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What is a Cancer?

Cells are the basic building blocks of the tissues and organs of our body. Usually, these cells divide to make new cells in a controlled manner, and beyond a point, the cells are replaced with new cells. This is how our bodies grow, heal and repair. Sometimes, this orderly growth of cells can go wrong due to the mutation or sudden change in the genes which control how cells behave. This can make the cells divide abnormally, producing more abnormal cells, forming a lump called a tumour. These cells cannot stay together, can easily detach from each other and spread via direct contact, lymphatics and bloodstream to different organs in the body.

What are Parathyroid glands?

Parathyroid glands are 4 small pea-sized glands located adjacent to 4 poles of the thyroid gland in front of the neck. The parathyroid glands secrete parathyroid hormones, which help regulate the calcium and phosphorus levels in the blood.

Fig.1 Parathyroid glands seen near the thyroid gland over the neck

How common are parathyroid tumours?

It is very rare tumor with incidence < 0.5%.

What are the symptoms of parathyroid tumours?

  • Swelling in the neck just adjacent to the midline
  • Pain in Neck
  • Features of high parathyroid hormone levels such as
    1. Painful bones
    2. Abdominal pain
    3. Pain due to stones in the urinary tract (Pain from loin to groin)
    4. Diffuse muscle ache producing extreme fatigue.
    5. Psychiatric disturbances.

  • What are the risk factors of parathyroid Neoplasms?

    The reason why parathyroid neoplasms occur is not known in most people is not known and occur sporadically. They can occur in patients who are exposed to head and neck radiation early in childhood and those who have a strong family history like people with MEN (Multiple Endocrine Neoplasia) syndromes

    How does one diagnose Parathyroid Neoplasms?

    Parathyroid neoplasms are diagnosed by a detailed history and a thorough clinical examination. The following investigations are also done

  • Blood tests
    Calcium level and Parathyroid hormone levels are high.
  • Technetium 99 Sestamibi scan
    Since there are 4 parathyroid glands in the neck, this test helps identify which parathyroid gland is involved in the disease process.

  • Fig.2 The scan shows the increased uptake in the neck indicative of a parathyroid adenoma

  • Ultrasound or Contrast CT of Neck- To know the exact anatomical location of the tumour to place the surgical incision appropriately.
  • Examination of vocal cords ( Laryngoscopy) To rule out asymptomatic vocal cord palsy.

  • What are the different types of Parathyroid Neoplasms?

    Parathyroid Adenoma
    Parathyroid adenoma is a benign tumour of one of the parathyroid glands which produce more parathyroid hormones. This is the most common form of parathyroid tumours.
    Parathyroid Hyperplasia
    Parathyroid hyperplasia involves the enlargement of all four parathyroid glands. These glands produce excess parathyroid hormones resulting in excess calcium levels in the blood. They are frequently associated with MEN (Multiple Endocrine Neoplasia) Syndromes, a genetic disorder.
    Parathyroid Carcinoma
    Parathyroid carcinomas occur as a malignant transformation of a parathyroid adenoma. They are very rare and usually diagnosed after exclusion.

    What are the treatment options for parathyroid neoplasms?

    Surgery is the most commonly used treatment modality for parathyroid neoplasms. Radiotherapy and chemotherapy are used rarely.

    What are the advances in parathyroid surgery?

    The parathyroids are seen very close to the thyroid glands and also the nerves responsible for good speech. Hence precise localisation of the tumour is important to avoid damage to the nerves responsible for speech and to avoid injury to the thyroid gland. Intra-operatively we inject Indocyanine green dye to localise the parathyroid glands.

    What are the surgeries done for parathyroid Neoplasm?

    Parathyroid Adenoma
    The involved parathyroid gland is removed. This is called parathyroidectomy.

    Fig. 3 A. Intra-operative picture of parathyroid adenoma

    B. Post operative scar

    Parathyroid Hyperplasia
    Around three-fourths of the parathyroid glands are removed, minced and implanted in the forearm.
    Parathyroid carcinoma
    The parathyroid gland is removed along with adjacent soft tissue.

    Facts at a glance about surgery and post operative instructions: ( May vary from person to person)

    Type of anaesthesia : General Anaesthesia
    Surgery time : 1 - 2 hours
    Hospital stay : 1 - 2 days
    Mobilisation : 1st day
    Normal Diet : 1st day
    Suture removal : No suture removal required
    Self-care : 5 days
    Full recovery : 2 weeks
    Return to work : 2 weeks