Surgical management of parathyroid carcinoma

Cancer of the parathyroid glands is an exceedingly rare endocrine malignancy representing a very uncommon cause of primary hyperparathyroidism. It is characterized by markedly increased serum calcium and parathyroid hormone (PTH) levels far in excess of those exhibited by benign parathyroid disease. Diagnosis is made by histopathology, which may be problematic before initiating treatment for hyperparathyroidism. Because of its rarity, both staging classification and prognostic factors have been difficult to define and less useful in predicting the course of disease and treatment outcomes. Effective management involves comprehensive surgical resection, which offers the best opportunity for cure. Both radiotherapy and chemotherapy are largely ineffective modalities for treatment. Recurrent disease is generally incurable; however, repeat surgery and medical management of tumor-induced hypercalcemia may provide intermediate-term palliation.