Thyroid cancer

• Founded by breast cancer survivor, Cynthia Jordan, LLL represents a modern kind of global education hub for breast cancer support.
• Dr. Lustberg is an acclaimed physician and researcher with an extensive background in all-phase clinical trials and breast cancer translational research.
• Lauren Giannetti Sferrazza, MS CGC, is a certified genetic counselor who currently practices as a National Medical Science Liaison in Oncology at Myriad Genetics.
• And in addition, LLL and Dr. Charles Weaver already release a monthly Breast Cancer Newsletter that offers support from diagnosis through treatment, and into survivorship.

• The same forces that turned dinosaurs into birds turn normal cells into cancer: genetic mutations and traits that confer a survival advantage.
• Evolution in animals is largely driven by mutations in the DNA of germ cells – the sperm and egg that fuse to form an embryo.
• We believe that understanding evolution is key to understanding how cancer arises and how to treat it.

Timing is of the essence

• However, if one survives and duplicates itself many times over, it can form a tumor made of multiple mutant cells.
• These tumor cells continue to reproduce and mutate, evolving until the tumor ultimately gains the ability to spread throughout the body.
• Precancerous polyps are easily removed during colonoscopy screenings, preventing them from evolving to invasive colon cancer.

Different cancers require different treatments

• In general, cancers from different organs look distinct from one another and contain different proteins.
• Tumors arising in a given organ also tend to have mutations in the same set of genes, even among different patients.
• For example, thyroid cancers typically have a low number of mutations while colon cancers have many mutations, a number that is increased dramatically in tumors that have lost genes involved in DNA repair.
• However, thyroid cancer and melanoma respond minimally to chemotherapy and require different approaches.

Treatments can drive cancer evolution

• Treatment can also push cancer to evolve further, gaining advantageous mutations that help them survive and resist therapy.
• For example, a subset of lung cancers is driven by mutation in a gene called EGFR.
• Similarly, metastatic prostate cancer is often treated with drugs that block androgen receptors, because it depends on them for growth and survival.

Not an easy fight

• The fight against cancer is a fight against evolution, the fundamental process that has driven life on Earth since time immemorial.
• This is not an easy fight, but medicine has made tremendous progress.
• Much of this is attributable to cancer screening programs and recently developed, more effective drugs.

• A thyroid nodule is a solid or fluid-filled lump found within the thyroid.
• The majority of thyroid nodules are small, can’t be felt by touch and do not cause symptoms.
• Thyroid nodules are very common, with more than half of people scanned show small nodules.

Who gets them

• At age 30 it is estimated around 30% of women will have a nodule.
• People often find out that they have thyroid nodules during a routine check-up or when investigating another unrelated health issue.
• Thyroid nodules are readily seen on common imaging tests such as an ultrasound or CT scans.

When should you worry?

• But we now know around 10% of patients with thyroid nodules harbour cancer – so approximately 90% of those detected don’t pose a cancer risk.
• Generally, the risk is only increased with past radiation exposure, a family history of thyroid cancer, obesity, or if aged younger than 20 at the time of discovery of the nodule.
• Symptoms of concern are: an enlarging thyroid nodule, recent onset of hoarseness, difficult swallowing, neck pain or discomfort, large firm nodule or surrounding enlarged lymph nodes.

When detection leads to poorer health

• In recent decades, the dramatic increase in new cases of thyroid cancer has largely been driven by findings of small, low-risk thyroid cancers; found when investigating thyroid nodules.
• Strong evidence exists overdiagnosis – that is, a correct but unnecessary diagnosis – accounts for a large proportion of thyroid cancer cases.
• In line with this, systems for ultrasound reporting have been introduced to reduce overtreatment of small thyroid nodules.
• Read more:
  Low- and middle-income countries struggle to provide health care to some, while others get too much medicine

Take-home advice

• Investigating and treating these nodules can lead to unwarranted physical, psychological and financial consequences including overdiagnosis, overtreatment, anxiety and out-of-pocket costs.
• Patti Shih's research projects are funded by the National Health and Medical Research Council (NHMRC)

• This marks the first full approval for an immunotherapy based on a predictive biomarker, regardless of solid tumor type.
• Important immune-mediated adverse reactions listed here may not include all possible severe and fatal immune-mediated adverse reactions.
• Patients were either prospectively enrolled with MSI-H/dMMR tumors (Cohort K) or retrospectively identified in one of 10 solid tumor cohorts (Cohorts A-J).
• In KEYNOTE-158 and KEYNOTE-164, the median duration of exposure to KEYTRUDA was 6.2 months (range, 1 day to 53.5 months).