Thyroid Tumor Treatment: Surgery vs. Chemotherapy Options

Surgery??

Dear Dr.
Wu,
I apologize for continually bothering you, but I am very confused lately.
My doctor did not perform surgery (nor a biopsy) and only increased my original medication dosage.
I consulted another doctor who mentioned that since I have already tried almost all available medications, the effectiveness of treatment (chemotherapy, oral chemotherapy, or targeted therapy) seems limited, so he suggested that surgery might be safer.
I then asked another doctor who said that because the tumor is quite large (it was 3 cm before and has grown to about 6-7 cm in just a few weeks), he recommended chemotherapy first and then surgery once the tumor shrinks.
I expressed my concern that chemotherapy has not been effective, and he replied that since I only completed two sessions of chemotherapy after my first surgery (I had four sessions of cranberry treatment and two of chemotherapy before the surgery), the entire treatment course was not completed, so we cannot conclude that the medication is ineffective.
I asked what would happen if the chemotherapy does not work and the condition worsens.
He said that even if chemotherapy cannot kill cancer cells, it can control the tumor and prevent it from worsening (Do you agree with this statement, Dr.
Wu?).
He also mentioned that I should not have undergone surgery when the tumor had not shrunk (it measured 6.8 x 5.5 x 3.5 cm) and that surgery should only be performed once the tumor has decreased in size, as operating on a tumor that has not shrunk may result in incomplete removal.
Regarding the efficacy of oral or targeted therapies, he believes that injections are more direct and effective, and he suggested that I continue with chemotherapy.
I have a few questions:
1.
Since the entire treatment course has not been completed, can we conclude that the medication is ineffective? Do you agree with this statement? What is your opinion? I have also speculated that perhaps I did not receive enough chemotherapy or the dosage was insufficient, rather than the medication being ineffective.
The doctor who suggested surgery believes that the medication is ineffective.
2.
With the tumor growing larger each day, is it really possible to avoid surgery? Can chemotherapy truly control the tumor and prevent it from worsening? Or is it possible that surgery should be performed first, but due to the tumor's size, it may not be completely removable?
3.
What are the pros and cons of surgery versus no surgery? Would you recommend surgery first, Dr.
Wu?
4.
Regardless of whether surgery is performed, would it be better to switch from oral Vinorelbine to Paclitaxel? I have already scheduled a surgery date but need to postpone it for now (I plan to have a biopsy first).
I look forward to your prompt reply and am infinitely grateful for your help.

len, 40~49 year old female. Ask Date: 2008/03/23

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Len,
1.
Since the entire treatment course has not been completed, we cannot conclude that the medication is ineffective.
Do you agree with this statement? What are your thoughts? -- This must be considered in light of the circumstances at the time.
The rate and extent of tumor shrinkage after chemotherapy are important factors.
If the physician deems it ineffective, changing the medication or opting for surgery would be reasonable.
Honestly, it is quite rare for tumors not to shrink after preoperative chemotherapy.
2.
With the tumor visibly growing day by day, is it really possible to avoid surgery? Can chemotherapy truly control it and prevent further deterioration? Or could it be that surgery might not be feasible due to the tumor's size? -- Based on your description, the issue is no longer whether the tumor can be completely resected, but rather about quality of life.
I previously mentioned "palliative resection," which takes such situations into account.
If there are no issues with the surgical wound postoperatively, proceeding with surgery is not a bad option! If there are wound complications, performing a biopsy first is also a good choice!
3.
Regardless of whether surgery is performed, would it be better to switch from oral Vinorelbine to Paclitaxel? -- If you have been using Vinorelbine, it might be worth trying Paclitaxel combined with Gemcitabine, as it could yield different results.
As for continuing Vinorelbine, since it has just been initiated, it may be worth considering continuing its use!
GO! GO! GO! Wishing you peace and health.
Sincerely,
Dr.
Wu Ching-Tang
Attending Surgeon, Taoyuan General Hospital, Department of Health

Reply Date: 2008/03/23

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your thyroid tumor treatment options. It’s understandable to feel confused given the varying opinions from different doctors. Let’s break down your questions and clarify the treatment landscape for thyroid tumors, particularly in the context of surgery versus chemotherapy.

1. Completing the Chemotherapy Regimen: Your doctor’s assertion that you cannot determine the efficacy of a chemotherapy regimen until it is fully completed is a common perspective in oncology. Chemotherapy often requires a full course to assess its effectiveness, as some patients may respond later in the treatment cycle. However, if the tumor is growing rapidly, as you mentioned, it raises concerns about whether the current regimen is effective. It’s crucial to have open discussions with your oncologist about the tumor's growth and the potential need for alternative treatments.

2. Surgery vs. Chemotherapy: The decision to proceed with surgery or continue with chemotherapy depends on several factors, including the tumor size, growth rate, and overall health. If the tumor is significantly large (6-7 cm), there is a risk that surgery may not achieve clear margins, which is essential for effective treatment. However, if chemotherapy can stabilize the tumor or reduce its size, it may make subsequent surgery more manageable. Chemotherapy can sometimes control tumor growth, but it is not guaranteed to shrink tumors, especially if the tumor is aggressive.

3. Pros and Cons of Surgery:
- Advantages of Surgery: The primary benefit of surgery is the potential to remove the tumor entirely, which can lead to a cure, especially if the tumor is localized. Surgery can also provide a definitive diagnosis through pathology.

- Disadvantages of Surgery: If the tumor is too large or has spread, surgery may be more complicated and carry higher risks. Additionally, if the tumor is not completely removable, it may lead to recurrence.

- Advantages of Chemotherapy: Chemotherapy can help control tumor growth and may be less invasive than surgery. It can also be used in conjunction with surgery to shrink tumors beforehand.

- Disadvantages of Chemotherapy: Chemotherapy may not be effective for all tumor types, and side effects can be significant. If the tumor continues to grow despite treatment, it may indicate that the chosen regimen is not effective.

4. Medication Change Considerations: Switching from your current medication (温诺平, or lenvatinib) to another treatment (紫衫醇, or paclitaxel) should be discussed with your oncologist. Each medication has different mechanisms of action and side effects. Your doctor will consider your specific situation, including tumor type and response to previous treatments, before making a recommendation.

In conclusion, the decision to proceed with surgery or continue chemotherapy should be made collaboratively with your healthcare team, considering the tumor's behavior, your overall health, and your treatment goals. It’s essential to communicate openly with your doctors about your concerns and preferences. If you feel uncertain, seeking a second opinion from a specialist in thyroid tumors may also provide additional insights.

I hope this information helps clarify your situation. Please feel free to reach out with any further questions or concerns.

Best regards,
Doctor Q&A Teams

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