How we’re improving parathyroid cancer care

Until recently, decades passed with little progress in improving the survival rates of parathyroid cancer patients. But our specialized, multidisciplinary team led by Naifa L. Busaidy, M.D., and Nancy D. Perrier, M.D., is bringing parathyroid cancer patients new hope.

We sat down with them to understand this rare disease and how MD Anderson is advancing parathyroid cancer treatment. Here’s what they shared.

What is a parathyroid?

We all have four parathyroids located in our necks. These endocrine glands are only the size of a sunflower seed, but they control the body’s calcium by producing a regulatory hormone.

When a parathyroid becomes overactive and produces too much of this hormone, it’s called hyperparathyroidism. The most common endocrine disorder, hyperparathyroidism can result in tumor growth in the neck. Most parathyroid tumors are benign, but some patients have a genetic mutation that leads to the development of parathyroid cancer.

If hyperparathyroidism progresses to cancer, it’s important that it’s caught and treated early, when treatment is most effective. That’s why it’s so important for patients with hyperparathyroidism to be monitored by skilled specialists, such as by our team.

What are common parathyroid cancer symptoms?

When monitoring hyperparathyroidism, we’re suspicious that it’s progressed to cancer if the patient’s calcium and parathyroid hormone levels are high. We’re also concerned if diagnostic imaging, such as a CT scan, ultrasound or a specialized sestamibi parathyroid scan, shows unusual features of the parathyroid gland, such as the glands appearing bigger than normal or calcified. In this case, we also check for a lump on the patient’s neck. In addition, we closely monitor patients who have a family history of kidney tumors or jaw tumors since they can be at higher risk, as well as carriers of the MEN1, CDC73 and P53 gene mutations.

Patients may notice bodily changes, such as excessive urination, excessive thirst, fatigue and bone pain. If you experience these symptoms, seek care from an experienced team to ensure an accurate diagnosis.

Why is an accurate diagnosis so important for parathyroid cancer patients?

A correct diagnosis is necessary to develop an effective treatment plan.

Because parathyroid cancer is so rare, pathologists are often unfamiliar with the disease when making a diagnosis. Your care team should be able to make a diagnosis by evaluating your diagnostic imaging, calcium levels and parathyroid hormone levels.

If you don’t feel comfortable with the choices laid out by your care team or feel they don’t have enough experience treating parathyroid cancer, get a second opinion. It may save your life.

Why is parathyroid cancer difficult to treat?

Malignant parathyroid tumors are often misdiagnosed as benign and treated improperly. Surgery is currently the gold standard for treating malignant parathyroid cancer. It’s best to completely remove the tumor during the initial surgery, so it’s important that your medical team have a suspicion of parathyroid cancer beforehand. Sometimes, the cancer returns when most but not all of the tumor is removed because cancer cells remain in the body. There’s then a higher risk of death due to complications associated with recurrence.

How common is a parathyroid cancer recurrence?

Most people with parathyroid cancer have a recurrence -- either in the same area of initial diagnosis or because the cancer spreads. Unfortunately, recurrence can be fatal. When the tumor comes back locally, it can be difficult to surgically remove because it often attaches to other vital structures like the esophagus, the breathing tube or the major blood vessels in the neck. Some then spread to the lungs, bones or liver. If the surgeon can’t remove all of the parathyroid tumor, the patient’s calcium levels won’t be regulated. The patient may then develop hypercalcemia, which can lead to fatigue, dehydration, increased infection and harm to the kidneys. Although we can relieve pain and discomfort with palliative care, the patient’s unregulated, high calcium levels eventually lead to death.

What parathyroid cancer research is underway?

We’re learning more about parathyroid cancer with six protocols that are currently enrolling patients. Two protocols are examining parathyroid tissue and hoping to predict recurrence through tumor staining. A third study is reviewing diagnostic imaging to more effectively diagnose parathyroid cancer. Fourth, we’re exploring immunotherapy as a treatment option. Fifth, with precision medicine, we’re evaluating molecular profiles of parathyroid tumors and sequencing patients’ genes to identify drugs that may specifically target the mutations. Lastly, we’re studying how circulating tumor cells can help us better monitor parathyroid cancer patients to better predict if a patient’s tumor will recur and, for those who need treatment, how the tumor will respond. By learning more about this disease, we hope to develop newer, better parathyroid cancer treatment options.

Anything else you’d like to share?

Without our patients, none of our new research would be possible. Because of patients like you who are reading this, we’re able to find new treatments. So thank you.

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