Pathophysiology
- Thyroid cancer: Papillary (most common, slow-growing), follicular, medullary (C cells, calcitonin), and anaplastic (highly aggressive). Cervical lymph nodes are the sentinel nodes
- Pancreatic cancer: Adenocarcinoma of exocrine ducts (85%) and neuroendocrine tumors (NETs) of islet cells. Tumors impinge on the celiac ganglion causing mid-back pain
- Adrenal cancer: Rare adrenocortical carcinomas and pheochromocytomas (usually benign medullary tumors causing epinephrine hypersecretion)
- Endocrine cancers frequently metastasize to lungs, liver, and bones
- Paraneoplastic syndromes: Small cell lung cancers can produce ectopic hormones (ACTH, ADH), causing endocrine symptoms from a non-endocrine primary tumor
Signs and Symptoms
Hallmark Indicators
- Thyroid: Painless, firm lump in the anterior neck. Hoarseness or dysphagia (tumor pressing on laryngeal nerve)
- Pancreas: Vague abdominal discomfort. Mid-back pain independent of movement. Jaundice. Rapid weight loss
- Adrenal: Symptoms of hormone excess — hypertension, "moon face," episodic headache/sweating/tachycardia (pheochromocytoma)
- General: Exhaustion not relieved by rest (cancer cachexia). Significant muscle wasting
- Thyrotoxic myopathy: Proximal muscle weakness in upper arms and thighs from hyperthyroidism
Red Flags and Rule-Outs
- Thyroid storm: Severe, life-threatening hyperthyroidism (rapid heart rate, high fever, agitation) — medical emergency. Absolute contraindication
- Mid-back pain independent of movement: Key red flag for pancreatic cancer
- Painless firm neck lump with hoarseness: Suggests thyroid malignancy — refer for evaluation
- Cushing-like features in a cancer patient: May indicate adrenal involvement or paraneoplastic ACTH production
MT Considerations
- Goal: Palliative care to reduce pain, anxiety, nausea, fatigue, and depression
- Radioactive iodine: Clients undergoing RAI for thyroid cancer must be in complete isolation — massage strictly contraindicated until protocol concluded
- Abdominal work: Avoid intrusive abdominal massage if a tumor is present
- Bone fragility: Conservative pressure if metastasis has affected bone
- Lymphedema risk: Cervical lymph node surgery can cause fluid accumulation in face or neck
- Secondary diabetes: Excess growth hormone or cortisol from endocrine tumors can cause insulin resistance
- Treatment side effects: See chemotherapy and radiation-therapy
CMTO Exam Relevance
- Know the distinct presentations: thyroid (painless neck lump, hoarseness), pancreatic (mid-back pain, jaundice), adrenal (hormone excess)
- Mid-back pain independent of movement is a key red flag for pancreatic pathology
- Cervical lymph nodes are the sentinel nodes for thyroid and head/neck cancers
- Thyroid storm is a medical emergency — absolute contraindication
- Radioactive iodine therapy requires complete patient isolation
Key Takeaways
- Endocrine cancers disrupt systemic metabolism. Thyroid cancer is the most common type
- Radioactive iodine therapy requires complete isolation. Massage must be delayed until protocol completion
- Mid-back pain independent of movement is a key red flag for pancreatic cancer (celiac ganglion impingement)
- Thyroid storm is a medical emergency — absolute contraindication to any session
- Endocrine cancers frequently metastasize to lungs, liver, and bones