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Cancer Institute
Regional Centers of Excellence
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2008 Annual Report
With Statistical Data for 2007
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Table of Contents
Chairman’s Letter—Dr. Sanford Sharp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Cancer Committee Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Cancer Registry Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Tumor Registry Statistics: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Distribution by Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Top Five Cancer Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Geographic Distribution by County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Five-year Graph of Patient Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2007 Cases by Age at Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2007 Cases by Stage at Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2007 Cases by Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2007 Cases by Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Head & Neck Cancers—Dr. Peter Hunt
What is Head & Neck Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Thyroid Histology-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Thyroid Histology-2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Thyroid Treatments-2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Thyroid Treatments-2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Thyroid Cancer Survival Rates MHCS versus NCDB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
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Memorial Health Care System 2008 Cancer Annual Report
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The 2008 Annual Report
of the cancer activities of the Memorial Health Care System
The Memorial Health Care System Cancer Institute is accredited by the American
College of Surgeons’ Commission on Cancer accreditation program as a Community
Hospital Comprehensive Cancer Program. We provide patients, their families, and
physicians in our community with a fully integrated, state-of-the-science,
multidisciplinary approach to the prevention, early intervention, diagnosis, and
treatment of cancer.
During 2007, the Cancer Committee provided professional guidance in a number of
cancer related activities, including:
●
●
●
●
An option to enroll in three Memorial clinical trials for promising prevention and
treatment research.
Dr. Sanford Sharp,
Serving our cancer patient population, their families, and the community:
Pathologist
Cancer Committee
Sponsoring the Komen Chattanooga Race for the Cure
Chairman
● Participating in the annual American Cancer Society 24-hour Relay for Life
● Sponsorship of the annual Memorial “We Care Weekend,” a retreat for cancer survivors
● Sponsorship of the American Cancer Society’s annual Cancer Survivors’ Day in June
● Continuing the many Health Fairs and “Hats Off for Health” Breast Health Programs held throughout
the community, North Georgia, and Northeast Alabama.
Tumor Conferences have been expanded and improved to allow for each session to be more sitespecific.
● A Breast Tumor Conference is held every week on Thursday morning
● A Chest Conference and a Head & Neck Conference is held on the 1st and 3rd Fridays of each month
● A Colorectal Conference and a Genitourinary Conference is held on the 2nd and 4th Fridays of each month
● A Gynecologic Tumor Conference is held on the second Monday of each month
● A general Tumor Conference time is available each Friday as needed to discuss any cases not presented at
the site-specific conferences
Frequency, case presentation, and attendance are monitored weekly for all tumor conferences and
required physician disciplines are present to contribute virtually 100% of the time.
● The Breast Cancer Risk Evaluation Program provided support and counseling to individuals concerned
about their risk of developing breast cancer due to an inherited gene mutation. The program facilitated
genetic testing and disclosure as appropriate.
● Memorial Health Care System committed to a healthier community by becoming a smoke-free campus
at both facilities—Memorial Glenwood campus and Memorial North Park campus in Hixson.
The Cancer Committee continues to oversee the overall cancer program in the Memorial Health Care
System through coordination and facilitation of all programs and services. The Committee sets annual
goals, reviews, and revises them, as needed, to improve the care of all our patients. It focuses on identifying
patient needs and developing strategies to meet those needs. Patients have the assurance of access to
hospital-associated resources, as well as community resources for treatment, rehabilitation, support, and
education about their specific disease. We continue to provide comprehensive care with state-of-the-science
technology. We also recognize the importance of caring for the whole person through the efforts of
dedicated staff and physicians.
●
Memorial Health Care System 2008 Cancer Annual Report 3
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2008 Cancer Committee Members
Physician Members
Dr. Sanford Sharp, Cancer Committee Chairman, Pathology
Dr. Edward R. Arrowsmith, Cancer Committee Co-Chairman, Medical Oncology
Dr. Mark Brzezienski, Plastic Surgery
Dr. Gale Fellows , VP, Medical Affairs & Chief Medical Officer
Dr. James R. Headrick, Thoracic Surgery
Dr. Peter Hunt, Performance Improvement Chairman, Otolaryngology
Dr. Terry Melvin, Family Practice/Hospice
Dr. Don Mills, Diagnostic Radiologist
Dr. Charles A. Portera, Jr., Surgical Oncology
Dr. Maurice Rawlings, Jr., Surgical Oncology
Dr. David W. Rice, Radiation Oncology
Dr. Eric Schubert, CME Committee Chairman, Pathology
Dr. William Young, Cancer Liaison Physician, Urology
Non-Physician Members
Penny Andrews, RN, Oncology Quality Coordinator
Bud Baker, Oncology Business Director
Bill Bunnell, Executive Director, Imaging Services
Lisa Casey, RN, BS, MSN, Nursing Coordinator/Educator, Breast Services
Angie Colbert, Community Outreach Coordinator
Crysty Cornett, CTR, Coordinator, Oncology Data Management
Kathy Dittmar, RT (R) (M), Director, Breast Services
Mary Dupree, RN, Public Member of Community Served
Debbie Dyer, RN, Coordinator, Clinical Trials
Rhonda Edwards, MSW, LCSW, Social Worker/Case Manager
Renee Epps, RT (T) ROCC, Radiation Oncology Coordinator
Cathy Fiacco, RN, MS, Colorectal Program Coordinator
Sharon Hopper, RD, Clinical Oncology Dietician
Kathy Igou, RN, OCN, Cancer Risk Counseling
Jackie Jackson, RN, BSN, MSN, V.P. of Service Line Administration
Betsy Kammerdiener, M. Div., BCC, Pastoral Care
A. Nasser Khalifeh, Ph. D., Director, Medical Physics
Marty Laird, D.Ph., Pharmacy
Mary McArthur, RN, Performance Improvement
Tanya Parker, RN, Coordinator, Oncology Nursing
Laurel Rhyne, MSN, Med, APRN-BC, Nurse Practitioner, Thoracic Program
Melissa Roden, RN, Executive Director, Quality & Utilization
Kim Shank, RN, OCN, Oncology Educator/Cancer Risk Counseling
Carla Sanderlin, BA, Marketing Communications Representative
Ashley Tanis, American Cancer Society
Lorraine Tilstra, RN, Director, Oncology Support Services
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Memorial Health Care System 2008 Cancer Annual Report
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The Cancer Registry Report
The Cancer Registry utilizes a data system designed for the collection, management, analysis, and reporting
of information on persons with cancer who have been diagnosed and/or treated in the Memorial Health
Care System (MHCS). The registry reports to the State of Tennessee Central Registry, the National Cancer
Database, and the IMPAC/Medical Registry Service National Data Set.
The Cancer Registry at Memorial has been in existence since January 1990 and has almost 28,000 cases
entered into the database. The data maintained in the Registry is available for use by the medical staff and
other healthcare professionals for special studies, reports, and research. The data is used for treatment
planning and evaluation, outcome measurement, clinical research, and cancer program strategic planning.
The American Joint Commission on Cancer TNM staging system is used for all applicable cancer sites. A
TNM staging form is used in the medical record to ensure compliance and accuracy of staging.
The Registry serves as staff support to the Cancer Committee and Oncology Conferences and coordinates
the implementation of the ACoS (American College of Surgeons) guidelines. Each patient is provided with
an annual lifetime follow-up that serves to continuously monitor for diagnostic and treatment results.
Follow-up procedures serve as automatic reminders to both physicians and patients to schedule regular
physical exams. The Cancer Registry follows over 13,000 patients annually throughout the United States
and has a successful follow-up rate of over 90% of these cases.
The staff includes a Certified Tumor Registrar (CTR), two registrars in training, a data assistant, and four
other CTRs that assist on an ‘as needed’ basis. Staff members are active in the National Cancer Registrar’s
Association and the Tennessee Tumor Registrars Association. They attend national, state and regional
meetings to stay abreast of the latest changes in the cancer registry field.
As our physician staff, site specific cancer programs, and the team of health care professionals have grown,
so has the caseload reviewed and abstracted in the Registry. Follow-up letters returned to the Registry from
patients are highly complimentary of the quality of care they received and of the caring and compassionate
manner in which their health care was delivered at Memorial.
A Ministry of Healing
At Memorial, we understand that cancer affects not just the body, but also the mind and spirit. We care for
the complete person and their family throughout their cancer journey by combining state-of-the-science
medicine with emotional and spiritual support. This comprehensive approach provides patients with
extensive resources to fight their disease and enjoy the blessings of life.
Caring for the body, mind and spirit
Memorial Health Care System 2008 Cancer Annual Report 5
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Distribution of Cancer by Site - 2007 Cases
All Sites
Breast
Respiratory System
Bronchus/Lungs
Larynx
Nose/Nasal Cavity
Male Genital System
Prostate
Testis/Penis/Other Male Genital
Digestive System
Colon
Rectosigmoid/Rectum
Anus/Anal Canal
Pancreas
Stomach
Liver
Small Intestine
Esophagus
Gallbladder/ Other Digestive
Skin
Melanoma
Other Skin (Excludes Basal & Squamous Cell)
Urinary System
Bladder
Kidney/Renal Pelvis
Ureter
Other Urinary
Lymph Nodes (Lymphoma)
Female Genital System
Cervix Uteri
Corpus Uteri/ Uterus
Ovary
Vulva/Vagina/ Other Female
Endocrine System
Thyroid
Other Endocrine
Hematopoietic/ Reticuloendothelial
Bones/ Soft Tissue
Head and Neck
Lip/Gum/ Floor of Mouth
Tongue
Nasopharynx
Pyriform Sinus/ Hypopharynx
Tonsil
Salivary Glands
Eye/ Adnexa
Brain/Central Nervous System
Other/Unknown Primary
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Total Cases
2122
338
305
278
24
3
338
331
7
334
145
56
10
38
29
5
11
25
15
227
220
7
149
90
55
2
2
88
74
10
34
21
9
61
47
14
48
19
45
14
10
3
1
12
5
0
39
57
Memorial Health Care System 2008 Cancer Annual Report
Analytic
2091
336
300
273
24
3
329
322
7
332
144
56
10
37
29
5
11
25
15
225
218
7
148
90
54
2
2
86
69
8
32
20
9
61
47
14
47
19
45
14
10
3
1
12
5
0
39
55
Non-analytic
31
2
5
5
0
0
9
9
0
2
1
0
0
1
0
0
0
0
0
2
2
0
1
0
1
0
0
2
5
2
2
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
2
Male
1080
2
179
155
22
2
338
331
7
171
63
30
3
17
17
4
8
21
8
110
109
1
112
74
35
2
1
45
0
0
0
0
0
14
9
5
26
10
30
8
7
1
1
9
4
0
16
27
Female
1042
336
126
123
2
1
0
0
0
163
82
26
7
21
12
1
3
4
7
117
111
6
37
16
20
0
1
43
74
10
34
21
9
47
38
9
22
9
15
6
3
2
0
3
1
0
23
30
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2007 Top Five Cancer Sites
The top five cancer sites in the Chattanooga service area have not changed significantly for the past ten
years except for the increasing prevalence of skin cancer possibly due to more sun exposure and increased
tanning bed use. Below is a chart showing the last ten years of major site groupings.
Site
Lung
Breast
Colorectal
Prostate
Skin
Head & Neck
Lymphoma/Leukemia
Corpus Uteri
Bladder
Cervix Uteri
Other
Total
1998
194
280
147
209
70
46
74
24
48
15
287
1394
All Others (735)
35.2%
1999
255
350
176
246
48
35
82
41
65
24
300
1622
2000
258
342
166
245
72
33
78
29
64
10
257
1554
2001
278
369
137
232
77
31
61
37
69
11
254
1556
2002
271
316
177
269
110
32
85
30
57
13
283
1643
2003
290
299
169
289
133
35
73
49
66
14
306
1723
2004
311
319
156
240
148
31
82
32
73
5
294
1691
2005
245
328
172
219
194
40
62
32
78
10
299
1679
2006
293
315
170
253
247
52
80
42
87
13
323
1875
2007
273
336
200
322
225
45
86
32
90
8
474
2091
Breast (336)
16.1%
Lung (273)
13.1%
Prostate (322)
15.4%
Skin (Melanoma) (225)
10.8%
Colorectal (200)
9.6%
Memorial Health Care System 2008 Cancer Annual Report 7
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2007 Geographic Distribution
Residence by County at Time of Diagnosis
County/State
Hamilton
Walker, GA
Catoosa, GA
Bradley
Whitfield, GA
Rhea
Marion
Dade, GA
Jackson, AL
Sequatchie
Meigs
Murray, GA
Polk
8
Cases
1262
192
117
117
77
76
58
56
29
29
26
22
17
County/State
Bledsoe
McMinn
Chattooga, GA
Grundy
Fannin, GA
Franklin
DeKalb, AL
Union, GA
Gordon, GA
Cherokee, NC
Monroe
Putnam
Van Buren
Memorial Health Care System 2008 Cancer Annual Report
Cases
11
10
7
7
6
6
5
5
4
3
3
2
2
County/State
Cherokee, AL
Morgan, AL
Duval, FL
Hillsborough, FL
Manatee, FL
Cherokee, GA
Clinch, GA
Emanuel, GA
Gilmer, GA
Du Page, IL
Macomb, MI
Clay, NC
Cumberland
Cases
1
1
1
1
1
1
1
1
1
1
1
1
1
County/State
Davidson
Hawkins
Knox
Macon
Roane
Weakley
Bexar
Washington, VA
Cases
1
1
1
1
1
1
1
1
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2007 Cancer Incidence
As the rate of cancer grows within the overall population, so does the growth of patients being treated at
Memorial. That growth has exceeded 26% since 2003. Most of those patients (60.2%) are from Hamilton
County in Tennessee with Walker, Catoosa, Whitfield, and Dade counties in Georgia adding another 21%
from that state. Overall, 75% of the patients came from Tennessee, 23% from Georgia, and 2% from
Alabama and other states.
Five-Year Patient Growth
2400
2200
2000
Patients
1800
2092
1935
1671
1652
1753
1600
1400
1200
1000
Analytic Patients
Non-Analytic Patients
800
600
400
200
0
2003
2004
Year
2005
2006
2007
The graph below reflects the age of the cancer patients at the time they were diagnosed. This is a typical
distribution that shows almost 29% of the patients diagnosed between the ages of 60 and 69. Another 40%
of patients are diagnosed after the age of 70, further verifying the fact that one of the biggest risk factors for
cancer is age.
Total 2007 Analytic Cases By Age at Diagnosis
Number of Analytic Cases
700
601
600
541
500
398
400
300
264
162
200
100
27
69
30
0
0-29
30-39
40-49
50-59
60-69
70-79
80-89
90 +
Age at Diagnosis
Memorial Health Care System 2008 Cancer Annual Report 9
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2007 Cancer Incidence
The earlier that a cancer can be detected, the better the probability of curing that disease. In the graph
below it shows that over 37% of the cancer cases at Memorial are diagnosed in the early stages of '0' and '1'.
Categories of 99 and 88 indicate that the stage is unknown or the cancer is not one that is staged (such as
brain).
Number of Analytic Cases
2007 Analytic Cases by Stage at Diagnosis
35.0%
27.5%
30.0%
25.2%
25.0%
20.0%
15.0%
10.0%
13.4%
12.4%
9.6%
8.5%
3.4%
5.0%
0.0%
0
1
2
3
Stage at Diagnosis
4
% of 2007 Analytic Cases by Gender
Male
51%
Female
49%
% of 2007 Analytic Cases by Race
White
92%
Other
1%
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Memorial Health Care System 2008 Cancer Annual Report
African American
7%
99
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What is head and neck cancer?
Head & Neck Cancer refers to several types of cancers including, but not limited to,
cancer of the tongue, gums, oral cavity, nasal cavity, voice box, and back of the throat.
Men have a higher incidence of head and neck cancer than women, although
incidence in women has been increasing significantly throughout the world.
What Kinds of Cancers are Considered Cancers of the
Head & Neck?
Most head and neck cancers begin in the squamous cells that line the structures found
in the head and neck. Because of this, head and neck cancers are often referred to as
squamous cell carcinomas. They are further defined by the area in which they begin:
Dr. Peter Hunt,
Otolaryngologist
Oral Cavity—lip, front 2/3 of the tongue, gums, lining inside
the cheeks and lips, floor of the mouth, bony top of mouth,
area behind wisdom teeth
Salivary Glands—located several places in head & neck region
Paranasal sinuses and nasal cavity—hollow spaces in the
bones surrounding the nose and hollow space inside the nose
Pharynx—the hollow tube that starts behind the nose and
goes to the esophagus and trachea
Larynx—the voice box
Lymph nodes—in the upper part of the neck
Cancers of the brain, eye, thyroid, scalp, skin, muscles, and
bones are not usually included in the head and neck category
of cancers.
Epidemiology
Head and neck carcinoma accounts for approximately 5%-6% of all new cancers. There will be
approximately 40,000 Americans diagnosed this year with cancer of the head and neck. Nearly 13,000
Americans will die this year from this disease.
Gender—Head and neck cancer is more common in men; 66%–95% of cases occur in men. The incidence
by gender varies with anatomic location and has been changing as the number of female smokers has
increased. The gender ratio is 5:1 male to female
Age—The incidence of head and neck cancer increases with age, especially after 50 years of age. Although
most patients are between 50 and 70 years old, head and neck cancer does occur in younger patients.
Race—The incidence of laryngeal cancer is higher in African Americans relative to the white, Asian, and
Hispanic populations. Additionally, in African Americans, head and neck cancer is associated with lower
survival for similar tumor stages. The overall 5-year survival rate is 56% in whites and 34% in African
Americans.
Geography—In the United States, the high incidence among urban males is thought to reflect exposure to
tobacco and alcohol. Among rural women, there is an increased risk of oral cancer related to the use of
smokeless tobacco (snuff).
Memorial Health Care System 2008 Cancer Annual Report 11
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Causes/ High Risk Factors
As many as 90% of the head & neck cancers occur after prolonged exposure to tobacco use (cigarettes,
cigars, chewing tobacco, or snuff) or excessive consumption of alcohol. Use of both of these products can
increase the overall cancer risk factor by more than 30 times. In adults who neither use tobacco products
nor drink alcohol, cancer of the mouth and throat are nearly nonexistent.
Symptoms
Fortunately, most head and neck cancers produce early symptoms. Knowing and recognizing these
symptoms can save lives. Symptoms include, but are not limited to:
●
A lump or thickening anywhere in the mouth or neck
●
A sore throat that does not go away
●
Difficulty swallowing or chewing
●
A change or hoarseness in the voice
●
A red or white patch in the mouth that does not go away
●
Unusual bleeding or pain in the mouth that does not go away
●
Pain that does not go away in the face, chin, jaw, or neck
With head and neck cancers (as with all cancers), be aware of your own body and if there are changes that
persist, see your physician. His/her physical examination is the best means for detecting lesions of the
“upper aerodigestive tract” and for indicating the severity and chronicity of the disease.
Staging
Tumor stage is of primary importance in determining treatment options and the prognosis of head and
neck carcinoma. It is important to note that once regional lymph node involvement occurs, the survival
rate drops by 50 percent. The TNM system is used.
T = tumor size
N = status of the neck lymph nodes
M = presence or absence of distant metastatic disease
Perineural invasion at the tumor site has been associated with more extensive local and regional disease
and, therefore, a worse prognosis.
Vascular invasion is an important step in the development of metastasis. Although most circulating tumor
cells do not develop into metastasis, the greater the number released into the vascular system, the higher
the likelihood.
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Memorial Health Care System 2008 Cancer Annual Report
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Treatment and survival
●
Surgery
●
Radiotherapy
●
Chemotherapy
Combined therapy
Two major methods are currently employed in the treatment of squamous cell carcinoma of the head and
neck—surgery and radiation therapy. Chemotherapy has been utilized as induction therapy or combined
with mixed results. More promising results are being obtained with combined chemotherapy and radiation
therapy.
●
Surgery
Surgery alone is generally reserved for early tumors in regions where significant functional and cosmetic
deficits will not result from this treatment.
Radiotherapy
Radiation therapy may be used alone in early tumors, most notable in early laryngeal cancer in order to
preserve laryngeal function. It also may be used alone for unresectable tumors. In this instance, it may be
considered a palliative treatment and not intended as a cure.
Chemotherapy
Although good initial responses have been obtained with induction chemotherapy, the long-term outcomes
are unclear. In general, it is not recommended to use chemotherapy as a sole treatment with curative intent
for head and neck squamous cell carcinoma.
Combined therapy
Surgery and radiation are often used together in more advanced lesions. As combined treatment has
evolved, surgery with postoperative radiation therapy is most often employed. Recent advances in
reconstructive surgery have further improved functional and cosmetic outcomes.
In select instances, promising results are being obtained with combined chemotherapy and radiation
therapy in an effort to avoid surgical resection.
The Future of Head and Neck Cancers
The decrease in the incidence of head and neck cancers over the past 20 years is largely due to a decrease
in smoking. Although approximately 90% of head and neck cancers are the result of tobacco use and
excessive consumption of alcohol, an increasing number of Head & Neck cancers are the result of Thyroid
cancers or Melanoma.
Memorial Health Care System 2008 Cancer Annual Report 13
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Thyroid Cancer
Thyroid cancer is one of the more prevalent ‘head and
neck cancers’. It is estimated that 37,340 men and women
(8,930 men and 28,410 women) will be diagnosed with
thyroid cancer in 2008. Approximately 1,600 men and
women will succumb to this disease in 2008. Thyroid
cancer is a cancer that starts in the thyroid gland which
is a butterfly-shaped gland in your neck, just above your
collarbone. In order to understand thyroid cancer, it
helps to know about the normal structure and function
of that gland. The thyroid gland makes hormones that
help control heart rate, blood pressure, body
temperature, weight, and the amount of calcium in the
blood. The picture to the right shows the thyroid
gland’s placement in the neck:
What Causes Thyroid Cancer?
No one knows the exact cause of thyroid cancer. Doctors
can seldom explain why one person will get thyroid
cancer and another person will not. Thyroid cancer
research has shown that people with certain risk factors
are more likely than others to develop thyroid cancer,
but it is important to note that risk factors do not cause
thyroid cancer. However, several thyroid cancer risk
factors may act together to increase a person’s
probability of having thyroid cancer.
Risk Factors
●
●
Being exposed to high levels of radiation
Having a family history of medullary thyroid cancer or certain other medical conditions (such as
goiters)
●
Being female
●
Being over 40 years of age
●
Being caucasian
●
Not getting enough iodine in one’s diet
Symptoms
Early thyroid cancer often does not have symptoms; but as the cancer grows, symptoms may include:
14
●
A lump in the front of the neck
●
Hoarseness or voice changes
Memorial Health Care System 2008 Cancer Annual Report
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●
Swollen lymph nodes in the neck
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Trouble swallowing or breathing
Pain in the throat or neck that does not go away
Most often, these symptoms are not due to cancer. An infection, a benign goiter, or another health problem
is usually the cause of these symptoms. Anyone with symptoms that do not go away in a couple of weeks
should see a doctor to be diagnosed and treated as early as possible.
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You should see a doctor if you have a lump or swelling in your neck. Your doctor can order tests to see if
you have cancer and, if so, which type. Treatment depends on the type and how far the cancer has spread.
They include surgery, radioactive iodine, hormone treatment, radiation therapy or chemotherapy. Some
patients receive a combination of treatments.
Types of Thyroid Cancer
There are four main types of thyroid cancer:
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Papillary
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Follicular
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Medullary, and
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Anaplastic
Treatments
Surgery is the most common form of treatment for thyroid cancer that has not spread to distant parts of the
body. The surgeon usually removes part, or all, of the thyroid and any other affected tissue, such as lymph
nodes. (If the patient has a surgical biopsy, the biopsy and the removal of the thyroid may be done in the
same operation).
Patients with localized papillary or follicular thyroid cancer also may receive treatment with I-131 (a
radioactive iodine isotope). The patient swallows the iodine, which collects in any thyroid cancer cells that
remain in the body after surgery. By damaging such cancer cells, the radioactive iodine helps prevent the
disease from recurring. The patient must remain in the hospital for a few days while the radiation is most
active. The treatment may be repeated, if necessary, at a later time.
Hormones usually are given to patients who have had surgery to remove the thyroid and/or treatment with
radioactive iodine. The hormones replace those that are normally produced by the thyroid. This treatment
also slows down the growth of any remaining thyroid cancer cells. The doctor may need to do follow-up
tests to determine whether the patient is receiving the proper amount of the necessary hormones.
Surgery may not be recommended when a patient is found to have thyroid cancer that has spread.
Treatment usually includes some form of systemic therapy (treatment that can kill or slow the growth of
thyroid cancer cells throughout the body), such as chemotherapy, radioactive iodine therapy, and/or
hormone therapy. Regular follow-up is very important after treatment for thyroid cancer. Follow-up care
may include periodic complete physician exams, x-rays, scans, and blood tests.
Patients should work with their doctor to develop a treatment plan that meets their medical needs and
personal values. Choosing the most appropriate thyroid cancer treatment is a decision that ideally involves
the patient, the family, and the healthcare team.
Memorial Health Care System 2008 Cancer Annual Report 15
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2002 vs. 2007 Thyroid Histology
Thyroid Histology 2002
(Number and % of total)
Other (2)
11%
Carcinoma (1)
5%
Adenocarcinoma (1)
5%
Follicular Variant
of Papillary
Carcinoma (10)
53%
Follicular
Adenocarcinoma (3)
16%
Medullary
Carcinoma (2)
10%
MHCS thyroid histology in both 2002 and 2007 reflects percentages reported throughout the thyroid
cancer literature. The most common thyroid malignancy is Papillary (65-85%), followed by Follicular (1022%), and Medullary (6-12%).
Thyroid Histology 2007
(Number and % of total)
Other (1)
2%
Follicular Variant
of Papillary
Carcinoma (35)
75%
Squamous (1)
2%
Follicular
Adenocarcinoma (7)
15%
Medullary
Carcinoma (3)
6%
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Memorial Health Care System 2008 Cancer Annual Report
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2002 vs. 2007 Thyroid Treatments
Thyroid Treatments 2002
(Number and % of total)
Thyroidectomy
NOS (1) - 5%
No Surgery (1)
5%
Lobectomy (6)
32%
Total
Thyroidectomy
(7) - 37%
Lobectomy
w/isthmus (1) - 5%
Subtotal
Thyroidectomy (2)
11%)
Partial Lobectomy (1)
5%
The thyroid cancer treatment graphs show an increase in total thyroidectomy procedures from 2002 to
2007, reflecting an increase from 37% to 66% during this five-year time period. This is a favorable trend as
total thyroidectomy procedures are now recognized as the standard of care for the majority of thyroid
malignancies.
Thyroid Treatments 2007
(Number and % of total)
No Surgery (1) - 2%
Total Thyroidectomy (31) 66%
Lobectomy (8) - 17%
Lobectomy w/isthmus (2) - 5%
Partial Lobectomy (1) - 2%
Removal Part of Lobe and part of
contralateral lobe (2) - 4%
Subtotal Thyroidectomy (2) -4%)
Memorial Health Care System 2008 Cancer Annual Report 17
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Thyroid Comparison Graphs
Thyroid Cancer NCDB 1998-2001 Survival Rates by Stage
100.0%
Percent Survival
90.0%
80.0%
Stage 1
70.0%
Stage 2
Stage 3
60.0%
Stage 4
50.0%
40.0%
30.0%
20.0%
Diagnosis
12 Months
24 Months
36 Months
48 Months
60 Months
Years
MHCS performed very favorably when compared to the National Cancer Data Base (shown above) for
stages 1, 2, and 3. Stages 1 and 2 performed better than the national averages, while stage 3 performed on
par with the NCDB. For stage 4 diagnoses though, there was only one patient in the MHCS data base for
this time period, not giving us a good statistical analysis, and that individual did not survive for 24 months.
Thyroid Cancer MHCS 1998-2001 Survival Rates by Stage
100.0%
Percent Survival
90.0%
80.0%
70.0%
Stage 1
60.0%
Stage 2
Stage 3
50.0%
Stage 4
40.0%
30.0%
20.0%
10.0%
0.0%
Diagnosis
18
12 Months
24 Months
Memorial Health Care System 2008 Cancer Annual Report
Years
36 Months
48 Months
60 Months
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Glossary
Accession
Cases that are entered into the Memorial Tumor Registry database
ACoS
American College of Surgeons
ACS
American Cancer Society
AJCC
American Joint Committee on Cancer
Analytic
Cases that were diagnosed and/or received their first course of treatment at Memorial
Health Care System
Basal Cells
Round cells under the squamous cells of the skin
CTR
Certified Tumor Registrar
Histology
Study of the microscopic anatomy of cells and tissues
H&N
Head and Neck
Lobectomy
A surgical excision of a lobe. This may refer to a lobe of the lung, a lobe of the thyroid
or a lobe of the brain
Lymph Nodes
Tiny, bean-shaped glands, located in many different areas of the body. The main
locations are the neck, under the arms, and in the groin
MHCS
Memorial Health Care System
NCDB
National Cancer Data Base
Reference Date
Starting date after which all eligible cases must be included in the Tumor Registry,
established January 1, 1990
Squamous Cells
Thin, flat cells that form the top layer of the epidermis
TNM
(T) tumor size (N) nodal involvement (M) metastatic status
Memorial Health Care System 2008 Cancer Annual Report 19
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Memorial Health Care System has proudly served the Chattanooga
community since 1952. It's Cancer Program has consistently received
three-year approvals with commendation in the CoC category of
“Comprehensive Community Cancer Program”.
Memorial’s Comprehensive Cancer Program Includes:
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The Area’s only Mobile Mammography Coach
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Breast Center of Excellence
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Colorectal Center of Excellence
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Thoracic Center of Excellence
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Comprehensive Radiation Oncology Center
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Clinical Trials and Research
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Genetic Testing and Counseling
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Dedicated 20-Bed Inpatient Oncology Unit
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Weekly Breast and General Cancer Conferences
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Bi-monthly Lung, Head &Neck, Genitourinary and Colorectal Conferences
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Monthly Gynecologic Conference
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Cancer Tumor Registry
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Comprehensive Community Outreach Programs
For more information contact:
Memorial Hospital
2525 de Sales Avenue
Chattanooga, TN 37404-3322
Tel: 423.495.7778 ● Fax: 423.495.6192
www.memorial .org
Memorial North Park Hospital
2051 Hamill Road
Hixson, TN 37343-4026
Tel: 423.495.7100 ● Fax 423.495.7388
Memorial
Cancer Institute
Regional Centers of Excellence
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Memorial Hospital 2525 de Sales Ave. Chattanooga, TN 37404 www.memorial.org
Memorial North Park Hospital 2051 Hamill Road Hixson, TN 37343
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Memorial Health Care System 2008 Cancer Annual Report