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A New Roadmap for Endocrine Cancers

Magnetic Resonance Imaging (MRI) scan of a patient's head and neck, showing a large thyroid tumor (center left and right). Thyroid tumors are more common in women than men, for reasons that are still unclear.

Magnetic Resonance Imaging (MRI) scan of a patient’s head and neck, showing a large thyroid tumor (center left and right). Thyroid tumors are more common in women than men, for reasons that are still unclear.

The 8th of March is International Women’s Day. To celebrate the remarkable achievements of women in healthcare while also highlighting the work yet to be done, The Pulse is posting a series of stories from the front line of women’s health around the world. At a time when women’s rights are being talked about more than ever, it is especially important to remind ourselves that we can always do better as a society to talk about healthcare matters that particularly impact women.

The Pulse spent some time with Dr Sylvia Asa, a Clinician-Scientist whose clinical expertise and research is focused on endocrine tumors. She is Pathologist-in-Chief and Medical Director of the Laboratory Medicine Program at the University Health Network and Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto.

Women’s health owes much of its advancement in recent years to the tireless efforts of women’s groups and charities. But while they raise funds and awareness for many of the biggest killers like breast cancer, it is vital that we do not deprive other key areas of medical research of the attention and funds they need.

“We’re making progress but it’s been relatively difficult in the endocrine area, because these are relatively rare tumors and people have never really thought about them as being of much clinical significance. When you talk to people about cancer research they talk about breast cancer and lung cancer and colon cancer… many endocrine tumors have been treated as rare diseases; they have not been given the kind of attention that they deserve, to manage patients and offer them the best possible outcomes. One of our biggest hurdles is recognition and awareness.”

The endocrine system keeps the body’s hormones in balance, and is responsible for everything from growth to reproduction, hunger to aggression, and whether a fetus will develop into a boy or a girl.

Diseases of the endocrine system (the thyroid being a major part of it) are more common in women.

Thyroid cancer in particular is three times more common in women than in men, and the reasons why are still unclear.

But with more research, money and time, we could find answers faster. Before any of that happens, however, awareness needs to be raised.

While we know that radiation causes thyroid cancer, most patients with this disease have no history of radiation exposure. “We don’t know exactly what causes sporadic thyroid cancer,” said Dr Asa. “We think that there may be hormonal regulatory mechanisms that play a role in enhancing tumor growth which is probably why young women manifest this tumor.”

Another hurdle standing in the way of progress is the issue of overtreatment. Thyroid tumors are treated with radioactive iodine, and without precise knowledge of how big or severe a tumor is, simply blasting it with a dose of radiation could have serious side effects. Interestingly, Dr Asa sees cases where thyroid tumors are under-treated, as well as over-treated.

“The other tumors that I work on, neuroendocrine tumors, include pituitary tumors which are considered to be benign, as well as tumors of the dispersed endocrine system. Some people call them “carcinoid” tumors; that is actually a misnomer. Many physicians pass them off as being very benign and they are not given respect, yet many of these patients come back with recurrent and disseminated disease, and it’s actually very lethal.”

Dr Asa believes that the future lies in treatments that are not only more precise in targeting tumors, but also more personalized. And to achieve that, she believes pathologists need to focus on the role of biomarkers.

“That’s really what the goal of pathology should be. Pathologists have to play a more important role in understanding the biology of every disease that they diagnose and really be able to focus more on not just what it is, but how it is likely to behave,” she said. At the moment, the key lead in this area of research is the growing field of biomarkers.

“I like to distinguish personalized medicine from precision medicine,” Dr Asa continued. “A lot of people talk about personalized medicine, when what they really mean is precision medicine. Precision medicine asks ‘what gene mutation is there, so what drug should we use?’”

Dr Sylvia Asa, MD, PhD, Pathologist-in-Chief and Medical Director of the Laboratory Medicine Program at the University Health Network and Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto.

Dr Sylvia Asa, MD, PhD, Pathologist-in-Chief and Medical Director of the Laboratory Medicine Program at the University Health Network and Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto.

“But personalized medicine goes beyond that. Because if you think about the ‘person’ in the context of their psychosocial environment and the many components of what makes their persona, there’s a lot more to the whole picture.”

This International Women’s Day, it is high time the spotlight be shone on less talked about diseases like thyroid cancer and pituitary tumors.

Stay with The Pulse this week as we continue to explore the big issues around women’s health, and celebrate the amazing work of inspirational women from around the world. We will continue our series for International Women’s Day 2015 with tomorrow’s heartwarming story about a young family from Brazil.

More Information

Thyroid Cancer

The Endocrine System

International Women’s Day 2015