Cancer is a chronic disease caused by damaged cells that arise from and invade the tissues of our own bodies.  Although there is currently no cure for cancer, early detection and treatment significantly improves outcome. Definitively, ease of resection of a primary site is associated with improved overall survival. After finding suspicious nodules in her jaw in 2015, Joy Steele of Wasaga Beach maintains “there is no good cancer” as she began a daily battle with the aftermath of surgical removal of her thyroid. 

The thyroid is a butterfly shaped gland in the throat that produces hormones to regulate healthy heart rate, body temperature, and metabolism. There are multiple types of thyroid cancer that arise from malignant cells in the tissues of the thyroid gland. Age and gender affect the risk. There is a hereditary component to thyroid cancer but the genetic basis for these cancers is not clearly defined. Exposure to radiation, for example radiation therapy used to treat childhood cancers such as lymphoma and neuroblastoma also promotes increased risk. Interestingly before the 1960s, low doses of radiation were used for treating ailments like acne, fungus infections of the scalp, or enlarged tonsils or adenoids. Years later, people exposed to such treatments faced a higher risk of thyroid cancers. 

In 2015, Joy discovered a lump below her jaw. Ultrasound revealed two nodules on each side of the thyroid that were subsequently removed due to their size and Joy’s history of familial cancer. Although her biopsy was inconclusive, Joy’s older sister had been diagnosed with thyroid cancer ten years earlier. Pathology established Joy had follicular thyroid cancer, an aggressive type of thyroid cancer, especially in woman which accounts for ~15% of thyroidcancer diagnosis.

Although thyroid cancer grows slowly which permits increased time for treatment, these cancers are highly metastatic; therefore, thyroid removal is the primary method of treatment. Joy proclaims, “People tell me, at least you had the good cancer which is easily removed.” She continues, “But there is no ‘good cancer’.  It is cancer and it puts my life at risk.” Resection of the tumor is unarguably positive, but although on one hand her cancer has been removed, on the other hand Joy is left without essential thyroid function. Following surgery to remove her tumors, Joy has struggled with chronic fatigue and muscle pain due to the loss of thyroid hormones. Currently, Joy is on a poorly optimized and inconsistent dosing regimen of a synthetic thyroid medication to help support healthy bodily functions, but unlike her sister she does not respond well. 

Due to her familial history of cancer, Joy underwent genetic counselling at the Princess Margaret Hospital (PMH) where it was determined she carries a mutation in a gene called Fanconi anemia complementation group C (FANCC). Mutation in FANCC is one of many genes that causes a rare recessive disorder called Fanconi anemia (FA) characterized by a plethora of symptoms affecting bone marrow, skin, kidney and digestion. Mutant FANCC carriers have a greatly increased risk of cancer due to defective mechanisms of DNA repair resulting in accumulation of genetic mutations. Although thyroid cancer is unusual in FA, endocrine problems are common and FA syndrome presents with 70-80% risk of endocrine abnormalities including thyroid nodules. Thyroid nodules can be firm mimicking a tumor diagnosis and although they are caused by abnormal growth of thyroid cells they are usually not cancer.

However, increasing evidence suggests that mutations in FA genes including FANCC does increase lifelong risk for cancer, especially invasive ductal breast carcinoma. Based on her sister’s diagnosis with breast cancer in 2016, Joy has recently been admitted to the Ontario high-risk breast cancer screening program at the PMH.

Encouraged to give back, in 2019 Joy participated in a Dear World event while attending a conference in Toronto. Dear World (dearworld.com) provides an opportunity for people to tell and share their stories to build a culture of authenticity, inclusivity and purpose. Joy says, “It is an experience I hope everyone gets a chance to have” as she tells her story as a force for good.  The idea is to think about words that mean something to you and take a photo with the words marked on your body. Frustrated by the ignorance and severity surrounding her own cancer diagnosis, Joy’s message: “there is no good cancer”. 

Submitted by: Dr. Oliver Kent, Cancer researcher and Senior Scientist at adMare BioInnovations. 

Do you have an idea or question you would like to read about in the Cancer Chat? Email (kent.uhn@gmail.com) or text (438-874-6546) and let me know!