Yuri Nikiforov: Making Cancer Disappear
Diagnosed with thyroid cancer at the age of 19, the young woman prepared herself for an unsettling fate. Her surgeon, citing existing treatment guidelines for thyroid cancer, said he would need to remove her entire thyroid and administer radioactive iodine to treat the disease.
But then her surgeon consulted Pitt’s Yuri Nikiforov, and the renowned thyroid specialist shook his head. He had seen too many cases like this—noninvasive thyroid tumors being over-treated. But this one stood out. Removing the entire gland would commit the teenage patient to a lifetime of hormone therapy, yearly checkups, and the dread of the cancer returning.
And all because the treatment guidelines for this type of tumor were becoming outdated.
Nikiforov, a professor and vice chair of the pathology department in Pitt’s School of Medicine, had seen many of these tumors before. Encased in a capsule of fibrous material, they were called “encapsulated follicular variant of papillary thyroid carcinoma.” But despite the “carcinoma” in the name, they do not spread like cancer. Nikiforov, who is also co-director of the UPMC/UPCI Multidisciplinary Thyroid Center, told the surgeon that the operation to remove the entire thyroid was most likely unnecessary because the woman’s tumor had only some, not all, features of cancer and was not invading outside its capsule. Nevertheless, the surgeon was bound to medical protocol, which required him to do it.
This 2013 case spurred Nikiforov to push for a change—a name change that would alter how thyroid tumors are treated.
“Something had to be done,” he said. “We are doing more harm than good by treating these tumors in the same way that we treat aggressive cancers.” But changing the existing treatment guidelines required strong scientific evidence.
So Nikiforov took on the herculean task of assembling an international team of 24 preeminent pathologists to generate enough data to convince various clinical societies and the World Health Organization that such tumors were not harmful and needed to be renamed.
Fellow pathologists agreed that it was the right thing to do—but warned him that it would be next to impossible to buck the medical establishment.
Nikiforov remained undaunted. “I knew it wouldn’t be easy.”
So began a two-year project in which the international panel conducted a retrospective study of thyroid tumors. The team reviewed 270 cases from more than 10 medical institutions in five countries. Half the cases involved invasive tumors, while the other half were noninvasive, which was the type of tumor the 19-year-old woman had. The panel discovered that once the noninvasive tumors were surgically removed, even by limited surgery, they did not return. The results called into question the established practice of removing the entire thyroid primarily to remove a noninvasive tumor.
In March 2015, Nikiforov’s panel voted to change the name of the noninvasive thyroid tumor from “encapsulated follicular variant of papillary thyroid carcinoma” to “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP).
It sounds like trading one technical term for another, but there is an important difference. The new name lacks the word carcinoma. A patient diagnosed with NIFTP no longer has to lose the entire thyroid and receive radioactive iodine treatment, because NIFTP is not a form of cancer. (Such patients do, however, have an initial surgery where half the thyroid is removed so doctors can make a proper diagnosis.)
Raja Seethala, director of the Head and Neck/Endocrine Pathology Center of Excellence at UPMC, served as a pathologist on the panel. “Yuri was the perfect person to spearhead it,” he said. “He is charismatic and diplomatic. Yuri was already a well-known thyroid and molecular pathologist who was able to bend the ear of international pathologists and recruit some of the best surgeons and endocrinologists out there. He got them into one room and also had several months of teleconferencing.”
Sally Carty, chief of the Division of Endocrine Surgery at Pitt and co-director of the UPMC/UPCI Multidisciplinary Thyroid Center, said Nikiforov pulled off an elegant feat in a relatively short amount of time. “He has removed the burden of the C-word for some patients who were previously told they had thyroid cancer. Thyroid cancer has had a lot of overdiagnosis.”
Born in Belarus, Nikiforov lived about 200 miles from Chernobyl in 1986 when the nuclear reactor accident occurred, and his wife’s family lived just 50 miles away.
As a pathology resident in Belarus at the time, Nikiforov noticed young children being diagnosed with thyroid cancer—something that should have been a very rare occurrence. “Nobody believed it,” he said, until an international group of pathologists visited his clinic. Some 6,000 young children had developed thyroid cancer because of exposure to radiation.
Nikiforov moved to the United States in 1993 and joined UPMC in 2006. His experience treating those children continues to propel his work on thyroid tumors and their treatment—and over-treatment.
Because he refused to accept the status quo, his efforts have saved many people from losing their entire thyroid glands and receiving radioactive iodine treatment. Even patients treated under the prior protocols felt better knowing that their ongoing worries about the possibility of cancer recurrence were now known to be unnecessary, too.
Some of those happy patients have written to Nikiforov, recounting their relief when told by their doctors that medical guidelines for treating their type of thyroid cancer had changed. Those doctors delivered the magic words: You don’t have cancer anymore.
Other Stories From This Issue
October 21, 2016
On the Freedom Road
Follow a group of Pitt students on the Returning to the Roots of Civil Rights bus tour, a nine-day, 2,300-mile journey crisscrossing five states.
Day 1: The Awakening
Day 2: Deep Impressions
Day 3: Music, Montgomery, and More
Day 4: Looking Back, Looking Forward
Day 5: Learning to Remember
Day 6: The Mountaintop
Day 7: Slavery and Beyond
Day 8: Lessons to Bring Home
Day 9: Final Lessons