Definition of Parathyroid cancer:

Parathyroid cancer is a cancerous (malignant) growth in a parathyroid gland.

Causes, incidence, and risk factors:

The parathyroid glands are responsible for managing the calcium levels in the body. There are four parathyroid glands, two on top of each lobe of the thyroid gland. They are located at the base of the neck.

Parathyroid cancer is an extremely rare type of cancer. Men and women are equally affected. It usually occurs in people older than 30.

The cause of parathyroid cancer is unknown. People with multiple endocrine neoplasia type I have an increased risk for this disease. People who had head or neck radiation may also be at increased risk. Such radiation exposure, however, is more likely to cause thyroid cancer.

Symptoms:

Symptoms of parathyroid cancer are primarily caused by high levels of calcium in the blood (hypercalcemia), and may affect various parts of the body. They include:

• Bone pain
• Constipation
• Fatigue
• Fractures
• Frequent thirst
• Frequent urination
• Kidney stones
• Muscle weakness
• Nausea
• Poor appetite
• Vomiting

It is important to note that only about 1 out of 200 people with primary hyperparathyroidism have parathyroid cancer.

Signs and tests:

Parathyroid cancer is extremely hard to diagnose.

Your doctor will perform a physical exam and ask about your medical history.

In about half of all cases, feeling the neck with the hands (palpation) can reveal a cancerous parathyroid tumor.

Cancerous parathyroid tumors tend to produce very high amounts of parathyroid hormone (PTH). Tests may include:

• Blood calcium (levels higher than 14 mg/dL are suspicious)
• Blood PTH (levels that are more than twice than normal may indicate cancer)

Before surgery, you will undergo a special radioactive scan of the parathyroid glands. The scan is called the sestamibi scan. You may also have a neck ultrasound. These tests are done to confirm which parathyroid gland is abnormal.

Treatment:

The following treatments may be used to correct hypercalcemia due to parathyroid cancer:

• A drug that lowers levels of calcium in the blood (gallium nitrate)
• A natural hormone produced by the body that helps control calcium levels (calcitonin)
• Drugs that stop the breakdown and reabsorption of bones into the body, such as pamidronate or etidronate (bisphosphonates)
• Fluids through a vein (IV fluids)

Surgery is the recommended treatment for parathyroid cancer. Very often, it is impossible to know whether a parathyroid tumor is cancerous or not. Your doctor may recommend surgery even without a confirmed diagnosis. Minimally invasive surgery, using smaller cuts, is becoming more common for parathyroid disease.

If tests before the surgery can find the suspicious gland, surgery may be done on one side of the neck (unilateral). If it is not possible to find the problem gland before surgery, the surgeon will look at both sides of your neck.

Chemotherapy and radiation do not work very well in preventing the cancer from coming back, although radiation can sometimes help reduce the spread of cancer to the bones. Repeated surgeries for cancer that has returned may increase survival rate and reduce the severe effects of hypercalcemia.

Expectations (prognosis):

Parathyroid cancer is a rare cancer. The tumor is slow growing. Surgery may help extend life even when the cancer spreads.

Complications:

The cancer may spread (metastasize) to other places in the body, most commonly the lungs and bones.

The most serious complication of parathyroid cancer is hypercalcemia. Most deaths from parathyroid cancer occur as a result of severe, difficult to control hypercalcemia, and not the cancer itself.

The cancer commonly comes back (recurs). Additional surgeries may be needed. Complications from surgery can include:

• Hoarseness or voice changes as a result of damage to the nerve that controls the vocal cords
• Infection at the site of surgery
• Low levels of calcium in the blood (hypocalcemia), a potentially life-threatening condition
• Scarring

Calling your health care provider: