Cancer of the parathyroid gland is rare. Benign (non-cancerous) tumours of the parathyroid gland are more common.
The parathyroid glands
You have 4 small parathyroid glands in your body. They are attached to your thyroid gland in the front of your neck. The thyroid gland and the parathyroid glands are close to each other and have similar names, but they are different and do different things.
We also have information about thyroid cancer. This is a different type of cancer and is treated differently.
The parathyroid glands are part of the endocrine system. This system makes hormones that help control the way the body works. The parathyroid glands make parathyroid hormone (PTH). This helps control calcium levels in the blood. Calcium helps:
- your muscles and nerves work
- to build strong bones
- your blood to clot.
Most of the calcium in your body is stored in the bones. PTH makes the bones release calcium into your blood. When calcium levels in the blood are high, the parathyroid glands make less PTH and your calcium levels drop.
Symptoms of parathyroid cancer are like those caused by benign parathyroid gland tumours. These symptoms are caused by having a high level of calcium in the blood (hypercalcaemia).
Symptoms of hypercalcaemia include:
- feeling thirsty and passing more urine (pee) than usual
- feeling sick or being sick (vomiting)
- changes in mood – feeling low, depressed, irritable or nervous
- pain in the tummy (abdomen) or back
- loss of appetite
- muscle weakness
- memory loss and difficulty concentrating.
If hypercalcaemia is not treated, it can cause bone thinning (osteoporosis). This is because the bones are losing calcium. This can damage the bones and increase the risk of broken bones (fractures) and pain.
High calcium levels in the blood can affect the kidneys. Some people develop kidney stones, or their kidneys may become damaged and not work as well.
Parathyroid cancer is more likely to be diagnosed in people who have a lump or swelling in their neck. This sometimes causes difficulty swallowing and a hoarse voice.
Parathyroid cancer is very rare. We do not know what causes most parathyroid cancers.
Sometimes, rare types of gene changes (mutations) can slightly increase the risk of parathyroid cancer. These include familial hyperparathyroidism and hyperparathyroidism-jaw tumour syndrome.
People who have had radiotherapy treatment to their neck area have an increased risk of developing non-cancerous (benign) parathyroid tumours. They may also have a higher risk of developing cancer of the parathyroid gland.
You usually start by seeing your GP. They will examine you and ask about your symptoms and general health. Your GP may arrange tests. They will refer you to a hospital for specialist advice and treatment if they:
- are unsure what the problem is
- think your symptoms could be caused by cancer.
It is often difficult to diagnose parathyroid cancer from tests and scans. This is because the symptoms are like those caused by non-cancerous tumours. It may not be diagnosed until after surgery to remove the tumours in the parathyroid glands.
Parathyroid cancer is sometimes diagnosed following a routine blood test. You may have no symptoms at all. If the blood test shows a very high calcium level, it may suggest a parathyroid tumour.
Tests for parathyroid cancer may include the following.
Blood and urine tests
You will have samples of blood and urine taken 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 not eat (to fast) overnight before they take the sample. You should follow any instructions carefully to get clear results.
An ultrasound scan uses sound waves to build up a picture of the parathyroid glands and other structures inside the neck. You lie on your back for the scan. When you are lying comfortably, the person doing the scan spreads a gel over your neck. They move a small hand-held device, like a microphone, around the skin on your neck area. A picture of the inside of your neck shows up on a screen. An ultrasound scan only takes a few minutes and is painless.
Parathyroid scan (sestaMIBI scan)
This scan shows the size and position of the parathyroid glands and any abnormal areas. You will visit the hospital scanning department twice on the same day when having this scan.
Before the scan, you have an injection of a radioactive substance (called sestaMIBI). The radiation dose is low and 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
- you are breastfeeding.
The person doing the scan injects the radioactive substance into a vein in your arm. Then you wait for about 10 minutes for your parathyroid glands to absorb the substance. After this, a camera that detects radioactivity (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
- you find it difficult to be in closed-in spaces (claustrophobia).
After the first part of the scan, you can leave the scanning department. You then go back after 2 to 3 hours to have more pictures taken of your neck. This may take 30 to 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 your body will release a small amount of radioactivity. The staff doing the test can tell you more about this.
You may have further tests to see if there are signs the cancer has spread outside the parathyroid glands.
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
Localised parathyroid cancer is in a parathyroid gland and may have spread to nearby tissues such as the:
- gullet (oesophagus)
- nerve for the voicebox (recurrent laryngeal nerve)
- nearby muscle.
Metastatic parathyroid cancer
This is also called secondary or advanced cancer. It means the cancer has spread to other parts of the body, such as the:
- the lymph nodes
The treatment you have depends on the stage of the cancer and your general health. Your team will discuss your treatment options with you.
Your doctor usually meets with other specialists to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). This includes your oncology team.
Surgery is the main treatment for parathyroid cancer. It is often the only treatment needed. This operation is called a parathyroidectomy.
Surgery can also be used to treat cancer that comes back again, or if the cancer spreads to other areas of the body.
We have more information about surgery for parathyroid cancer.
Radiotherapy uses high-energy rays to treat cancer. It works by destroying cancer cells in the area being treated. It is not often given for parathyroid cancer. It is sometimes used:
- after surgery, to reduce the risk of the cancer coming back
- if the cancer comes back.
You will need to have a mould or mask made before your treatment is planned. This is to keep your head still while you have your treatment. You may develop side effects during radiotherapy. These usually improve slowly 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.
Side effects of radiotherapy to the neck can include:
- pain when swallowing
- a dry mouth or throat
- taste changes
- dark or red sore skin
- a hoarse voice.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is rarely used to treat parathyroid cancer. But may be used if surgery is not possible. Your doctor or specialist nurse will give you more information.
Radiofrequency ablation is not often used to treat parathyroid cancer. It may be offered if the tumour is small and you are not able to have surgery with a general anaesthetic.
Clinical trials (research trials) try to find new and better treatments for cancer. Because parathyroid cancer is rare, it is difficult to research new treatments. Ask your doctor or specialist nurse if there are any clinical trials suitable for you.
ClinicalTrials.gov is a website that has up-to-date international clinical trials, including UK trials.
Treatments for hypercalcaemia
If the levels of calcium in your blood are high (hypercalcaemia), you will need treatment to control this. You may stay in hospital for a short while to have:
- a drip (infusion) into a vein to prevent dehydration
- 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
- if the cancer cannot be removed with surgery.
You may have some the following drugs.
Most of the calcium in the 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 have this treatment as an outpatient. It takes 15 to 60 minutes and you usually have it every 3 to 4 weeks.
You can also take bisphosphonates as tablets or capsules. Your doctor, specialist nurse or pharmacist will explain how you should take them.
Denosumab is a type of cancer drug called a monoclonal antibody. Monoclonal antibodies are also called targeted therapies. They work by targeting specific proteins that are made by cells or found on the surface of cells (receptors).
Denosumab is used to lower calcium levels and to prevent bones breaking (fractures) in people with advanced cancer. It is given as an injection, just under the skin (subcutaneous injection).
Drugs that reduce parathyroid hormone production
These drugs work by reducing the amount of parathyroid hormone (PTH) made in the body. PTH makes the bones release calcium into the blood. The most common drug of this type is a tablet called cinacalcet. Your doctor, specialist nurse or pharmacist will give you more information. They will tell you how often you should take the tablets and how often you should get your calcium and PTH levels checked.
This drug acts directly on parathyroid cells to lower how much PTH you release. You take it as a tablet. Your doctor will work out the dose based on how high your calcium levels are. The main side effect of this drug is nausea.
These will probably continue for several years. Because parathyroid cancer is rare, you are usually followed up by a team who specialise in hormones (specialist endocrinology team).
If you have any problems or notice any symptoms between appointments, tell your doctor or specialist nurse as soon as possible.
You may have lots of different emotions after being diagnosed with cancer. You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan is also here to support you. If you would like to talk, you can:
There are also other organisations that can give you information and support. These include:
Below is a sample of the sources used in our parathyroid cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Fingeret, A. Contemporary evaluation and management of parathyroid carcinoma. Journal of Clinical Oncology. 2020. Vol 1 (17) P.17-22.
Long, K, and Sippel, R. Current and future treatments for parathyroid carcinoma. International Journal of Endocrine Oncology. 2018. Vol 5 (1).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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