Parathyroid cancer

Symptoms of parathyroid cancer are like those caused by benign parathyroid gland tumours. These symptoms are caused by having a high level of calcium in the blood (hypercalcaemia).

Symptoms of hypercalcaemia include:

• feeling thirsty and passing more urine (pee) than usual
• tiredness
• feeling sick or being sick (vomiting)
• changes in mood – feeling low, depressed, irritable or nervous
• pain in the tummy (abdomen) or back
• indigestion
• loss of appetite
• constipation
• muscle weakness
• memory loss and difficulty concentrating.

If hypercalcaemia is not treated, it can cause bone thinning (osteoporosis). This is because the bones are losing calcium. This can damage the bones and increase the risk of broken bones (fractures) and pain.

High calcium levels in the blood can affect the kidneys. Some people develop kidney stones, or their kidneys may become damaged and not work as well.

Parathyroid cancer is more likely to be diagnosed in people who have a lump or swelling in their neck. This sometimes causes difficulty swallowing and a hoarse voice.

You usually start by seeing your GP. They will examine you and ask about your symptoms and general health. Your GP may arrange tests. They will refer you to a hospital for specialist advice and treatment if they:

• are unsure what the problem is
• think your symptoms could be caused by cancer.

It is often difficult to diagnose parathyroid cancer from tests and scans. This is because the symptoms are like those caused by non-cancerous tumours. It may not be diagnosed until after surgery to remove the tumours in the parathyroid glands.

Parathyroid cancer is sometimes diagnosed following a routine blood test. You may have no symptoms at all. If the blood test shows a very high calcium level, it may suggest a parathyroid tumour.

Tests for parathyroid cancer may include the following.

You may have further tests to see if there are signs the cancer has spread outside the parathyroid glands.

The treatment you have depends on the stage of the cancer and your general health. Your team will discuss your treatment options with you. 

Your doctor usually meets with other specialists to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). This includes your oncology team. 

Surgery is the main treatment for parathyroid cancer. It is often the only treatment needed. This operation is called a parathyroidectomy.

Surgery can also be used to treat cancer that comes back again, or if the cancer spreads to other areas of the body. 

We have more information about surgery for parathyroid cancer.

Radiotherapy uses high-energy rays to treat cancer. It works by destroying cancer cells in the area being treated. It is not often given for parathyroid cancer. It is sometimes used: 

• after surgery, to reduce the risk of the cancer coming back
• if the cancer comes back.

You will need to have a mould or mask made before your treatment is planned. This is to keep your head still while you have your treatment. You may develop side effects during radiotherapy. These usually improve slowly over a few weeks or months after treatment finishes. 

Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Side effects

Side effects of radiotherapy to the neck can include:

• pain when swallowing 
• a dry mouth or throat
• taste changes
• dark or red sore skin
• a hoarse voice.

 Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is rarely used to treat parathyroid cancer. But may be used if surgery is not possible. Your doctor or specialist nurse will give you more information.

Clinical trials (research trials) try to find new and better treatments for cancer. Because parathyroid cancer is rare, it is difficult to research new treatments. Ask your doctor or specialist nurse if there are any clinical trials suitable for you.
 

ClinicalTrials.gov is a website that has up-to-date international clinical trials, including UK trials.

If the levels of calcium in your blood are high (hypercalcaemia), you will need treatment to control this. You may stay in hospital for a short while to have:

• a drip (infusion) into a vein to prevent dehydration
• drugs to lower the calcium levels. 

You may need to take medicines for a longer time, to keep your calcium levels stable.

You may have treatment to lower your calcium levels:

• before surgery to remove a parathyroid cancer completely
• if the cancer has spread
• if the cancer cannot be removed with surgery.

You may have some the following drugs.

Bisphosphonates

Most of the calcium in the body is stored in your bones. Bisphosphonates are drugs that stop the bones releasing calcium into the blood. 

Some types of bisphosphonate are given as a drip into a vein. You can have this treatment as an outpatient. It takes 15 to 60 minutes and you usually have it every 3 to 4 weeks.

You can also take bisphosphonates as tablets or capsules. Your doctor, specialist nurse or pharmacist will explain how you should take them.

Denosumab

Denosumab is a type of cancer drug called a monoclonal antibody. Monoclonal antibodies are also called targeted therapies. They work by targeting specific proteins that are made by cells or found on the surface of cells (receptors). 

Denosumab is used to lower calcium levels and to prevent bones breaking (fractures) in people with advanced cancer. It is given as an injection, just under the skin (subcutaneous injection).

These drugs work by reducing the amount of parathyroid hormone (PTH) made in the body. PTH makes the bones release calcium into the blood. The most common drug of this type is a tablet called cinacalcet. Your doctor, specialist nurse or pharmacist will give you more information. They will tell you how often you should take the tablets and how often you should get your calcium and PTH levels checked.

Calcitonin

This drug acts directly on parathyroid cells to lower how much PTH you release. You take it as a tablet. Your doctor will work out the dose based on how high your calcium levels are. The main side effect of this drug is nausea.

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