Papillary cancer of the thyroid can present in four different ways:
Small occult tumours usually a few millimeters in diameter are commonly found in the thyroid and are of no clinical significance. They are important since they often cause great concern to the patient, which is totally unwarranted. Such tumours may be ignored as long as the blood TSH level is not raised.
This is the commonest way papillary cancer presents, and it may be associated with spread to the glands in the side of neck (80% in children). A change in voice is an ominous sign and signifies invasion of the laryngeal nerve by cancer (still a treatable condition). Invasion of the windpipe rarely occurs and is heralded by noisy breathing.
The spread to local glands is a common mode of presentation (sometimes called erroneously "lateral aberrant thyroid"). The presence of involved glands does not usually affect the prognosis.
Spread to lungs or bone is very rare but when it occurs unlike most other cancers, cure is possible.