Active surveillance, also known as “active monitoring”, “watchful waiting”, or “expectant management”, is a conservative care option for patients diagnosed with papillary thyroid cancers where the tumor is smaller than 1 cm in size. If active surveillance is a good fit for you and you choose this course of action, your physician will use ultrasound imaging to periodically monitor your cancer for changes or growth over time, rather than surgically removing it or treating it more aggressively.
With the rise in clinical acceptance of active surveillance, it is crucial to recognize what circumstances may make you a less suitable candidate for active surveillance.
Consider the Following Important Circumstances
1. An Aggressive Form of Thyroid Cancer
As described above, active surveillance is a care option for patients with small papillary thyroid cancers. These cancers can be classified as “low-risk”, which refers to the likelihood of recurrence and progression of the cancer. If you are diagnosed with an aggressive thyroid cancer or your cancer has spread to other parts of your body, you should not consider active surveillance. Additionally, if you have other thyroid or parathyroid diseases that require immediate surgery, you are not eligible for active surveillance, even if your thyroid cancer is low-risk. It is important for your physician to know what factors might disqualify you from pursuing active surveillance as a management option.
2. The Location of the Tumor
While a thyroid tumor may be small or classified as low-risk, its location can pose concerns. Your care team should pay close attention to the trachea and the recurrent laryngeal nerves. The trachea, or windpipe, is responsible for carrying air into and out of the lungs. The recurrent laryngeal nerves (left and right) are responsible for moving the vocal cords during speaking and breathing. If a thyroid tumor is suspicious for tracheal or recurrent laryngeal nerve invasion, surgical excision may be advised to avoid damage to these structures.
3. A History of Anxiety
Many people may feel anxious about leaving their tumors alone, rather than immediately having them removed. While evidence shows that patients who undergo active surveillance and delay surgery are not subject to greater risks, active surveillance may be mentally taxing for certain patients. Physicians can help reduce your stress-related side effects by providing thorough education on active surveillance. However, the psychological burden may still greatly impact your quality of life. Despite active surveillance’s proven effectiveness, it is important to prioritize and vocalize your comfort level and preference, which may also change throughout your care.
4. Progression of Thyroid Cancer
During the course of your thyroid cancer monitoring, your eligibility for active surveillance may change. If ultrasound imaging reveals disease progression, such as tumor enlargement or cancer that has spread to other areas, your physician may need to proceed with surgical excision. Making sure you receive ultrasound imaging as often as your physician recommends is an essential part of active surveillance.
5. Your Age
Age may influence your decision to choose active surveillance. For one, age can contribute to the likelihood of disease progression, with younger patients at greater risk of progression. Additionally, because active surveillance extends over time, experiences can differ significantly between younger and older patients. While older patients may be monitored continuously for a shorter portion of their lifespan, such monitoring can extend over many more years for younger patients. Careful consideration of your age and how it might impact your thyroid cancer management can help inform your decisions related to care.
6. Lack of Access to Consistent Follow-Up Visits
In order for active surveillance to be effective, your tumor must be monitored regularly. For many patients, barriers such as cost, transportation, or time can greatly affect their ability to make all their appointments. If this is the case, physicians may not be able to detect disease progression in a timely fashion. You and your physicians should consider the role these factors may play in your adherence with active surveillance when determining if it is an appropriate care option for you.
Conclusion
This post outlines some factors to keep in mind when considering active surveillance as your care option. However, you may still have other questions or concerns. It is important to address these with your physician to make sure you are informed about and comfortable with your course of treatment.
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