Parathyroid cancer

Parathyroid cancer, also known as parathyroid carcinoma, is an extremely rare disease, with fewer than 100 cases per year in the United States. It develops in the parathyroid glands—four rice-sized glands located behind the thyroid gland in your neck. These glands help regulate your body’s calcium levels by producing parathyroid hormone (PTH).

Parathyroid cancer is treated by a doctor who specializes in endocrinology, the study of hormones in the body. This specialist can be an endocrinologist or endocrine surgeon. Penn Medicine endocrine surgeons perform one of the highest volumes of parathyroid surgeries in the nation. This means we have experience treating this rare condition, giving you the best possible chance at a successful outcome.

Parathyroid cancer symptoms can often be subtle—fatigue, muscle weakness, or a lump on the neck. The symptoms might become more noticeable if the parathyroid glands are overactive (hyperparathyroidism). This overactivity leads to the production of too much parathyroid hormone in the body. The primary reason behind most symptoms is an excess of calcium in the blood (hypercalcemia).

Here’s how hypercalcemia can affect your body:

• Bone and muscle symptoms: Fatigue, muscle weakness, or difficulty swallowing
• Digestive issues: Nausea, vomiting, loss of appetite, or constipation
• Urinary problems: Increased thirst and urination
• Other symptoms: Voice changes or difficulty thinking clearly

The cause of parathyroid cancer is unknown. Despite being rare, parathyroid cancer can develop at any age and affects people equally. The average age of onset is between 44 and 54 years old. Suspected risk factors include:

• Inherited disorders: Certain inherited disorders, including familial isolated hyperparathyroidism or multiple endocrine neoplasia type 1 syndrome, can increase your risk of developing parathyroid cancer.
• Gene mutations: Cancer can develop from mutations in one or more genes. These mutations can be inherited, caused by environmental factors like smoking, or occur naturally with age.
• Radiation therapy: People who have had radiation treatment to their head or neck may have an increased risk of developing parathyroid cancer.

After a cancer diagnosis, your care team will want to determine if the cancer has spread to other parts of your body. This process, called staging, helps them plan the most effective treatment. Because parathyroid cancer is so rare, there is no standard system of staging, but your care team may classify your cancer as either localized, metastatic, or recurrent.

• Localized: The cancer is in the parathyroid gland and possibly in nearby tissue.
• Metastatic: The cancer has spread to other parts of the body, like the lungs, liver, or bones.
• Recurrent: The cancer has returned after the initial treatment and may be in other parts of the body.

Many of the same tests used to diagnose cancer are used to find out the stage of parathyroid cancer.

If you’ve been diagnosed with parathyroid cancer, a minimally invasive parathyroidectomy may be an option for you. During this procedure, we use advanced imaging techniques, like CT scans and x-rays, to pinpoint the exact location of your tumor or tumors before surgery. This allows us to precisely remove one or more of your parathyroid glands using the smallest possible incisions. This minimally invasive approach offers several advantages including less pain, reduced scarring, and a shorter hospital stay. Most of the parathyroidectomies we perform at Penn Medicine are minimally invasive.

What are the risks of parathyroid surgery?

When performed by an experienced parathyroid surgeon, parathyroid surgery is a safe procedure with minimal complications. In rare cases, complications can include:

• Bleeding: Like any surgery, bleeding is a possibility. Most often the blood loss is limited and the need for a blood transfusion is rare. You may be kept overnight for observation until there is no sign of bleeding.
• Voice changes (dysphonia): If the laryngeal nerves that control the vocal cords are irritated, there can be vocal changes or hoarseness. This can take a few weeks or up to six months to resolve.
• Low blood calcium levels (hypocalcemia): This can happen because the remaining parathyroid glands may need time to function properly again, and calcium can also be absorbed into bones.

Experts in parathyroid cancer

At Penn Medicine, you can be sure that you’re receiving the highest quality care and achieving the best possible outcomes for your parathyroid cancer. We offer:

• Extensive experience: Our team performs one of the highest volumes of parathyroid surgeries nationwide. We can effectively locate even the most hidden parathyroid glands—both those visible on imaging scans and those that are trickier to find. As a result, we can often achieve positive outcomes for patients who haven’t found success elsewhere.
• Comprehensive approach: Our parathyroid surgeons collaborate closely with specialists in pathology, radiology, endocrinology, nephrology, medical oncology, genetic counseling, and sleep medicine to ensure the best treatment.
• Guidance and support: A parathyroid cancer diagnosis can raise many questions and concerns. That’s why we provide a dedicated nurse navigator and a comprehensive range of support services to guide you every step of the way.