Parathyroid cancer

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What is parathyroid cancer?

Cancer of the parathyroid gland is a very rare cancer. It is also called parathyroid carcinoma. Benign (non-cancerous) tumours of the parathyroid gland called adenomas are more common.

The parathyroid glands

You have 4 small parathyroid glands in your body. They are attached to your thyroid gland which is in the front of your neck. They are situated just behind the thyroid.

The thyroid gland and the parathyroid glands are close to each other and have similar names. But they are different and do different things.

Parathyroid glands

 

A neck, showing the 4 parathyroid glands, attached behind the thyroid gland. The thyroid is in the lower middle part of the neck.
Image: The illustration shows the position of the 4 parathyroid glands. These are attached behind the thyroid gland. The thyroid gland is in the lower middle part of the neck, below and in front of. the larynx. There is a network of lymph nodes on either side of thyroid gland and under the chin.

 

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.

We also have information about thyroid cancer. It is is a different type of cancer and is treated differently.

Related pages

Symptoms of parathyroid cancer

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. This is called hypercalcaemia.

Symptoms of hypercalcaemia include:

  • feeling thirsty and peeing (passing more urine) than usual
  • tiredness
  • feeling sick or being sick (vomiting)
  • changes in mood – feeling low, depressed, irritable or nervous
  • pain in the tummy (abdomen) or back
  • indigestion
  • loss of appetite
  • constipation
  • 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.

Other symptoms

Parathyroid cancer is more likely to be diagnosed in people who also have a lump or swelling in their neck. This sometimes causes difficulty swallowing and a hoarse voice.

Some people may have pain in the bones and muscles.

Related pages

Booklets and resources

Two people are sitting down at a table. One person is a doctor. The doctor is wearing a white coat and they have a stethoscope around their neck. The other person is wearing a pink top. They have long dark hair tied in a pony tail.
Booklets
 01 Aug 2023
Seeing the doctor - easy read
An easy read booklet about going to see your GP. It talks about things you can do to prepare and things the...

Causes of parathyroid cancer

Doctors do not know the exact causes of most parathyroid cancers. But there are risk factors that can increase your chance of developing it.

Sometimes, rare types of gene changes (mutations) can slightly increase the risk of parathyroid cancer. These include:

  • familial hyperparathyroidism
  • 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.

Diagnosis of parathyroid cancer

If you have symptoms, you will usually begin by seeing your GP, who will examine you. If they think that your symptoms could be caused by cancer, they will refer you to a specialist doctor. You will usually meet with a doctor called an endocrinologist who treats problems with the endocrine system and hormones

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.

Rarely, parathyroid cancer is diagnosed following a routine blood test that shows a high calcium level in the blood. Although this may suggest a parathyroid tumour these tumours will often be non-cancerous (benign). But you will need to have further tests to check for parathyroid cancer.

Tests may include the following:

  • Blood and urine tests

    You will have samples of blood and pee (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 (fast) overnight before they take the sample. You should follow any instructions carefully to get clear results.

  • Ultrasound scan

    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. Before the scan, you have an injection of a radioactive substance called sestaMIBI. The radiation dose is low and unlikely to harm you.

    A camera that detects radioactivity moves around your head and takes pictures of your neck. After the first part of the scan, you can leave the scanning department. You then go back, usually after 2 to 3 hours, to have more pictures taken of your neck.

    You should avoid close contact with anyone who is pregnant and very young children for 24 hours after this test. This is because your body will release a small amount of radioactivity. We have more information about having a parathyroid scan (sestaMIBI scan).

  • PET-CT scan using Fluorine-18 Choline

    Some hospitals may use a newer type of scan called a F-18 Choline PET-CT scan. This test combines a PET scan and CT scan to give very detailed pictures of the parathyroid glands and any abnormal areas.

    Before the scan, you have an injection of a radioactive substance called Fluorine-18 Choline. Choline is a substance that parathyroid non-cancerous tumours called adenomas can absorb more of.

    Your hospital team will give you more information about this scan. They will tell you how to prepare for it and about any precautions you need to take afterwards.

Doctors usually need to do surgery to make a definite diagnosis of parathyroid cancer.

Waiting for test results can be a difficult time, we have more information that can help.

Further tests

Your specialist may arrange further tests to help with diagnosis or to check whether the cancer has spread:

  • CT scan

    A CT scan takes a series of x-rays. These build up a three-dimensional picture of the inside of the body.

  • MRI scan

    An MRI scan uses magnetism instead of x-rays to build up a detailed picture of areas of your body.

  • PET scan

    A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body.

Related pages

Staging of parathyroid cancer

The results of your tests help your doctors find out more about the size and position of the cancer. Knowing the stage and grade helps your doctors plan the best treatment for you.

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:

  • thyroid
  • 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:

  • lymph nodes near other organs, such as the lungs or liver  
  • lungs
  • liver
  • bones.

Treatment for parathyroid cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your treatment will depend on:

  • the stage of the cancer
  • your general health
  • your preferences.

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.

Your cancer team may also give you advice about preparing for your treatment. This is sometimes called prehabilitation. It helps to improve your fitness and diet and to get you ready mentally before treatment. 

  • Surgery

    Surgery is the main treatment for for parathyroid cancer. This operation is called a parathyroidectomy. It is often the only treatment needed. As well as the parathyroid gland, some people may have part of the thyroid gland removed and some nearby lymph nodes.

    Your surgeon and nurse will explain which type of surgery is suitable for you. 

  • Radiotherapy

    Radiotherapy uses high-energy rays to treat cancer. It works by destroying cancer cells in the area being treated. It is sometimes used:

    • after surgery for parathyroid cancer to reduce the risk of the cancer coming back
    • if parathyroid cancer comes back.

    You will have a mould or mask made before your treatment is planned. This is to keep your head still while you have your treatment.

    You usually 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. We have more information about radiotherapy to the head and neck area.

  • Chemotherapy

    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

    Radiofrequency ablation (RFA) uses heat to destroy cancer cells. It can help to reduce the level of parathyroid hormone being made in the body. RFA is sometimes used to treat parathyroid cancer that has spread to another part of the body. This is called secondary cancer or advanced cancer.  

You may have some treatments as part of a clinical trial.

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 cannot be removed with surgery.
  • if the cancer has spread.

You may have some the following drugs.

 
  • Bisphosphonates

    Bisphosphonates are drugs that treat hypercalcaemia. Some types of bisphosphonate, such as pamidronate or zoledronic acid, are given as a drip into a vein. You can have this treatment as an outpatient.

    You can also take bisphosphonates as tablets or capsules. Your doctor, specialist nurse or pharmacist will explain how you should take them.

  • Denosumab

    Denosumab is a type of targeted therapy drug called a monoclonal antibody. It can be used to lower calcium levels and to prevent bones breaking (fractures). 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.

You may have the following drugs:

  • Cinacalcet

    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 will have your calcium and PTH levels checked. 

    The main side effects of this drug are nausea and vomiting.

  • Calcitonin

    This drug acts directly on parathyroid cells to lower how much PTH you release. You have it as an injection, just under the skin (subcutaneously) or into a muscle (intramuscularly). It may also be given as a drip into a vein (infusion). Your doctor will work out the dose based on how high your calcium levels are.

    The main side effects of this drug are nausea, vomiting and flushing.

Related pages

After parathyroid cancer treatment

Follow-up after treatment for parathyroid cancer

You will have regular check-ups during and after your treatment has finished. This includes blood tests, and you may have ultrasound scans of your neck area.

Sometimes other types of scans might be used, such as a CT, MRI or PET scan. These will probably continue for several years.

Follow-up appointments are a good time to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments.

We have more information about follow-up care after treatment.

Wellbeing and recovery

Taking good care of yourself can help speed up your recovery after parathyroid cancer treatment. Even small lifestyle changes may improve your wellbeing and long term health.

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.

More information and advice

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

Support after parathyroid cancer

People often have many different feelings when they finish parathyroid cancer treatment. If you have finished treatment you my feel relieved it has ended but worried about what will happen in the future.

It is important to know where to get support or information if you need it. People often need support even if it has been some time since they finished cancer treatment. But sometimes it is difficult to know who to ask for help.

To find support:

The HOPE programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. 

Topics include goal setting, fatigue management, and wellbeing. You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk

Other organisations who offer information and support

There are also other organisations that can give you information and support. These include:

Related pages

About our information

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.

Cancer Information Development team

Author

Professor Nick Reed SME

Professor Nick Reed

Reviewer

Consultant Clinical Oncologist

Beatson Oncology Centre, Glasgow

Date reviewed

Reviewed: 01 October 2024
|
Next review: 01 October 2027
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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