Parathyroid Cancer (PTCa)
Parathyroid cancer (PTCa) is a very rare malignancy originating in one of the four parathyroid glands, which are small endocrine glands located behind the thyroid gland in the neck. These glands regulate calcium levels in the blood by producing parathyroid hormone (PTH).
Causes and Risk Factors
- The exact cause is not well understood due to its rarity.
- Risk factors include prior radiation exposure to the head or neck and certain genetic conditions.
- Parathyroid cancer accounts for less than 1% of cases of hyperparathyroidism.
Symptoms
Most symptoms arise from excessive PTH secretion, causing hypercalcemia (high blood calcium levels). These include:
- Fatigue, weakness, muscle pain
- Bone pain and fractures
- Kidney problems: kidney stones, nephrocalcinosis, upper back or flank pain
- Gastrointestinal symptoms: nausea, vomiting, constipation, abdominal pain, loss of appetite, weight loss
- Neuropsychiatric symptoms: confusion, depression, difficulty thinking clearly
- Excessive thirst and frequent urination
- A palpable lump or mass in the neck
- Hoarseness, difficulty swallowing, vocal cord paralysis (due to local tumor invasion)
- In some cases, symptoms related to tumor compression of nearby structures
Diagnosis
- Blood tests showing elevated calcium and PTH levels, often markedly higher than in benign disease.
- Imaging studies (ultrasound, sestamibi scan, CT, MRI) to localize the tumor and assess local invasion or metastasis.
- Biopsy and histopathological examination confirm malignancy.
- Staging distinguishes localized disease (confined to parathyroid and nearby tissues) from metastatic disease (spread to lymph nodes, lungs, liver, bones).
Treatment
- Surgical removal of the affected parathyroid gland and any involved surrounding tissues is the primary and most effective treatment.
- Preoperative management includes controlling hypercalcemia medically.
- Radiation therapy and chemotherapy have limited roles but may be used in advanced or recurrent cases.
- Lifelong monitoring of calcium and PTH levels is necessary due to risk of recurrence.
Prognosis
- Parathyroid cancer has a variable prognosis; early detection and complete surgical excision improve outcomes.
- Recurrence is common, and metastatic disease worsens prognosis.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Rare malignant tumor of the parathyroid glands causing hyperparathyroidism and hypercalcemia |
| Common Symptoms | Fatigue, bone pain, kidney stones, nausea, vomiting, constipation, neuropsychiatric symptoms, neck lump, hoarseness |
| Diagnosis | Elevated serum calcium and PTH, imaging (ultrasound, sestamibi, CT/MRI), biopsy |
| Treatment | Surgical excision (mainstay), medical management of hypercalcemia, limited role for radiation/chemotherapy |
| Prognosis | Variable; depends on stage and completeness of surgery; risk of recurrence |
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References
- Cleveland Clinic: Parathyroid Cancer
https://my.clevelandclinic.org/health/diseases/6182-parathyroid-cancer - Canadian Cancer Society: Symptoms of Parathyroid Cancer
https://cancer.ca/en/cancer-information/cancer-types/parathyroid/signs-and-symptoms - Macmillan Cancer Support: Parathyroid Cancer – Symptoms, Diagnosis, Treatment
https://www.macmillan.org.uk/cancer-information-and-support/parathyroid-gland-cancer - Johns Hopkins Medicine: Parathyroid Tumor
https://www.hopkinsmedicine.org/health/conditions-and-diseases/parathyroid-tumor - Yale Medicine: Parathyroid Cancer
https://www.yalemedicine.org/conditions/parathyroid-cancer - Mount Sinai: Parathyroid Cancer
https://www.mountsinai.org/health-library/diseases-conditions/parathyroid-cancer - Tampa General Hospital: Parathyroid Cancer Causes, Symptoms, Diagnosis, and Treatment
https://www.tgh.org/institutes-and-services/conditions/parathyroid-cancer - MedlinePlus Genetics: Parathyroid Cancer
https://medlineplus.gov/genetics/condition/parathyroid-cancer/
Parathyroid cancer is an extremely rare but serious disease characterized by excessive parathyroid hormone production and hypercalcemia, leading to diverse systemic symptoms. Early diagnosis and surgical treatment are critical for improving outcomes.
