacobone M, Lumachi F, Favia G: Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88 (4): 223-8, 2004.

  10. Rahbari R, Kebebew E: Parathyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1473-9.

  11. Clayman GL, Gonzalez HE, El-Naggar A, et al.: Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100 (5): 900-5, 2004.

  12. Peacock M, Bilezikian JP, Klassen PS, et al.: Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 90 (1): 135-41, 2005.

Recurrent Parathyroid Cancer

Approximately 40% to 60% of patients experience a postsurgical recurrence, typically between 2 to 5 years after the initial resection.[1][2] Because it is difficult to establish a histologic diagnosis of parathyroid cancer at the time of initial surgery, the appearance of recurrent or metastatic tumor can be the first sign of malignancy.[3]

Because these tumors are slow-growing, repeated resection of local recurrences and/or distant metastases can result in significant palliation.[4][5][6][7][8] Pulmonary metastases as well as bone metastases should be resected, if possible, to decrease the magnitude of the hypercalcemia.[7][9] Occasionally, long-term salvage is achieved in this group of patients with aggressive surgical treatment.[10] The major morbidity of recurrent or metastatic parathyroid cancer results from severe hypercalcemia, which can be difficult to control. For patients not fit for surgery, treatment with bisphosphonates, plicamycin, calcitonin, and gallium pamidronate may control hypercalcemia.[11] Control of malignant hypercalcemia with these medical measures is often only temporary.

Treatment options:[4][5][6][7][8][9][10]

  1. Surgical removal of the local recurrence with surgical removal of metastases when possible. Because parathyroid carcinoma can be slow-growing, resection of local recurrences or distant metastases can bring effective palliation but can rarely cure. Debulking of functional carcinomas may help reduce parathormone production.
  2. Medical management of hypercalcemia.[11][10][12][13]
  3. Surgery plus radiation therapy.
  4. Radiation therapy.
  5. Chemotherapy. Anecdotal reports show that short-term remissions with chemotherapy are possible.[10][11]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent parathyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

  1. Anderson BJ, Samaan NA, Vassilopoulou-Sellin R, et al.: Parathyroid carcinoma: features and difficulties in diagnosis and management. Surgery 94 (6): 906-15, 1983.

  2. Sandelin K, Auer G, Bondeson L, et al.: Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16 (4): 724-31, 1992 Jul-Aug.

  3. Busaidy NL, Jimenez C, Habra MA, et al.: Parathyroid carcinoma: a 22-year experience. Head Neck 26 (8): 716-26, 2004.

  4. Vetto JT, Brennan MF, Woodruf J, et al.: Parathyroid carcinoma: diagnosis and clinical history. Surgery 114 (5): 882-92, 1993.

  5. Wynne AG, van Heerden J, Carney JA, et al.: Parathyroid carcinoma: clinical and pathologic features in 43 patients. Medicine (Baltimore) 71 (4): 197-205, 1992.

  6. Hundahl SA, Fleming ID, Fremgen AM, et al.: Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86 (3): 538-44, 1999.

  7. Obara T, Okamoto T, Ito Y, et al.: Surgical and medical management of patients with pulmonary metastasis from parathyroid carcinoma. Surgery 114 (6): 1040-8; discussion 1048-9, 1993.

  8. Sandelin K: Parathyroid carcinoma. Cancer Treat Res 89: 183-92, 1997.

  9. Flye MW, Brennan MF: Surgical resection of metastatic parathyroid carcinoma. Ann Surg 193 (4): 425-35, 1981.

  10. Rahbari R, Kebebew E: Parathyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1473-9.

  11. Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.

  12. Clayman GL, Gonzalez HE, El-Naggar A, et al.: Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100 (5): 900-5, 2004.

  13. Peacock M, Bilezikian JP, Klassen PS, et al.: Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 90 (1): 135-41, 2005.


This information is provided by the National Cancer Institute.

This information was last updated on November 8, 2013.

  • Email
  • Print
  • Share
  • Text
Highlight Glossary Terms
  • Make an Appointment

    • For adults:
      877-442-3324 (877-442-DFCI)
    • For children:
      888-733-4662 (888-PEDI-ONC)
    • Or complete the online form.