Cancer of the parathyroid glands

Cancer of the parathyroid glands is rare.

The parathyroid glands are part of the endocrine system which makes hormones to control the body’s functions. They are attached to the thyroid gland at the front of the neck.

Parathyroid cancer usually causes high levels of calcium in the blood (hypercalcaemia). Symptoms include:

  • feeling thirsty and passing a lot of urine
  • tiredness
  • feeling or being sick
  • mood changes
  • tummy or back pain
  • indigestion
  • loss of appetite
  • constipation
  • muscle weakness.
  • a lump or swelling in the neck.

You may have tests including blood and urine tests, an ultrasound, CT or MRI scan or a parathyroid scan.

The main treatment for parathyroid cancer is surgery. Surgery can also be used if the cancer comes back again or spreads. Other treatments that may be used include radiotherapy, chemotherapy and radiofrequency ablation. You may also have other treatments to control the level of calcium in your blood.

The parathyroid glands

This information is about cancer of the parathyroid glands. We also have information about thyroid cancer, which is a different type of cancer and is treated differently.

There are four small parathyroid glands attached to the thyroid gland in the front of the neck. Although the thyroid gland and the parathyroid glands are close to each other and have similar names, they are different and do different things.

Position of the parathyroid glands
Position of the parathyroid glands

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Parathyroid glands are part of the endocrine system. This system makes chemicals called hormones that help control many of the body’s functions.

Parathyroid glands make parathyroid hormone (PTH), which helps control calcium levels in the blood. Calcium helps your muscles and nerves work, builds strong bones and helps your blood clot.

Most of the calcium in the body is stored in the bones. PTH makes the bones release calcium into the blood. When calcium levels in the blood are high, the parathyroid glands produce less PTH and calcium levels drop.


Causes and risk factors of parathyroid cancer

We don’t know what causes parathyroid cancer in most people. But people who have genetic conditions such as multiple endocrine neoplasia 1 (MEN1) or familial hyperparathyroidism have a higher risk of parathyroid cancer. These are rare conditions caused by a gene change (mutation) passed on from parent to child (inherited).

People who have had radiotherapy treatment to their neck area also have a higher risk.


Signs and symptoms of parathyroid cancer

Most people with parathyroid cancer (about 9 out of 10) make too much PTH. This causes high levels of calcium in the blood (hypercalcaemia).

Common symptoms of hypercalcaemia include:

  • feeling thirsty and passing a lot of urine
  • tiredness
  • feeling sick and being sick (vomiting)
  • changes in mood – feeling low, depressed, irritable or nervous
  • pain in the tummy or back
  • indigestion
  • loss of appetite
  • constipation
  • muscle weakness.

Untreated hypercalcaemia can cause bone thinning due to loss of calcium from the bones. This can lead to bone damage and pain.

The kidneys can be affected by high calcium levels in the blood. Some people develop kidney stones, or their kidneys may become damaged and not work as well.

Rarely, people with parathyroid cancer have a lump or swelling in their neck. This can sometimes cause difficulty swallowing and hoarseness.


Diagnosing parathyroid cancer

You usually start by seeing your GP, who will examine you and ask about your symptoms and general health. Your GP may arrange tests. If they are unsure what the problem is, or think that your symptoms could be caused by cancer, they will refer you to a hospital specialist to be assessed.

Sometimes it can be difficult to diagnose parathyroid cancer before an operation to remove the tumours in the parathyroid glands. This is because the symptoms can be similar to those caused by non-cancerous tumours.

Tests for parathyroid cancer may include:

Blood and urine tests

You’ll have blood and urine tests to check your calcium and PTH levels. For the urine test, your doctor may ask you to collect all the urine you pass in 24 hours. For some blood tests, the doctor will ask you to fast (not eat) overnight before they take the sample. You should follow any instructions carefully to get clear results.

Ultrasound scan 

This test uses sound waves to build up a picture on a computer screen of the parathyroid glands and other structures in the neck. Ultrasound is painless and only takes a few minutes. The person doing the scan puts some gel on your neck. They then move a small device, which produces sound waves, over the skin. 

Parathyroid scan (sestaMIBI scan)

This scan shows the size and position of the parathyroid glands, and any abnormal areas. To have this scan, you’ll visit the hospital scanning department twice on the same day. 

Before the scan you have an injection of a slightly radioactive substance (called sestaMIBI). The radiation dose is low and very unlikely to harm you. But always tell your doctor or staff in the scanning department before the scan if you are, or think you could be, pregnant, or if you are breastfeeding. 

The person doing the scan will inject the radioactive substance into a vein in your arm. You then wait for about 10 minutes for the substance to be absorbed by your parathyroid glands. After this a gamma camera moves around your head and takes pictures of your neck. You need to lie still for about 40 minutes while this happens. Tell your doctor or the staff doing the scan if you think you might not be able to lie still or if you have difficulty being in closed in spaces (claustrophobia).

After the first part of the scan you can leave the scanning department. You then go back after three hours to have more images taken of your neck. This may take 30–40 minutes.  

If you are taking thyroid medications, you may need to stop taking them before you have the scan. Your doctor will advise you about this.

You should avoid close contact with pregnant women and very young children for 24 hours after this test. This is because a small amount of radioactivity will be released by your body. The staff doing the test can tell you more about this.

Further tests

You may have further tests to see if there are signs the cancer has spread outside the parathyroid glands.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes about 10-30 minutes. CT scans use a small amount of radiation, which would be very unlikely to harm you or anyone you come into contact with. You'll be asked to not eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it is safe for you to have the MRI scan. Before the scan, you will be asked to remove metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones.


Staging

Staging describes if the cancer has spread from where it first started to other parts of the body.

Parathyroid cancer is staged as localised or metastatic.

  • Localised parathyroid cancer is in a parathyroid gland and may have spread to nearby tissues such as the thyroid, gullet, the nerve for the voice box (laryngeal nerve), or nearby muscle.
  • Metastatic parathyroid cancer is also called secondary or advanced cancer. It means it has spread to other parts of the body, such as the lymph nodes, lungs, liver or bones.


Treatment

Your care will be organised by a team of specialists with experience in managing endocrine tumours. This multidisciplinary team (MDT) will often include:

  • an endocrinologist doctor who specialises in disorders of the endocrine system
  • a surgeon who specialises in endocrine glands
  • a cancer doctor (oncologist) who specialises in treating endocrine cancers
  • a radiologist – a specialist in x-rays and scans
  • a pathologist – a specialist in examining tissues and cells samples to diagnose tumours
  • a specialist endocrine nurse who can give you support and information.

The main treatment for parathyroid cancer is surgery. It is often the only treatment needed. Surgery can also be used to treat cancer that comes back again or if the cancer spreads to other areas of the body.

Rarely, radiotherapy is used to reduce the risk of cancer coming back after surgery. Chemotherapy may be given if you can’t have surgery. You may also have other treatments to control the level of calcium in your blood.

Surgery

The surgeon removes the cancer and any nearby affected areas. They will remove one or more of the parathyroid glands and part or all of the thyroid gland. They may also remove nearby lymph nodes. Usually, you have a general anaesthetic for surgery. You will need to stay in hospital for a few days.  

Surgery may also be used to remove cancer that has come back in the neck area or cancer that has spread, for example to the brain or lungs. Your specialist can give you more information about these types of operation.

After parathyroid gland surgery

The calcium levels in your blood may take two or three days to go back to normal after surgery. You will have regular blood tests to check the calcium levels. If the level is too low, your doctor will prescribe extra calcium as an injection into a vein (intravenously) or as tablets. You may also be prescribed Vitamin D supplements to help your body absorb calcium.

You are likely to have some small scars on your neck after the operation. These usually fade as they heal. Rarely, surgery can damage a nerve in the neck. This can cause hoarseness or problems with how you swallow. You may need further treatment for this.

Radiotherapy

Radiotherapy is not often given for parathyroid cancer. But you may have it after surgery to reduce the risk of the cancer coming back.

This treatment uses high-energy rays to destroy cancer cells. You have treatment in small doses (called fractions) over a few weeks from a radiotherapy machine similar to an x-ray machine. It does not make you radioactive.

Side effects of radiotherapy

You may develop side effects during radiotherapy. These usually disappear gradually over a few weeks or months after treatment finishes. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Your skin may become sore, dry and red (or darker if you have dark skin) in the area being treated. Your radiotherapy team will give you advice about skin care during treatment.

Your throat may become sore after a couple of weeks of treatment. This can affect eating and your voice may also become hoarse. You will be given help and support to cope with this.

We can have more information about radiotherapy and coping with side effects.

Chemotherapy

This treatment uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy if surgery isn’t possible. Chemotherapy is carried around the body in the bloodstream, so it can treat cancer wherever it is.

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain any treatment you are offered and what to expect. Let them know about any side effects during treatment. They can often give you advice or prescribe drugs to reduce these.

Most chemotherapy drugs can reduce the number of white cells in your blood during treatment. This will make you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause other side effects such as feeling tired, a sore mouth, feeling sick (nausea) or being sick (vomiting), diarrhoea and hair loss.

We can send you more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.

Radiofrequency ablation

This treatment is sometimes used to treat parathyroid cancer that has spread to another part of the body (secondary cancer). It uses heat to destroy cancer cells, and helps to reduce the level of parathyroid hormone being made in the body.

Your doctor will give you a local anaesthetic and sedation before the treatment begins. In some cases, general anaesthetic is used instead. Your doctor will place a needle into the tumour. This is usually done using a CT scanner to make sure the needle is in the right place. The doctor then passes radiowaves down the needle into the tumour to heat and destroy the cancer cells.

There are few side effects with this treatment, although you may have some discomfort or tiredness afterwards. You’ll usually need to stay in hospital overnight.

Clinical trials

Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials.

Research into treatments for parathyroid cancer is ongoing and advances are being made. But because it’s a rare type of cancer, there may not always be a trial in progress. If there is you may be asked to take part. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. You may decide not to take part or to withdraw from a trial at any stage. You will still receive the best standard treatment available.


Treatments for hypercalcaemia

If the levels of calcium in your blood are high you may need treatment to control this. Some people will stay in hospital for a short while to have a drip (infusion) into a vein and drugs to lower the calcium levels. You may need to take medicines for a longer time to keep your calcium levels stable.

You may have treatment to lower your calcium levels before surgery to remove a parathyroid cancer completely. If the cancer has spread or can’t be removed with surgery you may need treatment to control hypercalcaemia.

The following drugs may be given:

Bisphosphonates and denosumab

Most of the calcium in your body is stored in your bones. Bisphosphonates are drugs that stop the bones releasing calcium into the blood.

Some types of bisphosphonate are given as a drip into a vein. You can usually have this treatment as an outpatient. It takes 15 to 60 minutes and is usually given every three or four weeks.

Bisphosphonates can also be taken as tablets or capsules. If you are prescribed these, your doctor, nurse or pharmacist will explain how you should take them.

Sometimes bisphosphonate treatment is given with a new drug called denosumab. This is given as an injection, just under the skin (subcutaneous injection).

Drugs that reduce PTH production (calcimimetic agents)

These drugs work by reducing the amount of PTH (the hormone that raises blood calcium levels) made in the body. This helps to reduce calcium levels in the blood. The most commonly used drug of this type is a tablet called Cinacalcet (Mimpara®).

Calcitonin (Miacalcic®)

This drug is given as a drip into a vein or an injection under the skin. It is sometimes used to get very high levels of calcium under control if you are in hospital.


Follow-up

You will have regular check-ups and blood tests once your treatment has finished. These will probably continue for several years.

If you have any problems or notice any symptoms between these times, let your doctor know as soon as possible.


Your feelings

You may have many different emotions, from shock and disbelief to fear and anger. At times, these feelings can be overwhelming and hard to control. But they are natural and it’s important to be able to express them.

The need for practical and emotional support is different for each person. Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. You may wish to contact our cancer support specialists free on 0808 808 00 00, Monday–Friday, 9am–8pm for information about counselling in your area.

Talking to other people in a similar position may help you feel less alone. Useful organisations such as AMEND: the Association for Multiple Endocrine Disorders can provide this, as well as specialist advice and counselling. Our online community is also a good place to meet people who may be in a similar situation.

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