What The Fault in Our Stars Can Teach Us About Thyroid and Bone Cancer

Two teenagers, two very different diseases

The Fault in Our Stars puts two young people in the same support group with cancers that have almost nothing in common. Hazel Grace Lancaster lives with thyroid cancer that has spread to her lungs. Augustus Waters has had osteosarcoma, a cancer of bone.

The film is fiction and is not a description of anyone's care. But the two diagnoses it names are real, they are commonly confused with each other by everyone outside oncology, and pulling them apart is genuinely useful.

Why lung deposits are still thyroid cancer

Hazel's cancer started in the thyroid and is in her lungs. That does not make it lung cancer. It is thyroid cancer in the lungs, and the distinction is not a technicality.

A cancer is named for the tissue it came from, because that is where its behavior comes from. Thyroid cells that travel to the lung keep acting like thyroid cells. They grow at thyroid-cancer speed. And, crucially, they often keep the one habit that makes this disease unusual: they absorb iodine.

That habit is the basis of treatment. NCI's clinical summary describes using iodine I 131 in evaluating thyroid tissue. Because differentiated thyroid cancer cells take up iodine and almost nothing else in the body does, a radioactive form of it can be swallowed, carried through the bloodstream, and concentrated in the cancer wherever it happens to be — including deposits in the lungs.

A cancer that started in the lung would ignore it completely. Our page on metastatic cancer explains why naming by origin is the rule everywhere in oncology.

Four thyroid cancers, not one

NCI describes four main types of thyroid cancer: papillary, follicular, medullary, and anaplastic. They are grouped for treatment into differentiated thyroid cancer and medullary thyroid cancer.

The well-differentiated tumors — papillary and follicular — are, in NCI's words, highly treatable and usually curable. They make up the large majority of cases.

Medullary thyroid cancer is a neuroendocrine cancer with an intermediate outlook, and it does not take up iodine, so the treatment route above is not available for it.

Anaplastic thyroid cancer is at the other end. NCI describes it as less common, aggressive, spreading early, and carrying a poor outlook. It is a different clinical problem sharing an organ name.

NCI notes that thyroid cancer commonly appears as a "cold nodule" — a lump in the gland found on examination that does not take up tracer normally. It affects women more often than men, and usually turns up between the ages of 25 and 65.

Osteosarcoma: a cancer of growing bone

Osteosarcoma is not thyroid cancer's opposite number so much as a different category of disease. It is a sarcoma, arising in the bone-forming tissue itself, most often near the knee or the shoulder, and most often in adolescents and young adults during the years of fastest growth.

It usually announces itself as pain over a bone that gets worse rather than better, often worse at night, sometimes with a swelling you can feel. It is regularly mistaken for a sports injury for weeks. NCI notes that people with tumors in weight-bearing bones are advised to limit weight through the limb, because a fracture through the weakened bone can rule out limb-preserving surgery.

Treatment, NCI states, generally requires both effective systemic chemotherapy and complete removal of all detectable disease. Randomized trials established that chemotherapy given before surgery and after it both help prevent relapse. Most operations today are limb-sparing rather than amputations: the affected bone is removed and replaced with a metal implant or a graft.

When osteosarcoma spreads, NCI reports the lungs are the most common site, and that outlook depends on how many deposits there are and whether they can be removed surgically. Our guide to adult bone cancers covers the wider group.

When to get checked

For the thyroid:

• A lump in the front of the neck that you can feel and that does not go away.
• A hoarse voice lasting more than three weeks with no cold behind it.
• Trouble swallowing or a sensation of pressure in the throat.
• A swollen lymph node in the neck that persists beyond a month.

For bone:

• Bone pain that has lasted more than a few weeks, is worse at night, and is not clearly linked to an injury.
• Swelling or a hard lump over a bone.
• A bone that breaks after a minor knock.

Neither cancer has a screening test for people at average risk. Both are found because someone brought a persistent symptom to a clinician.

What the registries show

About 45,240 new thyroid cancers and about 2,320 deaths are projected in the United States for 2026 — an American Cancer Society projection, published by SEER. The survival numbers come from NCI's own registry work, and are based on people diagnosed between 2016 and 2022. Five-year relative survival is 98.3% overall — 99.9% for cancer confined to the thyroid, 98.1% once it has reached nearby nodes, and 48.3% once it has spread to distant sites. The median age at diagnosis is 51.

Bone and joint cancers are far rarer: the Society projects about 4,110 new cases in 2026 and about 2,210 deaths, while NCI's SEER data for people diagnosed between 2016 and 2022 show five-year relative survival of 68.7% and a median age at diagnosis of 48. That last figure surprises people, because it covers all bone cancers rather than only the ones concentrated in teenagers.

All of these are group averages, and the counts for 2026 are projections. They describe populations, and they are not a forecast for any individual.

What this does not mean

A film is written to move an audience. Fiction compresses time, skips the dull months, and gives characters the course the story needs. Neither of these diagnoses runs to a script.

Thyroid cancer that has spread is also not a common story. The great majority of thyroid cancers are found while still in the neck and are treated with surgery, sometimes radioactive iodine, and long-term follow-up. Reading Hazel's situation as typical would get the disease badly wrong.

And "bone cancer" in ordinary speech usually means something else entirely — cancer that started elsewhere and spread to bone. That is far more common than osteosarcoma and is treated as the original cancer. Our page on what cancer is sorts out the vocabulary.

Sources

• The Fault in Our Stars (20th Century Studios)
• NCI PDQ: Thyroid Cancer Treatment (Health Professional Version)
• NCI PDQ: Osteosarcoma and Undifferentiated Pleomorphic Sarcoma of Bone Treatment (Health Professional Version)
• NCI SEER Cancer Stat Facts: Thyroid Cancer
• NCI SEER Cancer Stat Facts: Bone and Joint Cancer

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

Cancer Explained is published by the National Cancer Information Foundation. It is not medical advice and does not suggest a test or treatment.

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