Former New York Mets pitcher Ron Darling, 58, announced recently that he has been diagnosed with thyroid cancer. Darling, who was a key member of the Mets’ 1986 World Series team, has been a sportscaster for New York-area cable network SNY as well as Turner Sports.
In April 2019, Darling had taken a leave of absence from the SNY booth to have a mass in his chest surgically removed. At that time, he wrote:
“Over the last couple of months, I have not been feeling well. A series of tests revealed a large mass on my chest which will require surgery next week to remove.”
On May 6, he took to Twitter again to announce:
“After the removal of the mass on my chest along with further tests, I have been diagnosed with thyroid cancer. My doctors have said they are optimistic that the cancer is treatable and that I would be back on air talking baseball in the next month or so. I would also like to take this opportunity to thank everybody for their continued support.”
Former Mets teammate and current co-announcer Keith Hernandez wrote: “My heart goes out to Ron Darling. I know that Ron will beat this insidious disease. I’m heartened to hear that his doctors are very optimistic for a full recovery … I look forward to RJ’s return.”
What you should know about thyroid cancer
- There are four main types of thyroid cancer:
- Papillary thyroid cancer: In the U.S., this type makes up about 80% of all thyroid cancers. It begins in follicular cells and grows slowly.
- Follicular thyroid cancer: This type makes up about 15% of all thyroid cancers. It begins in follicular cells and grows slowly.
- Medullary thyroid cancer: This type makes up about 3-4% of all thyroid cancers. It begins in the C cells of the thyroid. Cancer that starts in the C cells can make abnormally high levels of calcitonin.
- Anaplastic thyroid cancer: This type makes up about 2% of all thyroid cancers. It begins in the follicular cells of the thyroid. The cancer cells tend to grow and spread very quickly. Anaplastic thyroid cancer is very hard to control.
For clinical management of the patient, thyroid cancer is generally divided into the following two categories:
1. Differentiated thyroid cancer, which includes well-differentiated tumors, poorly differentiated tumors, and undifferentiated tumors (papillary, follicular, or anaplastic)
2. Medullary thyroid cancer
Well-differentiated tumors (papillary and follicular thyroid cancer) are highly treatable and usually curable. Poorly differentiated and undifferentiated thyroid tumors (anaplastic thyroid cancer) are less common, aggressive, metastasize early, and have a poorer prognosis.
Medullary thyroid cancer is a neuroendocrine cancer that has an intermediate prognosis. It tends to grow slowly. About 25-30% of cases occur as part of a disease syndrome called multiple endocrine neoplasia type 2 (MEN2), caused by mutations in the RET gene. Mutations in RET are also found in >60% with non-MEN2 medullary thyroid cancers.
The thyroid gland may occasionally be the site of other primary tumors including sarcomas, lymphomas, epidermoid carcinomas, and teratomas. The thyroid may also be the site of metastasis from other cancers, particularly of the lung, breast, and kidney.
According to the American Cancer Society, it is estimated that there will be 52,070 new cases and 2170 deaths from thyroid cancer in the U.S. in 2019. The five-year relative survival rate (the percentage of people who survive at least five years after cancer is detected, excluding those who die from other diseases) for all stages of thyroid cancer is about 98%. The five-year relative survival rate of papillary and follicular thyroid cancers and MTC range from 97% to 100% for early-stage cancer and decrease with later-stage cancer. Anaplastic thyroid cancer is associated with a much lower survival rate.
Thyroid cancer affects women more often than men and usually occurs in people ages 25 to 65 years. The incidence of this malignancy has been increasing over the last decade.
Patients with a history of radiation therapy administered in infancy or childhood for benign conditions of the head and neck (such as enlarged thymus, tonsils, or adenoids; or acne) have an increased risk of cancer and other abnormalities of the thyroid gland. In this group of patients, malignancies of the thyroid gland appear as early as 5 years after radiation therapy and may appear 20 or more years later.
Other risk factors for thyroid cancer include the following:
- Family history of thyroid disease or multiple endocrine neoplasia (MEN) syndrome
- RET gene mutation
- A history of goiter
- Female gender
- Asian race
Symptoms of thyroid cancer include:
- A lump in the front of the neck
- Hoarseness or voice changes
- Swollen lymph nodes in the neck
- Trouble swallowing or breathing
- Pain in the throat or neck that does not go away
Thyroid cancer commonly presents as a so-called cold nodule. It is detected as a palpable thyroid gland during a physical exam and evaluated with radioactive iodine scans; scintigraphy shows that the isotope is not taken up in an area of the gland. The overall incidence of cancer in a cold nodule is 12% to 15%, but it is higher in people younger than 40 years and in people with calcifications present on preoperative ultrasonography.
Standard Treatment Options
Localized/regional papillary and follicular thyroid cancer
Surgery is the therapy of choice for all primary lesions. Surgical options include total thyroidectomy or lobectomy. The choice of procedure is influenced mainly by the age of the patient and the size of the nodule. The objective of surgery is to completely remove the primary tumor, while minimizing treatment-related morbidity, and to guide postoperative treatment with ablative radioactive iodine-131 (RAI) therapy. The goal of RAI is to kill the remnant thyroid tissue to improve the specificity of thyroglobulin assays, which allows the detection of persistent disease by follow-up whole-body scanning.
Total thyroidectomy is often used because of the high incidence of multicentric involvement of both lobes of the gland and the possibility of dedifferentiation of any residual tumor to the anaplastic cell type.
Thyroid lobectomy alone may be a sufficient treatment for small (<1 cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of previous head and neck irradiation or radiologically or clinically involved cervical nodal metastases. This procedure is associated with a lower incidence of complications, but approximately 5% to 10% of patients will have a recurrence in the thyroid after a lobectomy.
Studies have shown that a postoperative course of therapeutic (ablative) RAI doses result in a decreased recurrence rate among high-risk patients with papillary and follicular carcinomas.
After thyroid surgery, all patients, except those undergoing lobectomy, will require thyroid hormone replacement therapy. For patients who have undergone thyroidectomy, supratherapeutic doses of thyroid hormone are routinely administered to suppress TSH levels. The degree of TSH suppression recommended depends on the risk of recurrence and the comorbidities of the patient. Studies have suggested that TSH suppression improves progression-free survival, but there is no definitive evidence that it improves overall survival.
Metastatic papillary and follicular thyroid cancer
Total thyroidectomy is still recommended as the initial treatment for metastatic papillary or follicular thyroid cancer. RAI is the second treatment and is given to ablate the remnant thyroid and treat the metastatic disease. Standard treatment for patients with iodine-sensitive thyroid cancer consists of surgery, RAI therapy, and thyroid suppression therapy. For those with iodine-resistant thyroid cancer, surgery and thyroid suppression therapy may be supplemented with external-beam radiation therapy (EBRT) and/or targeted therapy. Sorafenib (Nexavar) and lenvatinib (Lenvima) are orally active, multitargeted tyrosine kinase inhibitors that have been approved for use in locally recurrent or metastatic, progressive differentiated thyroid carcinoma that is refractory to radioactive iodine treatment.
Standard Treatment for Medullary Thyroid Cancer
Patients with MTC are treated with a total thyroidectomy unless there is evidence of distant metastasis. In patients with clinically palpable MTC, the incidence of microscopically positive nodes is more than 75%. Routine central and bilateral modified neck dissections are generally done. When cancer is confined to the thyroid gland, the prognosis is excellent.
EBRT has been used for palliation of locally recurrent tumors without evidence that it provides any survival advantage.
Standard treatment options for locally advanced and metastatic MTC include targeted therapy and palliative chemotherapy. There are currently three drugs that are approved to MTC: cabozantinib (Cometriq), lenvatinib, and vandetanib (Caprelsa). These drugs target the RET gene.
Palliative chemotherapy has been reported to produce occasional responses in patients with metastatic disease. No single drug regimen can be considered standard. Some patients with distant metastases will experience prolonged survival and can be managed expectantly until they become symptomatic.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.