theflanclan4
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The surgeon who treated my husband for medullary thyroid cancer suggested he get his levels tested twice yearly to see if it returns. The surgeon's oncology nurses seconded that opinion, and we trust them both implicitly. However, my husband's new endocrinologist recommended being tested just once a year. If it were me, I'd do it twice. But my husband says it's not worth the anxiety that comes with thinking about it. What would be your recommendation?
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Reply # - August 3, 2014, 08:46 AM
Reply To: Maintenance blood tests for Medullary Thyroid Cancer
I will ask our head and neck specialist to comment.
Until then I'll leave what I found.
From the info below it appears the guidelines suggests 6-12 month testing so either would be ok. I can say from a wife's perspective I've seen the stress upcoming tests have on my husband, he's just gone from 3 to 6 months and he's has begun to worry about the test 22 days from now. If you feel strongly about it the you can probably contact the surgeon's office or his current endocrinologist to have a conversation about the differing opinions. I don't know if this fits in your situation but a big handful of times our doctors have stated they sometimes make final choices based on how much or how little the person with cancer wants the tx or follow up, etc. in other words it's a personal choice with no right or wrong answer.
according to the 2009 guidelines, "RECOMMENDATION 69
Postoperatively, the TNM classification (Table 4) and other
factors, such as the postoperative Ct level and the Ct and
CEA DTs, should be used to predict outcome and to help
plan long-term follow-up of patients with MTC" found on pg 587 http://thyca.org/download/document/280/MTCguidelines.pdf
From figure 5 Long-Term surveillance pg 589 of guidelines
"Basal calcitonin +
examination every
6–12 months
initially, then
annually. "
I hope all goes smoothly,
Janine
Reply # - August 3, 2014, 09:55 AM
Reply To: Maintenance blood tests for Medullary Thyroid Cancer
I appreciate your quick response, and for passing along what you found in the meantime. (And it's nice to hear things from a fellow wife's perspective!) Sounds like our husbands feel the same way about these tests...
I look forward to the opinion of your head and neck specialist.
Thanks so much,
Robin
Reply # - August 3, 2014, 11:52 AM
Reply To: Maintenance blood tests for Medullary Thyroid Cancer
The truth is that there's no great reason to be passionate about either answer. Amazingly, there are very few, if any studies on the frequency of followup for any cancer. Most of the guidelines are made up by common sense. I suspect that if a trial were ever done randomizing patients to every 6 month checks of tumor markers vs. every year that survival would either be identical or pretty close. The reason is that, while MTC can occasionally grow quickly, it is more common for it to grow slowly. In fact, my most common treatment of metastatic (spread, incurable) MTC is observation. I can safely watch many such patients for years where they have either no growth of cancer or such slow growth that treatment would have more risk to quality of life via side effects than the cancer is likely to cause via growth.
In the absence of some medical detail that made a patient higher risk or lower risk of recurrence, I have no problem with community docs tailoring this to patient preference. If a patient feels more anxious by waiting a long time to be tested, it would be reasonable to test more often. If a patient feels anxious each time he is tested, it would be reasonable to test less frequently.