Q.  What are the symptoms of papillary carcinoma of the thyroid (PTC)?

The most common symptom is a lump in the throat

Papillary thyroid cancer is made up of one or more tumours, which are uncontrolled growths of thyroid cells. There will be at least one "primary" tumour (often referred to as a "nodule") in the thyroid gland, a large, butterfly-shaped organ that sits in front of the windpipe on your neck. There may also be tumours outside the thyroid gland (called "metastases"), most commonly in the lymph nodes of the neck. The discovery of these tumours is the most common symptom of papillary thyroid cancer (Schlumberger).

Sometimes a patient experiences difficult swallowing, a sore throat, or hoarseness, because the tumour is interfering with the tissues responsible for these activities. These symptoms are more common in comparatively advanced cases of papillary thyroid carcinoma, and are rare (Schlumberger).

However, do not imagine that any or all of these symptoms indicate that you do have a tumour. For example, my family doctor told me he sees hundreds of swollen lymph glands every year, and I'm his first case of thyroid cancer (my only symptom was a swollen lymph node). For lymph nodes without signs of thyroid nodules, your doctor may want you to wait a week or more to see if the swelling subsides. Similarly, many people have nodules in their thyroid glands which are not cancer at all - in fact the great majority are benign. The lifetime risk of thyroid nodules is 5-10% (AACE), while the lifetime risk of all types of thyroid cancer combined is only 0.27% in men and 0.68% in women (SEER).

There are a few factors which may lead your doctor to suspect that a lump is cancerous

When your physician examines you, he or she will check whether the lump is firm or soft, regular or irregular, and whether it moves freely when you swallow. Firm, irregular lumps could be suspicious, although benign nodules would also behave in the same way. There will be physical checks for other lumps in the area, because lumps in both the neck and the thyroid gland would be more suspicious than a lump on its own. If your doctor is still in doubt, you may be directed to an endocrinologist specialising in thyroid disease for further physical examination - an expert is more likely to be able to rule out cancer in suspicious cases, thus saving you and your doctor from the delay, discomfort, and expense of tests that go beyond your external symptoms (AACE).

In addition to physical symptoms, your doctor may be interested in your history

Because the physical symptoms of papillary thyroid cancer are so similar to other, much more common problems, your doctor will probably also ask you about your history. While nothing in your history can prove or disprove that you have thyroid cancer, it may be enough to swing a decision about whether to rush you off to an expert, or to wait and see. The following are examples from the AACE Clinical Practice Guidelines of "historical" factors that might favour or disfavour the suspicion of thyroid cancer:

Sources:

• AACE (American Association of Clinical Endocrinologists), "AACE Clinical Practice Guidelines fo the diagnosis and management of thyroid nodules", 1996.
• Schlumberger, "Medical progress: papillary and follicular thyroid carcinoma." New England Journal of Medicine, volume 338, number 5, 29 Jan 1998, pp. 297-306.
• SEER, "Cancer Statistics Review 1973-1996", National Cancer Institute.