Management of parathyroid cancer
Surgery is the mainstay of treatment for parathyroid cancer because radiation and chemotherapy have shown little benefit. Local invasion and pathologic nodes should be assumed to represent cancer. Any suspicious parathyroid lesions should be carefully removed without disrupting the parathyroid capsule because this may result in tumor spillage and local recurrence. If a parathyroid gland is obviously abnormal and infiltrating other tissues, those tissues should be resected en bloc with the tumor whenever possible, including the ipsilateral thyroid lobe when necessary. Removal of the central nodes on the side of the tumor is indicated at the initial operation. Any obviously enlarged lateral nodes should be resected by formal neck dissection. Prophylactic neck dissections have shown no benefit. The histopathologic diagnosis of this cancer is also difficult; thus, intraoperative frozen section is rarely useful other than to confirm parathyroid tissue.