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Life after treatment
For most people, the cancer experience doesn’t end on the last day of treatment. Life after cancer treatment can present its own challenges. You may have mixed feelings when treatment ends, and worry that every ache and pain means the cancer is coming back.
Some people say that they feel pressure to return to “normal life”. It is important to allow yourself time to adjust to the physical and emotional changes, and establish a new daily routine at your own pace. Your family and friends may also need time to adjust.
Cancer Council 13 11 20 can help you connect with other people who have had cancer, and provide you with information about the emotional and practical aspects of living well after cancer.
After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread. How often you will need to see your doctor will depend on the type of cancer and which treatments you had. During these check-ups, you will also be able to discuss how you’re feeling and mention any concerns, and you may have some blood tests and scans.
Blood tests to measure Tg – If you have been treated for papillary or follicular thyroid cancer, you will have blood tests to check the levels of thyroglobulin (Tg). This protein is made by normal thyroid tissue and it may also be made by papillary or follicular thyroid cancer cells. After a total thyroidectomy, you should have little or no Tg in your body, but levels will rise if the cancer comes back.
In the past, people often had to raise the TSH levels in their blood before having a Tg blood test. This improved the accuracy of the results. However, newer Tg tests are more sensitive, and most people will not need to do this.
If Tg is found in your blood, your doctor may suggest having some scans. A small number of people have Tg antibodies. The antibodies cause no harm but they make it hard to accurately measure Tg. They tend to fade after RAI treatment.
Other blood tests – For medullary thyroid cancer, blood levels of calcitonin and carcinoembryonic antigen (CEA, a protein made by some cancer cells) will be measured periodically.
Blood tests are also done regularly to check if you are on the right dose of thyroid hormone replacement. Once this dose is stable, thyroid function blood tests are needed only every 6–12 months.
Neck ultrasound – An ultrasound is used to see if any cancer is left or has come back in the area where the thyroid was removed. It also checks for cancer in the lymph nodes around the neck.
Radioisotope scan – This test is used to check if there are any thyroid cancer cells remaining in your body after treatment. It is used less often now as the Tg blood test and neck ultrasound usually provide enough information.
If you are having a radioisotope scan, you may need to raise your TSH levels beforehand – for more details talk to your doctor.
For the scan, a small amount of radioactive dye (such as iodine or technetium) is injected into a vein in your arm. After about 20 minutes, you will be asked to lie under a machine called a gamma camera, which takes the scan. The camera measures the amount of radioactive dye taken up by any remaining thyroid tissue or other areas of disease. A radioisotope scan is painless and causes few side effects. After the scan, you will not be radioactive and it is safe to be with other people.
Other scans – If your doctor needs more information, or if cancer cells are found elsewhere in your body, you may also need a CT or PET scan.
Anxiety about follow-up appointments
When a follow-up appointment or test is approaching, many people find that they think more about the cancer and may feel anxious. Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.
Check-ups will become less frequent if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.
For most people, thyroid cancer does not come back (recur) after the initial treatment. However, some people do have a recurrence. This is why it’s important to have regular check-ups.
If thyroid cancer does come back, it will often just be in the lymph nodes and you may be offered further surgery, sometimes with a repeat of radioactive iodine (RAI) treatment. If the cancer has spread into other parts of the body, the first treatment will usually be RAI. Additional treatments such as targeted therapy, external beam radiation therapy or chemotherapy may also be used.
If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.
Talk to your GP, as counselling or medication – even for a short time – may help. Some people can get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible.
This information is reviewed by
This information was last reviewed January 2020 by the following expert content reviewers: A/Prof Diana Learoyd, Endocrinologist, Northern Cancer Institute, and Northern Clinical School, The University of Sydney, NSW; Dr Gabrielle Cehic, Nuclear Medicine Physician and Oncologist, South Australia Medical Imaging (SAMI), and Senior Staff Specialist, The Queen Elizabeth Hospital, SA; Dr Kiernan Hughes, Endocrinologist, Northern Endocrine and St Vincents Hospital, NSW; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Dr Christine Lai, Senior Consultant Surgeon, Breast and Endocrine Surgical Unit, The Queen Elizabeth Hospital, and Senior Lecturer, Discipline of Surgery, University of Adelaide, SA; A/Prof Nat Lenzo, Nuclear Physician and Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics, and The University of Western Australia, WA; Ilona Lillington, Clinical Nurse Consultant (Thyroid and Brachytherapy), Cancer Care Services, Royal Brisbane Women’s Hospital, QLD; Jonathan Park, Consumer.