Surgical Procedures: Surgery and Staging for Parathyroid Cancer

Cancerous cells in the parathyroid gland is called parathyroid cancer. This disease is rare and affects the small, pea sized parathyroid glands located behind the thyroid gland. The parathyroid gland is responsible for making parathyroid hormone and the storage and use of calcium.

Some people are at a higher risk of developing parathyroid cancer than others. Those at a higher risk for developing parathyroid cancer include those with genetic disorders such as familial isolated hyperparathyroidism (FIHP) and multiple endocrine neoplasia type 1 (MEN1) syndrome. 

What is staging and how is it performed?

Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For oropharyngeal cancer, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues.

Serum Markers: Blood samples may be taken to check calcium and parathyroid levels. A technique called venous sampling may be used in which blood samples are taken from specific veins.

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include: 

• CAT scan (CT scan).
• Ultrasound.
• Single Photon Emission Computed Tomography (SPECT scan). 
• X-Ray.
• Magnetic resonance imaging (MRI). 
• Bone Density Testing.
• Angiogram.
• Sestamibi Scan.  

Other: Your healthcare team may recommend additional tests to evaluate for parathyroid cancer including urine tests.

Note: A diagnosis of parathyroid cancer is at times challenging because malignant cells, and those of a benign parathyroid adenoma are similar. Criteria for diagnosis of parathyroid cancer includes symptoms, serum calcium and parathyroid hormone levels and tumor characteristics.

Parathyroid cancer spreads to other parts of the body through the tissue, lymph, and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread, and what treatment course will be recommended. Parathyroid cancer does not have a standard staging process and is described as localized or metastatic.

What types of surgery are used to treat parathyroid cancer? 

Surgical procedures used to treat parathyroid cancers include:

En bloc resection: Also called a parathyroidectomy, an en bloc resection removes the entire parathyroid gland, the surrounding capsule, and at times the half of the thyroid that the cancer is found in, muscles, tissues, and nerves. This procedure can be done as an open procedure with an incision in the neck or as a minimally invasive procedure using a fiber-optic scope.

Tumor debulking: Removal of the maximum amount of tumor that can safely be removed. At times the entire tumor is unable to be removed.

Metastasectomy: A metastasectomy is a procedure to remove cancer that has metastasized (spread) to other parts of the body.

What are the risks associated with parathyroid surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Bleeding.
• Cardiovascular complications, such as heart attack.
• Blood clots.
• Wound infections.
• Chest infections like pneumonia.
• Low calcium levels.
• Hypothyroid if the thyroid gland was also removed.
• Keloid (thick scar tissue) formation.
• Temporary incisional numbness or numbness under the chin.
• Temporary feeling of a lump in the throat or throat pressure.
• Incisional itching.
• Neck stiffness, tightness, pulling.
• Chest discomfort.
• Headache, ear pain, and/or congestion.
• Temporary hoarse/weak voice and/or pitch/tone changes. Permanent hoarseness may be experienced in those with injury to the recurrent laryngeal nerve.
• Emotional changes which typically resolve, including depression, irritability, fatigue, and/or weakness.

Some people are at a higher risk for developing side effects or are at a higher risk for surgical complications. Speak with your healthcare team if you have concerns regarding surgical risks and/or to discuss additional risks based on your personal situation.

What is recovery like?

Your team will decide if you need to stay in the hospital and for how long. You will be told how to care for your surgical incision before leaving the hospital. Most patients will return to their normal activities within 1-2 weeks.

Your medical team will discuss with you the medications you will be taking, such as those for pain and/or to treat hypothyroidism, as well as your particular activity restrictions depending on the surgery you have had.

Common activity restrictions and postoperative instructions for parathyroid surgery include:

• Showering is usually allowed 48 hours following surgery. Pat incision dry following a shower. Allow steri-strips to fall off, or remove by day 10-14.
• Avoid swimming or tub soaking for 2 weeks.
• Avoid driving until you are not taking pain medication and can turn the neck side to side, typically within 1-2 weeks following surgery.
• Due to potential temporary throat discomfort or swallowing difficulties, eat soft foods or easily swallowed foods/drinks such as juice, soup, applesauce, scrambled eggs, etc.

Contact your healthcare team if you experience:

• Fever or signs of an infection like chills, incisional redness, tenderness, and/or drainage.
• Lightheadedness.
• Shortness of breath/difficulty breathing.
• Nausea/Vomiting.
• Numbness/tingling in the hands, feet, and/or mouth.
• Muscle spasms.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.