The HEALTH | May-June. 2026

NECK ALERT: Thyroid cancer often develops quietly, but recognising warning signs such as a persistent neck lump can lead to earlier diagnosis, more effective treatment and better outcomes

QUICK ACTION: A simple check-up can make all the difference when it comes to detecting thyroid cancer before it progresses to an advanced stage

• A seemingly harmless swelling may be an early warning sign of a cancer that often develops without obvious symptoms.

• Unlike common thyroid disorders, thyroid cancer usually does not affect hormone production.

• Women are diagnosed more often than men, making awareness and early evaluation especially important.

Thyroid cancer, one of the most treatable cancers, remains under-discussed in Malaysia. According to the Malaysia National Cancer Registry Report 2017 – 2021, it ranks as the eighth most common cancer among women, with an incidence rate of 4.2 per 100,000 population.

Women are more affected than men, a trend researchers believe may be influenced by hormonal factors, particularly oestrogen.

Often dubbed a silent disease, thyroid cancer can develop without obvious symptoms. In many cases, a persistent neck lump or subtle voice changes are the first signs.

While awareness has improved and more cases are now caught early through routine health screenings, confusion about thyroid conditions continues to delay timely action.

Sunway Medical Centre’ s( SMC) Consultant Breast and Endocrine Surgeon,

Dr Wong Mei Wan

Dr Wong Mei Wan, and Consultant Nuclear Medicine Physician, Dr Tan Teik Hin, shared their perspectives on thyroid cancer, from early signs and diagnosis to treatment options and long-term follow-up.

“ The thyroid produces thyroxine, a hormone essential for metabolism. Too much makes you restless and energetic, too little and you feel sluggish and cold,” explained Dr Wong.

UNDERSTANDING THYROID

However, thyroid cancer is not about hormones.

“ Most patients with thyroid cancer have normal thyroid function. The cancer is typically a physical growth or nodule within the gland; it does not cause hyperthyroidism or hypothyroidism,” clarified Dr Tan.

Diagnosis usually starts when a patient notices a hard lump in the neck. Other symptoms may include changes in voice, difficulty swallowing, or swollen lymph nodes. Not all nodules are cancerous, and ultrasound and biopsy help distinguish benign from malignant growths.

Unlike many other cancers, thyroid cancer in Malaysia is not strongly linked to lifestyle factors such as smoking. Family history can be a factor, although hereditary cases are relatively uncommon. About two-thirds of Dr Wong’ s patients are women, reflecting a global trend.

Most Malaysians today are diagnosed at Stage 1, often through health screenings.

“ A decade ago, we used to see more latestage cases, often Stage 3 or 4. This is a very encouraging shift,” said Dr Tan.

About 85 per cent of thyroid cancers are slow-growing, mainly papillary or follicular types, and usually respond well to treatment. However, outcomes worsen if the cancer spreads to distant organs such as the lungs or bones.

TREATMENT PATHWAYS

Treatment often begins with surgery.“ Once the tumour is removed, we check how aggressive it is. If it is high-risk, we usually follow up with radioactive iodine( RAI) therapy,” explained Dr Tan.

RAI helps destroy remaining cancer cells and detect hidden spread. For small tumours measuring less than one centimetre, surgery alone may be sufficient. Dr Tan reassured patients that RAI is safe, well-tolerated, and rarely causes allergic reactions.

While outcomes are usually good, recurrence can happen, often in the lymph nodes, even years later.“ That is why long-term followup is critical,” said Dr Wong.

Post-surgery, patients typically need lifelong thyroid hormone replacement. For Stage 1 and 2 patients, Dr Tan recommended checks every six months for two years, followed by annual reviews.

For advanced or resistant cases, tyrosine kinase inhibitors( TKIs) may be used when RAI is no longer effective. These drugs can help shrink tumours or manage metastatic disease.

PUBLIC AWARENESS IS KEY

Dr Tan Teik Hin