Types of thyroid cancer from papillary to anaplastic

Most neck lumps turn out to be related to infection or benign thyroid changes. However, thyroid cancer is one possible cause, and understanding its main types and treatments can help you know when a neck lump may need medical review. Keep reading this blog to find out the main types of thyroid cancer, the symptoms they may cause, and how each is treated at AHNA Neck Lump Clinic.

Key takeaways

• Most thyroid nodules are benign, but some develop into thyroid cancer and need specialist assessment.

• Thyroid cancer is classified into four main types: papillary, follicular (including Hurthle cell), medullary, and anaplastic.

• Papillary and follicular cancers grow slowly and have excellent long-term outcomes when treated early.

• Medullary and anaplastic cancers behave more aggressively and require specialised, multidisciplinary care.

• A painless neck lump is the most common symptom across all types, and persistent or growing nodules should be checked.

What is thyroid cancer and how is it classified?

Thyroid cancer begins in the cells of the thyroid gland, which sits at the front of the neck. Most thyroid cancers arise from follicular cells, which produce thyroid hormones. These are called differentiated thyroid cancers and include papillary, follicular, and Hurthle cell types. Medullary thyroid cancer arises from C-cells that produce calcitonin. Anaplastic thyroid cancer is the least common type and behaves very aggressively. Classification helps guide treatment, predict behaviour, and determine the follow-up required.

What are the main types of thyroid cancer?

Papillary thyroid cancer

Papillary thyroid cancer accounts for 70 to 85 percent of all cases and most often affects adults in their 30s to 50s. It usually grows slowly and can spread to lymph nodes in the neck. Treatment typically involves thyroid surgery, which may be a lobectomy or a total thyroidectomy, sometimes with lymph node removal. Radioactive iodine may be used to destroy remaining thyroid tissue, followed by long-term thyroid hormone replacement to prevent recurrence. Prognosis is excellent, with more than 98 percent five-year survival when diagnosed early.

Follicular and Hurthle cell thyroid cancer

Follicular thyroid cancer makes up 10 to 15 percent of cases and tends to spread through the bloodstream rather than to lymph nodes. Hurthle cell cancer is a less common variant that may respond less well to radioactive iodine. Treatment usually includes total thyroidectomy and radioactive iodine for suitable cases, along with thyroid hormone suppression therapy. Localised follicular thyroid cancer has high survival rates, with more than 85 to 90 percent ten-year survival.

Medullary thyroid cancer

Medullary thyroid cancer represents 4 to 10 percent of cases and begins in the C-cells of the thyroid. It often produces calcitonin, which can be used as a tumour marker. Some cases are linked to inherited RET gene mutations, so family members may need genetic testing. Treatment involves total thyroidectomy with removal of nearby lymph nodes. Radioactive iodine is ineffective, so advanced disease may require targeted therapies such as tyrosine kinase inhibitors. Ten-year survival is around 90 percent when the cancer has not spread beyond the neck.

Anaplastic thyroid cancer

Anaplastic thyroid cancer is rare, accounting for only 1 to 3 percent of cases. It usually affects older adults and grows very quickly. Symptoms often include rapid neck swelling, difficulty breathing or swallowing, and hoarseness. Treatment requires urgent multidisciplinary care and may include surgery when possible, radiotherapy, chemotherapy, or targeted medications such as BRAF inhibitors. Although prognosis is poor, early intervention can help improve local control and symptom relief.

What symptoms can thyroid cancer cause?

Not all neck lumps carry the same level of concern. Where the lump appears can help guide how urgently it should be assessed by a head and neck surgeon.

Back of neck lymph nodes

There are natural chains of lymph nodes along both sides of the spine at the back of the neck.These often swell in response to:

• Scalp infections

• Ear infections

• Upper respiratory illnesses

They are commonly benign and tend to settle as the underlying issue improves.

Lower neck or collarbone area

Lumps in the lower neck or just above the collarbone can indicate a more concerning cause.Enlargement in this region should always be assessed promptly.

Multiple or clustered lumps

Having several enlarged nodes on one or both sides of the neck, especially if they feel hard, fixed, or irregular, can sometimes be linked to systemic illnesses such as lymphoma.

What symptoms can thyroid cancer cause?

Many thyroid cancers do not cause symptoms early on. A painless lump or nodule in the front of the neck is the most common sign. As the cancer grows, patients may notice:

• A sense of pressure or fullness in the neck

• Difficulty swallowing

• Hoarseness or voice changes

• Swelling of lymph nodes in the neck

• Breathing discomfort

• Persistent cough

Symptoms vary between cancer types. Papillary cancer may cause swollen lymph nodes. Follicular and Hurthle cell cancers may create pressure symptoms if they become large. Medullary cancer can cause flushing or diarrhoea due to hormone release. Anaplastic cancer often presents with rapidly progressing symptoms that require urgent assessment.

How are the different thyroid cancer types treated?

Treatments for thyroid cancers varies based on the type of thyroid cancer, its stage and overall health. Key approaches include:

1.     Surgery

• Main treatment for most thyroid cancers

• May involve removing part or all of the thyroid

• Lymph node removal if cancer has spread locally

2.     Radioactive iodine therapy

• Commonly used for papillary and follicular cancers

• Helps destroy remaining thyroid tissue or small metastases

• Hurthle cell cancers may respond less predictably

3.     Targeted and systemic therapies

• Used for medullary thyroid cancer (e.g., tyrosine kinase inhibitors)

• Essential for anaplastic cancer, often combined with chemotherapy or immunotherapy

• Options depend on tumour genetics, including RET and BRAF mutations

4.     Radiotherapy

• Used for advanced or aggressive cancers, especially anaplastic

• Helps control local disease and manage symptoms

5.     Long-term follow-up

• Thyroglobulin monitoring for differentiated cancers

• Calcitonin monitoring for medullary cancer

• Ultrasound and imaging used to detect recurrence early

Worried about a thyroid lump?

A thyroid lump that is persistent, growing, or causing symptoms should be checked. If you are unsure what to do next, reach out to our team at Auckland Head and Neck Associates and they will guide you through the next steps.