Precision approaches that incorporate targeted therapies and other treatments are changing the surgeon’s role.
Otolaryngologist and head and neck surgeon Zoukaa Sargi, M.D., M.P.H., will join a panel discussion on thyroid cancer care during the annual American Society of Clinical Oncology (ASCO) meeting. Dr. Sargi specializes in head and neck cancers and will provide a surgeon’s perspective on how thyroid cancer treatment is evolving.
“For many years, thyroid cancer was mostly treated with surgery,” said Dr. Sargi, professor of otolaryngology and neurosurgery at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. “As the science evolved and our understanding of the disease progressed, other treatment options became available. As a result, this cancer is now managed in a truly multidisciplinary fashion, in which surgery plays a role but must be incorporated into a more complex treatment plan.”
A More Nuanced View of Surgical Care
At ASCO, Dr. Sargi will join a panel with a medical oncologist and an endocrinologist. Twenty years ago, many patients with thyroid cancer received total thyroidectomies, which removes the entire thyroid, and many had lymph nodes surrounding the thyroid removed as well. These procedures saved many lives, but they also generated long-term side effects. Now, with new therapies that target specific tumor genome variations, patients have many more choices.
“Our understanding of the nuances about the extent of surgery required and how surgery may impact a patient’s quality of life have significantly changed,” said Dr. Sargi. This has now modified surgery both for early thyroid cancer and for advanced thyroid cancer. “We can counsel patients better and engage them in decisions about how extensive a surgery they want and how to mitigate the potential side effects of surgery. Every patient, every individual cancer has its unique molecular and biological behavior. It’s important to come up with a personalized treatment plan incorporating all modalities.”
Quality of life is particularly important in thyroid cancer care because many patients are diagnosed when they are young, some as early as their teenage years and many in their 20s and 30s. The average age of a patient at time of thyroid cancer diagnosis is 51, according to the American Cancer Society. As a result, both patients and providers are often quite motivated to minimize long-term treatment side effects as much as possible.
“Most of these patients will survive their cancer, and they may live another 20, 30, even 60 years,” said Dr. Sargi. “Cancer care decisions could impact them for decades after they finish their treatments. That has to be part of the conversation.”
Dr. Sargi notes that, as the field evolves, the surgeon’s role in thyroid cancer will continue to change. In the past, surgery was the first line of treatment. Now, as targeted therapies and other new medications emerge, surgery for certain patients may become more of a secondary option if those treatments fail. This new context could potentially change how some procedures are conducted.
Surgeons do not often present at medical conferences like ASCO, and Dr. Sargi is both honored and humbled to have been invited. He recognizes that many of the physicians in the audience have never personally experienced the challenges associated with thyroid cancer surgery, such as a tumor wrapping around a nerve or invading the larynx. He looks forward to sharing his experiences at the conference, as well as learning from his medical colleagues.
“Cancer in general, and thyroid cancer in particular, should be treated in a multidisciplinary setting, like the one we have at Sylvester,” said Dr. Sargi. “In addition to multidisciplinary care, I would tell patients to find a high-volume treatment center, where they can be confident in the experience and expertise in every medical and surgical subspecialty.”