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Types of Endocrine and Thyroid Cancer

The endocrine system is complex and at UPMC Hillman Cancer Center, our knowledge of it is comprehensive.

We're pioneers in caring for people with endocrine cancers. Our multidisciplinary treatment team includes recognized leaders in their fields of practice and research.

What Is Endocrine Cancer?

The endocrine system is the master regulator of the human body.

Through the secretion of chemical messengers — called hormone — the endocrine system controls many actions and reactions such as:

  • Metabolism
  • Reproduction
  • Mood
  • Growth

When cancer affects the endocrine system, it throws hormone production off balance and causes the involved gland or organ to malfunction.

Sometimes, the tumor itself can begin to make hormones. We call this a functioning tumor.

Cancer can also spread to other glands, organs, or structures.

Because the endocrine system includes many parts, we think of endocrine cancer as a family of distinct diseases.

Besides certain types of pancreatic cancers and thyroid cancer, other endocrine cancers include:

  • Adrenal cancer
  • Neuroendocrine cancer
  • Parathyroid cancer
  • Pituitary cancer

Adrenal Cancer

The two adrenal glands are above the kidneys — one over each.

Two types of tissue make up the adrenal glands: the cortex and medulla.

The adrenal cortex — or outer part of the gland — makes hormones that control our metabolism and blood pressure like:

  • Glucocorticoids, such as cortisol
  • Aldosterone
  • Sex steroids, such as dehydroepiandrosterone (DHEA)

The adrenal medulla, inside the gland, makes epinephrine and norepinephrine. These hormones — called catecholamin — control the “fight or flight” response.

Depending on where the disease begins, adrenal tumors can include:

  • Adenoma — the most common type of adrenal tumor, this non-cancerous type of mass affects the adrenal cortex. It can be functional or non-functional. Functional adrenal tumors commonly need surgery. If the tumor is non-functional and remains small, it may not need treatment.
  • Adrenocortical carcinoma — this adrenal cortex cancer is rare, affecting between 200 and 500 people in the United States each year. An adrenocortical carcinoma can be functioning or non-functioning.
  • Metastases — cancer from other sites may spread to the adrenal glands. Removal of these metastases depends on tumor type and other areas of spread.
  • Neuroblastoma — this cancer starts in the adrenal medulla when neuroblasts, or immature nerve cells, fail to develop normally. Doctors cross-classify this type of cancer as a neuroendocrine tumor because of the cells involved. It most often affects children under the age of five.
  • Pheochromocytoma — this rare tumor begins in the adrenal medulla. Doctors also cross-classify this as a neuroendocrine tumor. Usually benign, this type of mass can cause life-threatening high blood pressure because of the over-secretion of adrenaline. Some of these tumors are part of a hereditary syndrome.
  • Paraganglioma — like pheochromocytoma, this type of tumor secretes catecholamines (hormones made by the adrenal glands). It can occur in the skull base, neck, chest, abdomen, and pelvis. Paragangliomas are often part of an inherited syndrome, including von Hippel-Lindau (VHL) Syndrome. The Cancer Genetics Program is a joint program of UPMCUPMC Hillman Cancer Center, and UPMC Magee-Womens Hospital. It's one of only 15 designated VHL Alliance Clinical Care Centers in the country and the only one in the state.

Neuroendocrine Cancer

These cancers affect the neuroendocrine system. The neuroendocrine system is a dual-tissue network of nerve cells spread throughout the body that produces hormones. It reaches into the gastrointestinal tract, the lungs, and elsewhere. These cancers can also affect the endocrine tissues of the pancreas.

Neuroendocrine tumor types include:

  • Merkel cell carcinoma — this is a rare type of cancer. It starts in the hormone-producing cells just beneath the skin, in the hair follicles, or in the spongy (trabecular) bone cells. Merkel cell carcinoma is very aggressive. It often occurs in the head and neck region.
  • Neuroendocrine tumors — these masses can begin in any of the neuroendocrine tissues of the body. This includes the lungs, the brain, the pancreas, and the GI tract. They can be either benign or malignant. Doctors include carcinoid tumors in this group of tumors.

Parathyroid Cancer

The parathyroid glands are four tiny glands — the size of a grain of rice — found near the thyroid gland. One parathyroid gland is at the top and bottom of each thyroid lobe. Some people may have more than four parathyroid glands.

These glands secrete parathyroid hormone (PTH), which regulates calcium and vitamin D in the blood and keeps them at normal levels.

Most parathyroid tumors are benign — not cancerous — and cause primary hyperparathyroidism. Doctors see parathyroid cancer in less than 1 percent of all cases of primary hyperparathyroidism.

Surgery is the main treatment for parathyroid carcinoma. It's vital that surgeons recognize the cancerous parathyroid at the time of surgery so they can also resect the affected nearby tissue. Recurrence after surgical resection is uncommon.

Pituitary Cancer

The pituitary gland is the “master gland” that controls or helps the regulation of many of the body’s functions, such as:

  • Growth
  • Blood pressure
  • Sexual function
  • Metabolism
  • Kidney function
  • Pregnancy
  • Childbirth
  • Nursing
  • Body temperature
  • Mood

The hormones the pituitary secretes affect other parts of the endocrine system, which then produce their own distinct hormones.

This is why cancer of the pituitary gland can affect many organ systems and functions.

The pituitary gland includes two lobes: the anterior and posterior.

The anterior — or frontlobe makes hormones that affect the:

  • Thyroid
  • Adrenal glands
  • Gonads
  • Milk ducts
  • Fat metabolism
  • Growth of bone and other tissues

The posterior — or rearlobe makes hormones that stimulate uterine contractions and act as antidiuretics.

A benign or cancerous tumor on either of these lobes can cause serious issues for a wide range of biological processes.

Common Types of Thyroid Cancer

There are three main types of thyroid cancer: differentiated, medullary, and anaplastic/poorly differentiated.

Differentiated thyroid cancers come from the follicular cells, which use iodine from the blood to make thyroid hormones:

  • Follicular thyroid cancer is uncommon. Only about one in 10 thyroid cancers falls into this subtype. Follicular cancer tends to affect people whose diets lack enough iodine. Most people in the United States get enough iodine from table salt and salt used in food processing. This type of cancer doesn't tend to spread to the lymph nodes, but may travel to the lungs or bones.
  • Hürthle cell cancer comes from a larger type of follicular cell and is rare. Considered a variant of follicular thyroid cancer, it has the highest rate of spread of any of the differentiated thyroid cancers.
  • Papillary cancer is the most common of the thyroid cancers, accounting for about 80 percent of all cases. It grows slowly. Papillary cancers may spread to the lymph nodes of the neck. But — when found early — this type of cancer is very treatable.

Medullary thyroid cancer begins in the cells that make calcitonin, a hormone that controls calcium metabolism. Doctors associate this form of thyroid cancer with a genetic condition called multiple endocrine neoplasia type 2 (MEN2).

Anaplastic/poorly differentiated thyroid cancer is very rare and hard to treat. It's an aggressive form of thyroid cancer.

Primary thyroid lymphoma is a rare type of cancer seen in the thyroid. Metastatic cancers — cancers that spread from another site — can also affect the thyroid gland, but these aren't common.

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