Active Surveillance of Thyroid Cancer Under Study

Researchers at Cedars-Sinai are conducting a clinical trial that could significantly change treatment for lower risk thyroid cancers.

The Cedars-Sinai study, the first of its kind on the West Coast, is comparing results from the active surveillance of papillary thyroid microcarcinoma to immediate surgery.

Active surveillance of thyroid cancer is modeled after a similar observational method that is becoming more common in the treatment of low-risk prostate cancer. The American Thyroid Association has released new guidelines that suggest that active surveillance is an appropriate option for small, low-risk cancers.

The Cedars-Sinai trial will estimate the rate of thyroid cancer progression over a three-, five- and 10-year period in patients. Treatment includes physical exams, blood tests and ultrasounds every six to 12 months.

The active surveillance study is open to patients 18 years or older with tumors 1.5cm in diameter or smaller. Eligible patients must be able to understand and sign a HIPAA authorization form. Patients who have cancers that have spread to the lymph nodes, hoarseness or high-risk, aggressive cancers do not qualify for the study.

Allen Ho, MD, and Wendy Sacks, MD, co-directors of the Thyroid Cancer Program, say that active surveillance can maintain a patient's quality of life without compromising their survival, depending on tumor size and growth rate.

"There are many thyroid cancers that are slow growing, where aggressive treatment is not necessary," Ho said. "Ninety percent or more of small papillary thyroid cancers are indolent, nonaggressive and unlikely to hurt or kill someone over the course of their lives. Everything is being monitored; we are doing this under the auspices of a trial in a careful, thoughtful way."

Although surgery is a relatively safe and standard treatment for cancer, thyroidectomies can have negative side effects, such as vocal cord paralysis, numbness, tingling and adverse reactions to synthetic hormones including weight gain and loss of energy.

Active surveillance provides an alternative treatment plan for less aggressive cancers. Patients can choose to stop surveillance at any time to undergo surgery, and surgery is recommended if there is growth over time.

"Surgery is not wrong; patients are choosing between two right answers," Sacks said. "We want to offer patients options that match the severity of their disease."

For more information on active surveillance, email allen.ho@cshs.org or wendy.sacks@cshs.org.