Advanced medullary thyroid cancer can cause problems with swallowing, voice changes, neck swelling, weight loss, and pain. Salivary drooling and internal bleeding are less common symptoms.

Medullary thyroid cancer forms in the thyroid, a gland in the front of the neck that sends hormones to the rest of the body. It accounts for approximately 5–10% of all thyroid cancers.

All subtypes of a condition called multiple endocrine neoplasia syndrome type 2 (MEN2) involve medullary thyroid carcinoma. Any person with a new diagnosis of medullary thyroid cancer will also undergo careful examination for MEN2.

After someone receives a diagnosis of thyroid cancer, doctors will carry out tests to determine if the disease has spread, or metastasized, and if so, whether it has spread to nearby or distant sites in the body. Doctors call this process staging.

Read on to learn more about the symptoms of advanced medullary thyroid cancer.

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Advanced medullary thyroid cancer will affect individuals and their lives in different ways.

Some common symptoms of advanced medullary thyroid cancer include:

  • Neck problems: If a tumor is present and large enough, it may press on the neck, causing pain and stiffness. Approximately 65% of those with medullary thyroid cancer have a thyroidectomy, which involves removing the thyroid. Long-term symptoms are rare, but neck stiffness after surgery may continue.
  • Voice changes and hoarseness: The nerve that controls the vocal cords sits near the thyroid. A tumor can press on this nerve, which can cause voice changes. Some people also experience voice changes, including hoarseness after thyroid surgery, but this is often temporary.
  • Coughing: The lungs are the most common distant site for this cancer to spread. When the disease presents in the lungs, it can cause coughing.
  • Dysphagia, or trouble swallowing: A tumor can press on or grow into the organs surrounding the thyroid, including the esophagus. This can make swallowing and eating difficult.
  • Dyspnea, or shortness of breath: This can be due to the tumor pressing on or growing into the windpipe or lung metastasis — which refers to secondary cancerous growths — blocking the airways.
  • Pain: Pain from the progression of the disease, including growing into nearby parts of the body, needs careful management.
  • Emotional changes: Changing emotions are common in those living with advanced cancer. Concerns about support, care, living arrangements, and finances can arise and increase stress and anxiety levels.
  • Side effects from medications: Medications, including pain relief, can have side effects, including lethargy and sleepiness.
  • Lethargy: Those with advanced cancer may feel extreme fatigue. Healthcare professionals do not fully understand the reasons for this. Medications, weight loss, stress, and the toll that advanced cancer takes on the body may all contribute.
  • Weight loss: Healthcare professionals estimate that unexpected weight loss, including muscle loss, occurs in up to 80% of people with advanced cancer. This can be due to the effects of advanced cancer on the body but also from difficulties in swallowing and eating in those with advanced medullary cancer.

Not all those with advanced medullary thyroid cancer will experience all these symptoms. However, some people may experience the following:

  • Severe diarrhea: High levels of the hormone calcitonin are observable in people with advanced medullary thyroid cancer. This can cause loose stools and severe diarrhea.
  • Facial flushing: High levels of calcitonin also cause a warm face and redness or color changes in the face, neck, or chest.
  • Lymphedema: This refers to swelling, tightness, and heaviness in the body due to a buildup of lymph fluid. It often occurs in the legs or arms but can also occur in the neck in those with neck cancers.
  • Excessive oral secretions and salivary drooling: Problems with the salivary glands can present due to treatment or structural changes from tumors or surgery. It can cause rashes and soreness under the mouth and chin.
  • Bleeding: Tumor growth can cause internal bleeding. This can be from the thyroid or to other sites where the cancer has metastasized, such as the lung.
  • Blood clots: These can form or break away as cancer advances, causing problems, particularly in the lungs.

Medullary thyroid cancer is a rare cancer that people can live with for many years. It can cause many symptoms, including problems with swallowing, voice changes, neck swelling, weight loss, and pain.

There are treatments available to help with these symptoms. Speaking with a doctor and care team about these can be beneficial.