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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.
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. We also have a dedicated Thyroid Cancer Treatment Center with nationally-recognized specialists who are advancing our understanding of thyroid cancer and nodular disease.
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:
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.
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Referring physicians: 617-632-6869Fax: 617-632-4448
Mailing addressHead and Neck Oncology CenterDana-Farber Cancer Institute450 Brookline Ave.Boston, MA 02115-5450
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.
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:
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.
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):
Treatment with radiation therapy may increase the risk of developing a parathyroid adenoma.
Most parathyroid cancer signs and symptoms are caused by the hypercalcemia that develops. Signs and symptoms of hypercalcemia include the following:
Other signs and symptoms of parathyroid cancer include the following:
Other conditions may cause the same signs and symptoms as parathyroid cancer. Check with your doctor if you have any of these problems.
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:
The prognosis (chance of recovery) and treatment options depend on the following:
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:
Cancer can spread through tissue, the lymph system, and the blood:
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.
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.
Parathyroid cancer is described as either localized or metastatic:
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.
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.
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.
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:
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 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 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 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:
Information about clinical trials is available from the NCI Web site.
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.
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.
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 of localizedparathyroid cancer may include the following:
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.
Treatment of metastaticparathyroid cancer may include the following:
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.
Treatment of recurrentparathyroid cancer may include the following:
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.
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 June 10, 2014.
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. 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. The median age in most series is between 45 and 51 years. 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).
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. Parathyroid cancer has also been associated with external radiation exposure; however, most reports describe an association between radiation and the more common parathyroid adenoma.
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%). In the National Cancer Database series of 286 patients, only 16 (5.6%) had lymph node metastases noted at the time of initial surgery. 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. 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.
Approximately 40% to 60% of patients experience a postsurgical recurrence, typically in the range of 2 to 5 years after the initial resection. 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. 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. In older studies, distant metastases were reported to occur in 25% of patients, primarily in the lungs but also in the bone and liver. 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. 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. In the National Cancer Database series of 286 patients, the 10-year survival rate was reported to be approximately 49%. 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.
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. 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. In approximately 50% of the patients, the malignant tumor is surrounded by a dense, fibrous, grayish-white capsule that infiltrates adjacent tissues. Histopathologically, as with other endocrine neoplasms, the distinction between benign and malignant parathyroid tumors is difficult to make. 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.
Parathyroid cancers are hyperfunctional unlike other endocrine tumors that become less hormonally active when malignant. 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. 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. Renal colic is a frequent presenting complaint of patients with parathyroid carcinoma. In a study involving 43 cases, the prevalence of nephrolithiasis and the prevalence of renal insufficiency were reported to be 56% and 84%, respectively.
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. (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. These symptoms are present simultaneously at diagnosis in 50% or fewer patients with parathyroid cancer. In contrast, simultaneous renal and overt skeletal involvement is distinctly unusual in primary HPT.
Signs and symptoms of the hyperparathyroid state associated with parathyroid cancer that may be found at diagnosis include:
(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.
carcinoma should be suspected clinically if:
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. 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.
Surgery is the only effective therapy for parathyroid carcinoma. 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.
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. Accessible distant metastases should be resected when possible. 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; CT and magnetic resonance imaging are useful imaging adjuncts for the localization of distant metastases.
Nonsurgical forms of therapy for parathyroid carcinoma generally have poor results. Some investigators have advocated the use of adjuvant radiation therapy to decrease the local recurrence rate. 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. As stated previously, patients rarely die from the tumor itself; rather, they die from the metabolic complications of uncontrolled HPT.
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.
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.
Fraker DL: Update on the management of parathyroid tumors. Curr Opin Oncol 12 (1): 41-8, 2000.
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.
Shane E: Clinical review 122: Parathyroid carcinoma. J Clin Endocrinol Metab 86 (2): 485-93, 2001.
Mallette LE, Bilezikian JP, Ketcham AS, et al.: Parathyroid carcinoma in familial hyperparathyroidism. Am J Med 57 (4): 642-8, 1974.
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.
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.
Busaidy NL, Jimenez C, Habra MA, et al.: Parathyroid carcinoma: a 22-year experience. Head Neck 26 (8): 716-26, 2004.
Clayman GL, Gonzalez HE, El-Naggar A, et al.: Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer 100 (5): 900-5, 2004.
Anderson BJ, Samaan NA, Vassilopoulou-Sellin R, et al.: Parathyroid carcinoma: features and difficulties in diagnosis and management. Surgery 94 (6): 906-15, 1983.
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.
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.
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.
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.
Neumann DR, Esselstyn CB, Kim EY: Recurrent postoperative parathyroid carcinoma: FDG-PET and sestamibi-SPECT findings. J Nucl Med 37 (12): 2000-1, 1996.
Sandelin K, Tullgren O, Farnebo LO: Clinical course of metastatic parathyroid cancer. World J Surg 18 (4): 594-8; discussion 599, 1994 Jul-Aug.
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.
Levin KE, Galante M, Clark OH: Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia. Surgery 101 (6): 649-60, 1987.
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.
Lafferty FW: Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests. Arch Intern Med 141 (13): 1761-6, 1981.
Nikkilä MT, Saaristo JJ, Koivula TA: Clinical and biochemical features in primary hyperparathyroidism. Surgery 105 (2 Pt 1): 148-53, 1989.
Vetto JT, Brennan MF, Woodruf J, et al.: Parathyroid carcinoma: diagnosis and clinical history. Surgery 114 (5): 882-92, 1993.
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.
Strewler GJ: Medical approaches to primary hyperparathyroidism. Endocrinol Metab Clin North Am 29 (3): 523-39, vi, 2000.
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The histologic distinction between benign and malignant parathyroid tumors is difficult to make. 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. Capsular and vascular invasion appears to correlate best with tumor recurrence. In a study of 286 patients, pathologists described well-differentiated carcinomas in approximately 80% of the patients.
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. Aneuploidy occurs too frequently in parathyroid adenomas to be significant in differentiating benign from malignant parathyroid lesions. 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.
Schantz A, Castleman B: Parathyroid carcinoma. A study of 70 cases. Cancer 31 (3): 600-5, 1973.
Bondeson L, Sandelin K, Grimelius L: Histopathological variables and DNA cytometry in parathyroid carcinoma. Am J Surg Pathol 17 (8): 820-9, 1993.
Levin KE, Chew KL, Ljung BM, et al.: Deoxyribonucleic acid cytometry helps identify parathyroid carcinomas. J Clin Endocrinol Metab 67 (4): 779-84, 1988.
Mallette LE: DNA quantitation in the study of parathyroid lesions. A review. Am J Clin Pathol 98 (3): 305-11, 1992.
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.
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.
Patients are considered to have either localized or metastatic disease.
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.
The rarity of this tumor does not provide large published series of treatment
experience or permit the systematic evaluation of combination therapies. 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.
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.
Metastatic disease can appear shortly after the initial diagnosis and operation
or for up to 20 years later. 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. Approximately 50% of the patients who experience
recurrence will have distant metastases. The most common site of distant
metastasis is the lung. Some patients experience years of survival even after the diagnosis of distant metastases. Aggressive surgical resection has been associated with a 30% long-term survival
in retrospective series.
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.
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.
Approximately 40% to 60% of patients experience a postsurgical recurrence, typically between 2 to 5 years after the initial resection. 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.
Because these tumors are slow-growing, repeated resection of local recurrences and/or distant metastases can result in significant palliation. Pulmonary metastases as well as bone metastases should be resected, if possible, to decrease the magnitude of the hypercalcemia. Occasionally, long-term salvage is achieved in this group of patients with aggressive surgical treatment. 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. Control of malignant hypercalcemia with these medical measures is often only temporary.
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.
Flye MW, Brennan MF: Surgical resection of metastatic parathyroid carcinoma. Ann Surg 193 (4): 425-35, 1981.
This information was last updated on November 8, 2013.
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The Friends' Corner Gift Shop, located on the first floor of the Yawkey Center for Cancer Care, offers a wide selection of unique gifts and everyday items for patients, families and staff.
Dana-Farber offers several services to help you and your family manage the financial side of cancer treatment. From creating bill payment schedules and estate planning advice to debt management and resource assistance for patients in need, our team is here for you.
Every year, thousands of patients with cancer from around the world come to Dana-Farber for their care. We provide a wide array of logistical and other services for individuals who live outside the United States.
Dana-Farber provides interpreting services for patients whose first language is not English. Interpreters may be requested for any activity, including registration, booking appointments, attending treatments and exams, support groups, and meetings with doctors and other members of your health care team.
Our nutritionists are registered dietitians who can assist you in planning an optimal diet during any stage of your cancer journey, cope with any side effects you may experience, and answer your questions about the latest findings on cancer and nutrition.
One-to-One connects adult patients, family members and caregivers with individuals who have gone through cancer themselves, providing an experienced and reassuring perspective for those facing a cancer diagnosis, treatment and recovery.
The Eleanor and Maxwell Blum Patient and Family Resource Center and its satellite resource rooms are staffed by health care professionals and provide computer stations, books, brochures, videos, and CDs to help you find information and support on a variety of issues about cancer treatment and care.
Patients websites help friends and family members stay up-to-date on their loved ones' condition and write messages of support and encouragement.
The Dana-Farber pharmacy fills prescriptions for all pediatric and adult patients. Our pharmacists are an extension of the patient care team and work closely with your physicians to provide seamless, convenient, safe care.
More than 1,200 Dana-Farber patients and their families have enjoyed free trips to baseball games, theater shows, museums, and other attractions this year through the Recreational Resources program.
The Sexual Health Program provides education, consultation and personalized rehabilitation for patients and their partners who have experienced changes in sexual health during and after cancer treatment.
Through all stages of cancer treatment and survivorship, our Spiritual Care staff is available 24 hours a day to provide emotional and spiritual support for adults and pediatric patients and family members.
Young adults with cancer face very different challenges than patients who were diagnosed earlier in childhood or later in adulthood. The Young Adult Program can help you to find the resources and expertise available at Dana-Farber to help support your cancer experience.
Integrative therapies, also known as complementary therapies, range from acupuncture and massage to nutritional guidance and music therapy. Patients treated at the Zakim Center credit its services with easing nausea, improving circulation, and reducing pain, stress, and anxiety associated with cancer treatment.
Patients who are receiving cancer therapy often have changes in the mouth. This information can help you understand possible side effects of cancer treatment, including tips for mouth care that may help prevent or minimize these changes.
Chemotherapy affects rapidly dividing cells. Cancer cells and some normal cells, such as those lining the mouth, the gastrointestinal tract, bone marrow cells, and hair cells, divide rapidly.
Chemotherapy cannot tell the difference between normal cells and malignant cells and sometimes injures both. Chemotherapy may lower your white blood cell count, platelet count, and red blood cell count. This is known as bone marrow suppression (another name is myelosuppression). This makes you more at risk for infection and/or bleeding.
If there is pre-existing dental infection such as cavities, abscesses, or gum (periodontal) disease, the infection may become worse. In addition, your gums may bleed easily if they are irritated or swollen.
Chemotherapy may also cause mouth sores (mucositis). These sores usually heal in one to two weeks; however, more serious ulcers may become infected with bacteria or yeast that are commonly found in the mouth. Irritation from sharp teeth or fillings may worsen the condition. Medications to prevent sores and help with discomfort are available and can be prescribed for you.
As a comfort, ask for ice chips or sugar free popsicles to suck on while you are receiving chemotherapy. Research has shown this may decrease mouth sores by 60 percent.
Radiation therapy is often used to treat individuals with cancer of the head and neck. It is delivered to the head and neck area to destroy cancer cells but unfortunately, some normal cells are injured as well. During radiation treatment, patients may also experience mouth sores. This usually lessens within a couple of weeks after therapy ends. Unlike chemotherapy, radiation therapy has long-term side effects in the mouth. The most common side effect is dry mouth (xerostomia). Xerostomia is a result of radiation injury to the salivary glands. It means the salivary glands produce less saliva and the saliva is thicker. The normal protective effect of saliva on the teeth is lost and there is an increase in oral bacteria that cause cavities. Also, plaque and tarter deposits occur faster, which places you more at risk for cavities and gum disease.
Another side effect of radiation treatment to the head and neck is severe bone infection. This is caused by a decrease in the blood supply to the bones of the head and tissue of the neck during radiation treatment. These changes result in slow healing from infection, trauma or especially when teeth are removed soon after radiation therapy. Restorative and preventive dental care is very important to avoid infection.
To prevent infection and tooth decay, it is very important to see your dentist early in your treatment and to continue good mouth cleaning daily. Outlined below are helpful suggestions for mouth care inpatients undergoing cancer treatment.
See your dentist so that (s)he may identify potential sources of dental infection or irritation. Teeth with severe infection or those that may cause problems during or after therapy should be removed (extracted). Extractions should be done at least one week before the start of chemotherapy or radiation therapy to provide enough time for proper healing. Teeth with cavities should be restored with fillings. A thorough cleaning and scaling of teeth should be done to remove tartar (calculus). All sharp areas should be smoothed to prevent unnecessary irritation. Procedures that may be included in the first dental visit are:
During treatment it is important to adhere strictly to your mouth care plan. If your mouth is sore, some of the following tips may help:
Fluoride treatments are important during and after radiation treatments to the head and neck area. They should be done twice daily by using soft trays that are custom made for you by your dentist.
When therapy ends, you need to continue with good dental care in order to keep your teeth and gums healthy. Your salivary glands will be making less saliva and you will still be at risk for developing cavities and gum disease.
You will need to have:
Mouth dryness may continue after therapy. Salivary flow will gradually increase, but may not completely return to normal. To add moisture to your mouth it is helpful to:
Dentures should be made or relined about six months after treatment to allow for changes in your mouth. There should be no pressure areas which could result in irritation to your mouth.