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Thyroid cancer forms in the thyroid gland, an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight. Learn about our Thyroid Cancer Center and find information on how we support and care for people with thyroid cancer before, during, and after treatment.
The Head and Neck Oncology Program is dedicated exclusively to treating patients with head and neck cancers, which include cancers of the throat, larynx, nose, sinuses, and mouth.
Our specialists evaluate and treat all types and stages, from early lesions to the rarest and most challenging cases. We also specialize in the treatment of all forms and stages of salivary gland and thyroid cancer.
As a patient, you will be seen by highly experienced clinicians from numerous specialties, including head and neck surgery, medical and radiation oncology, dentistry, oral surgery, reconstructive surgery, nutrition services, social work, speech, voice, and swallowing therapy. We also have a dedicated Thyroid Cancer Treatment Center with nationally-recognized specialists who are advancing our understanding of thyroid cancer and nodular disease.
Beginning with the initial consultation, your team of specialists will work with you to create a comprehensive treatment plan tailored to your type of cancer, as well as your lifestyle and personal needs, to achieve the best possible outcome.
Providers meet regularly to discuss new developments in clinical and basic research. The close relationships between world-class researchers and medical clinicians ensure that the latest research findings are translated into new, effective treatment approaches as quickly as possible.
Learn more about treatment and support for patients with head and neck cancers
Our clinicians are experts in treating all types of head and neck cancers, including:
If you have never been seen before at Dana-Farber/Brigham and Women’s Cancer Center, please call 877-442-3324 or use this online form to make an appointment.
For all other inquiries, please call 617-632-3090
Referring physicians: 617-632-6869Fax: 617-632-4448
Mailing addressHead and Neck Oncology CenterDana-Farber Cancer Institute450 Brookline Ave.Boston, MA 02115-5450
The thyroid is a gland at the base of the throat near the trachea (windpipe). It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin piece of tissue, connects the two lobes. A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin.
The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:
There are four main types of thyroid cancer:
See the PDQ summary on Unusual Cancers of Childhood for information about childhood thyroid cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for thyroid cancer include the following:
The genes in cells carry hereditary information from parent to child. A certain change in a gene that is passed from parent to child (inherited) may cause medullary thyroid cancer. A test has been developed that can find the changed gene before medullary thyroid cancer appears. The patient is tested first to see if he or she has the changed gene. If the patient has it, other family members may also be tested. Family members, including young children, who have the changed gene can decrease the chance of developing medullary thyroid cancer by having a thyroidectomy (surgery to remove the thyroid).
Thyroid cancer may not cause early signs or symptoms. It is sometimes found during a routine physical exam. Signs or symptoms may occur as the tumor gets bigger. Other conditions may cause the same signs or symptoms. Check with your doctor if you have any of the following:
The following tests and procedures may be used:
The prognosis (chance of recovery) and treatment options depend on the following:
The process used to find out if cancer has spread within the thyroid or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
Cancer can spread through tissue, the lymph system, and the blood:
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.
In stage I papillary and follicular thyroid cancer, the tumor is any size, may be in the thyroid, or may have spread to nearby tissues and lymph nodes. Cancer has not spread to other parts of the body.
In stage II papillary and follicular thyroid cancer, the tumor is any size and cancer has spread from the thyroid to other parts of the body, such as the lungs or bone, and may have spread to lymph nodes.
In stage I papillary and follicular thyroid cancer, cancer is found only in the thyroid and the tumor is 2 centimeters or smaller.
In stage II papillary and follicular thyroid cancer, cancer is only in the thyroid and the tumor is larger than 2 centimeters but not larger than 4 centimeters.
In stage III papillary and follicular thyroid cancer, either of the following is found:
Stage IV papillary and follicular thyroid cancer is divided into stages IVA, IVB, and IVC.
Stage 0 medullary thyroid cancer is found only with a special screening test. No tumor can be found in the thyroid.
Stage I medullary thyroid cancer is found only in the thyroid and is 2 centimeters or smaller.
In stage II medullary thyroid cancer, either of the following is found:
In stage III medullary thyroid cancer, the tumor is any size, has spread to lymph nodes near the trachea and the larynx (voice box), and may have spread to tissues just outside the thyroid.
Stage IV medullary thyroid cancer is divided into stages IVA, IVB, and IVC.
Anaplastic thyroid cancer grows quickly and has usually spread within the neck when it is found. Stage IV anaplastic thyroid cancer is divided into stages IVA, IVB, and IVC.
Recurrentthyroid cancer is cancer that has recurred (come back) after it has been treated. Thyroid cancer may come back in the thyroid or in other parts of the body.
Different types of treatment are available for patients with thyroid cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Surgery is the most common treatment of thyroid cancer. One of the following procedures may be used:
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Radiation therapy may be given after surgery to kill any thyroid cancer cells that were not removed. Follicular and papillary thyroid cancers are sometimes treated with radioactive iodine (RAI) therapy. RAI is taken by mouth and collects in any remaining thyroid tissue, including thyroid cancer cells that have spread to other places in the body. Since only thyroid tissue takes up iodine, the RAI destroys thyroid tissue and thyroid cancer cells without harming other tissue. Before a full treatment dose of RAI is given, a small test-dose is given to see if the tumor takes up the iodine.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Thyroid Cancer for more information.
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In the treatment of thyroid cancer, drugs may be given to prevent the body from making thyroid-stimulating hormone (TSH), a hormone that can increase the chance that thyroid cancer will grow or recur.
Also, because thyroid cancer treatment kills thyroid cells, the thyroid is not able to make enough thyroid hormone. Patients are given thyroid hormone replacement pills.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitor (TKI) therapy is a type of targeted therapy that blocks signals needed for tumors to grow. Vandetanib is a TKI used to treat thyroid cancer.
Information about clinical trials is available from the NCI Web site.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment of stage I and II papillary and follicular thyroid cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I papillary thyroid cancer, stage I follicular thyroid cancer, stage II papillary thyroid cancer and stage II follicular thyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Treatment of stage III papillary and follicular thyroid cancer is usually total thyroidectomy. Cancer that has spread outside the thyroid, as well as any lymph nodes that have cancer in them, will also be removed. Radioactive iodinetherapy or external radiation therapy may be given after surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III papillary thyroid cancer and stage III follicular thyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Treatment of stage IV papillary and follicular thyroid cancer that has spread only to the lymph nodes can often be cured. When cancer has spread to other places in the body, such as the lungs and bone, treatment usually does not cure the cancer, but can relieve symptoms and improve the quality of life. Treatment may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV papillary thyroid cancer and stage IV follicular thyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Treatment may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with thyroid gland medullary carcinoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with anaplastic thyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Treatment of recurrentthyroid cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent thyroid cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about thyroid cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
This information is provided by the National Cancer Institute.
This information was last updated on June 10, 2014.
Estimated new cases and deaths from thyroid cancer in the United States in 2014:
Carcinoma of the thyroid gland is an uncommon cancer but is the
most common malignancy of the endocrine system. Differentiated tumors
(papillary or follicular) are highly treatable and usually curable. Poorly differentiated tumors (medullary or anaplastic) are much less common, are
aggressive, metastasize early, and have a much poorer prognosis. Thyroid
cancer affects women more often than men and usually occurs in
people between the ages of 25 and 65 years. The incidence of this malignancy has
been increasing over the last decade. Thyroid cancer commonly presents
as a cold nodule. The overall incidence of cancer in a cold nodule is 12% to
15%, but it is higher in people younger than 40 years and in people with calcifications present on preoperative ultrasonography.
Patients with a history of radiation administered in infancy and childhood for
benign conditions of the head and neck, such as enlarged thymus, acne, or
tonsillar or adenoidal enlargement, have an increased risk of cancer as well as
other abnormalities of the thyroid gland. In this group of patients,
malignancies of the thyroid gland first appear beginning as early as 5 years
following radiation and may appear 20 or more years later. Radiation exposure as a consequence of nuclear fallout has also been associated with a high risk of thyroid cancer, especially in children. Other risk
factors for the development of thyroid cancer include the following:
The prognosis for differentiated
carcinoma is better for patients younger than 40 years without
extracapsular extension or vascular invasion. Age appears to be the
single most important prognostic factor. The prognostic significance of lymph node status is controversial. One
retrospective surgical series of 931 previously untreated patients with
differentiated thyroid cancer found that female gender, multifocality, and
regional node involvement are favorable prognostic factors. Adverse factors
included age older than 45 years, follicular histology, primary tumor larger than 4
cm (T2–T3), extrathyroid extension (T4), and distant metastases.
Other studies, however, have shown that regional lymph node involvement had no
effect  or even an adverse effect on survival. Use of sentinel lymph node biopsy may aid in identifying patients with occult metastases who might benefit from central neck dissection.
immunostaining for vascular endothelial growth factor in patients with
papillary cancer has been associated with a high rate of local recurrence and
distant metastases. An elevated serum thyroglobulin level correlates
strongly with recurrent tumor when found in patients with differentiated
thyroid cancer during postoperative evaluations. Serum thyroglobulin
levels are most sensitive when patients are hypothyroid and have elevated serum
thyroid-stimulating hormone levels. Expression of the tumor suppressor
gene p53 has also been associated with an adverse prognosis for patients with
Patients considered at low risk by the age, metastases, extent, and size
(AMES) risk criteria include women younger than 50 years and men younger
than 40 years without evidence of distant metastases. Also included in
the low-risk group are older patients with primary tumors smaller than 5
cm and papillary cancer without evidence of gross extrathyroid
invasion or follicular cancer without either major capsular invasion or blood
vessel invasion. Using these criteria, a retrospective study of 1,019
patients showed that the 20-year survival rate is 98% for low-risk patients and
50% for high-risk patients. The 10-year overall relative survival rates for patients in the United States are 93% for papillary cancer, 85% for follicular cancer, 75% for medullary cancer, and 14% for undifferentiated/anaplastic cancer.
thyroid gland may occasionally be the site of other primary tumors, including
sarcomas, lymphomas, epidermoid carcinomas, and teratomas and may be the site
of metastasis from other cancers, particularly of the lung, breast, and kidney.
Other PDQ summaries containing information related to thyroid cancer include the following:
American Cancer Society: Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer Society, 2014. Available online. Last accessed May 21, 2014.
Hundahl SA, Fleming ID, Fremgen AM, et al.: A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see comments] Cancer 83 (12): 2638-48, 1998.
Tennvall J, Biörklund A, Möller T, et al.: Is the EORTC prognostic index of thyroid cancer valid in differentiated thyroid carcinoma? Retrospective multivariate analysis of differentiated thyroid carcinoma with long follow-up. Cancer 57 (7): 1405-14, 1986.
Khoo ML, Asa SL, Witterick IJ, et al.: Thyroid calcification and its association with thyroid carcinoma. Head Neck 24 (7): 651-5, 2002.
Carling T, Udelsman R: Thyroid tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1457-72.
Pacini F, Vorontsova T, Molinaro E, et al.: Prevalence of thyroid autoantibodies in children and adolescents from Belarus exposed to the Chernobyl radioactive fallout. Lancet 352 (9130): 763-6, 1998.
Cardis E, Kesminiene A, Ivanov V, et al.: Risk of thyroid cancer after exposure to 131I in childhood. J Natl Cancer Inst 97 (10): 724-32, 2005.
Tronko MD, Howe GR, Bogdanova TI, et al.: A cohort study of thyroid cancer and other thyroid diseases after the chornobyl accident: thyroid cancer in Ukraine detected during first screening. J Natl Cancer Inst 98 (13): 897-903, 2006.
Iribarren C, Haselkorn T, Tekawa IS, et al.: Cohort study of thyroid cancer in a San Francisco Bay area population. Int J Cancer 93 (5): 745-50, 2001.
Grant CS, Hay ID, Gough IR, et al.: Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important? Surgery 104 (6): 954-62, 1988.
Sanders LE, Cady B: Differentiated thyroid cancer: reexamination of risk groups and outcome of treatment. Arch Surg 133 (4): 419-25, 1998.
Mazzaferri EL: Treating differentiated thyroid carcinoma: where do we draw the line? Mayo Clin Proc 66 (1): 105-11, 1991.
Staunton MD: Thyroid cancer: a multivariate analysis on influence of treatment on long-term survival. Eur J Surg Oncol 20 (6): 613-21, 1994.
Mazzaferri EL, Jhiang SM: Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97 (5): 418-28, 1994.
Shah JP, Loree TR, Dharker D, et al.: Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164 (6): 658-61, 1992.
Andersen PE, Kinsella J, Loree TR, et al.: Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg 170 (5): 467-70, 1995.
Coburn MC, Wanebo HJ: Prognostic factors and management considerations in patients with cervical metastases of thyroid cancer. Am J Surg 164 (6): 671-6, 1992.
Voutilainen PE, Multanen MM, Leppäniemi AK, et al.: Prognosis after lymph node recurrence in papillary thyroid carcinoma depends on age. Thyroid 11 (10): 953-7, 2001.
Sellers M, Beenken S, Blankenship A, et al.: Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer. Am J Surg 164 (6): 578-81, 1992.
Cunningham DK, Yao KA, Turner RR, et al.: Sentinel lymph node biopsy for papillary thyroid cancer: 12 years of experience at a single institution. Ann Surg Oncol 17 (11): 2970-5, 2010.
Lennard CM, Patel A, Wilson J, et al.: Intensity of vascular endothelial growth factor expression is associated with increased risk of recurrence and decreased disease-free survival in papillary thyroid cancer. Surgery 129 (5): 552-8, 2001.
van Herle AJ, van Herle KA: Thyroglobulin in benign and malignant thyroid disease. In: Falk SA: Thyroid Disease: Endocrinology, Surgery, Nuclear Medicine, and Radiotherapy. Philadelphia, Pa: Lippincott-Raven, 1997, pp 601-618.
Ruiz-Garcia J, Ruiz de Almodóvar JM, Olea N, et al.: Thyroglobulin level as a predictive factor of tumoral recurrence in differentiated thyroid cancer. J Nucl Med 32 (3): 395-8, 1991.
Duren M, Siperstein AE, Shen W, et al.: Value of stimulated serum thyroglobulin levels for detecting persistent or recurrent differentiated thyroid cancer in high- and low-risk patients. Surgery 126 (1): 13-9, 1999.
Godballe C, Asschenfeldt P, Jørgensen KE, et al.: Prognostic factors in papillary and follicular thyroid carcinomas: p53 expression is a significant indicator of prognosis. Laryngoscope 108 (2): 243-9, 1998.
Cell type is an important determinant of prognosis in thyroid cancer. There
are four main varieties of thyroid cancer (although, for clinical management of
the patient, thyroid cancer is generally divided into two categories: well differentiated or
A definition for each major type can be found under stage information.
LiVolsi VA: Pathology of thyroid disease. In: Falk SA: Thyroid Disease: Endocrinology, Surgery, Nuclear Medicine, and Radiotherapy. Philadelphia, Pa: Lippincott-Raven, 1997, pp 127-175.
Kushchayeva Y, Duh QY, Kebebew E, et al.: Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with Hurthle cell or follicular thyroid cancer. Am J Surg 195 (4): 457-62, 2008.
Mills SC, Haq M, Smellie WJ, et al.: Hürthle cell carcinoma of the thyroid: Retrospective review of 62 patients treated at the Royal Marsden Hospital between 1946 and 2003. Eur J Surg Oncol 35 (3): 230-4, 2009.
The American Joint Committee on Cancer (AJCC) has designated staging by TNM
classification to define thyroid cancer.
Primary tumor cannot be assessed.
No evidence of primary tumor.
Tumor ≤2 cm in greatest dimension limited to the thyroid.
Tumor ≤1 cm, limited to the thyroid.
Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid.
Tumor >2 cm but ≤4 cm in greatest dimension, limited to the thyroid.
Tumor >4 cm in greatest dimension limited to the thyroid or any tumor with minimal extrathyroid extension (e.g., extension to sternothyroid muscle or perithyroid soft tissues).
Moderately advanced disease.
Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve.
Very advanced disease.
Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels.
Intrathyroidal anaplastic carcinoma.
Anaplastic carcinoma with gross extrathyroid extension.
aReprinted with permission from AJCC: Thyroid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
bAll categories may be subdivided: (s) solitary tumor and (m) multifocal tumor (the largest determines the classification).
cAll anaplastic carcinomas are considered T4 tumors.
Regional lymph nodes cannot be assessed.
No regional lymph node metastasis.
Regional lymph node metastasis.
Metastases to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes).
Metastases to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII).
bRegional lymph nodes are the central compartment, lateral cervical, and upper mediastinal lymph nodes.
No distant metastasis.
Papillary or follicular (differentiated)
YOUNGER THAN 45 YEARS
45 YEARS AND OLDER
Medullary carcinoma (all age groups)
bSeparate stage groupings are recommended for papillary or follicular (differentiated), medullary, and anaplastic (undifferentiated) carcinoma.
cAll anaplastic carcinomas are considered Stage IV.
Stage I papillary thyroid cancer
Stage I papillary carcinoma is localized to the thyroid gland. In as many as
50% of cases, there are multifocal sites of papillary adenocarcinomas throughout
the gland. Most papillary cancers have some follicular elements, and these may
sometimes be more numerous than the papillary formations, but this does not
change the prognosis. The 10-year survival rate is slightly better for
patients younger than 45 years than for patients older than 45 years.
Stage II papillary thyroid cancer
Stage II papillary carcinoma is defined as either: (1) tumor that has spread
distantly in patients younger than 45 years, or (2) tumor that is larger than 2 cm but 4 cm or smaller and is limited to the thyroid gland in patients older
than 45 years. In as many as 50% to 80% of cases, there are multifocal
sites of papillary adenocarcinomas throughout the gland. Most papillary
cancers have some follicular elements, and these may sometimes be more numerous
than the papillary formations, but this does not appear to change the
Stage III papillary thyroid cancer
Stage III is papillary carcinoma in patients older than 45 years that is larger than 4 cm and is limited to the thyroid or with minimal extrathyroid extension, or positive lymph nodes limited to the pretracheal, paratracheal, or prelaryngeal/Delphian nodes. Papillary carcinoma that has
invaded adjacent cervical tissue has a worse prognosis than tumors confined to
Stage IV papillary thyroid cancer
Stage IV is papillary carcinoma in patients older than 45 years with
extension beyond the thyroid capsule to the soft tissues of the neck, cervical lymph node metastases, or distant metastases. The lungs and bone are the most frequent distant sites of
spread, though such distant spread is rare in this type of thyroid cancer.
Papillary carcinoma more frequently metastasizes to regional lymph nodes than
to distant sites. The prognosis for patients with distant metastases is poor.
Stage I follicular thyroid cancer
Stage I follicular carcinoma is localized to the thyroid gland. Follicular
thyroid carcinoma must be distinguished from follicular adenomas, which are
characterized by their lack of invasion through the capsule into the
surrounding thyroid tissue. While follicular cancer has a good prognosis, it
is less favorable than that of papillary carcinoma. The 10-year survival is better for
patients with follicular carcinoma without vascular invasion than it is for
patients with vascular invasion.
Stage II follicular thyroid cancer
Stage II follicular carcinoma is defined as either tumor that has spread
distantly in patients younger than 45 years, or tumor that is larger than 2 cm but 4 cm or smaller and is limited to the thyroid gland in patients older
than 45 years. The presence of lymph node metastases does not worsen
the prognosis among patients younger than 45 years. Follicular thyroid carcinoma must be distinguished from
follicular adenomas, which are characterized by their lack of invasion through
the capsule into the surrounding thyroid tissue. While follicular cancer has
a good prognosis, it is less favorable than that of papillary carcinoma; the
10-year survival is better for patients with follicular carcinoma without vascular
invasion than for patients with vascular invasion.
Stage III follicular thyroid cancer
Stage III is follicular carcinoma in patients older than 45 years, larger than 4 cm and limited to the thyroid or with minimal extrathyroid extension, or positive lymph nodes limited to the pretracheal, paratracheal, or prelaryngeal/Delphian nodes. Follicular carcinoma invading
cervical tissue has a worse prognosis than tumors confined to the thyroid
gland. The presence of vascular invasion is an additional poor prognostic
factor. Metastases to lymph nodes do not worsen the prognosis in patients younger than 45 years.
Stage IV follicular thyroid cancer
Stage IV is follicular carcinoma in patients older than 45 years with
extension beyond the thyroid capsule to the soft tissues of the neck, cervical lymph node metastases, or distant metastases. The lungs and bone are the most frequent sites of spread.
Follicular carcinomas more commonly have blood vessel invasion and tend to
metastasize hematogenously to the lungs and to the bone rather than through the
lymphatic system. The prognosis for patients with distant metastases is poor.
Hürthle cell carcinoma
Hürthle cell carcinoma is a variant of follicular carcinoma with a similar prognosis and should be treated in the same way as equivalent stage non-Hürthle cell follicular carcinoma.
Several staging systems have been employed to correlate extent of disease with
long-term survival in medullary thyroid cancer. The clinical staging system of
the AJCC correlates survival to size of the primary tumor, presence or absence
of lymph node metastases, and presence or absence of distance metastasis.
Patients with the best prognosis are those who are diagnosed by provocative
screening, prior to the appearance of palpable disease.
Stage 0 medullary thyroid cancer
Clinically occult disease detected by provocative biochemical screening.
Stage I medullary thyroid cancer
Tumor smaller than 2 cm.
Stage II medullary thyroid cancer
Tumor larger than 2 cm but 4 cm or smaller with no metastases or larger than 4 cm with minimal extrathyroid extension.
Stage III medullary thyroid cancer
Tumor of any size with metastases limited to the pretracheal, paratracheal, or prelaryngeal/Delphian lymph nodes.
Stage IV medullary thyroid cancer
Stage IV medullary thyroid cancer is divided into the following categories:
Medullary carcinoma usually presents as a hard mass and is often accompanied
by blood vessel invasion. Medullary thyroid cancer occurs in two forms,
sporadic and familial. In the sporadic form, the tumor is usually unilateral.
In the familial form, the tumor is almost always bilateral. In addition, the
familial form may be associated with benign or malignant tumors of other
endocrine organs, commonly referred to as the multiple endocrine neoplasia
syndromes (MEN 2A or MEN 2B).
In these syndromes, there is an association with pheochromocytoma of the adrenal
gland and parathyroid hyperplasia. Medullary carcinoma usually secretes
calcitonin, a hormonal marker for the tumor, and may be detectable in blood
even when the tumor is clinically occult. Metastases to regional lymph nodes
are found in about 50% of cases. Prognosis depends on extent of disease at
presentation, presence or absence of regional lymph node metastases, and
completeness of the surgical resection.
Family members should be screened for calcitonin elevation to identify
individuals who are at risk of developing familial medullary thyroid cancer.
MEN 2A gene carrier status can be more accurately determined by analysis of
mutations in the RET gene. Whereas modest el
mutation is the optimal approach in evaluating MEN 2A. All patients with
medullary carcinoma of the thyroid (whether familial or sporadic) should be
tested for RET mutations, and, if they are positive, family members should
also be tested. Family members who are gene carriers should undergo
prophylactic thyroidectomy at an early age.
No generally accepted staging system is available for anaplastic thyroid cancer.
All patients are considered to have stage IV disease.
Undifferentiated (anaplastic) carcinomas are highly malignant cancers of
the thyroid. They may be subclassified as small cell or large cell carcinomas.
Both grow rapidly and extend to structures beyond the thyroid. Both small cell
and large cell carcinomas present as hard, ill-defined masses, often with
extension into the structures surrounding the thyroid. Small cell anaplastic
thyroid carcinoma must be carefully distinguished from lymphoma. This tumor
usually occurs in an older age group and is characterized by extensive local
invasion and rapid progression. Five-year survival with this tumor is poor.
Death is usually from uncontrolled local cancer in the neck, usually within
months of diagnosis.
Thyroid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 87-96.
Haigh PI, Urbach DR: The treatment and prognosis of Hürthle cell follicular thyroid carcinoma compared with its non-Hürthle cell counterpart. Surgery 138 (6): 1152-7; discussion 1157-8, 2005.
Colson YL, Carty SE: Medullary thyroid carcinoma. Am J Otolaryngol 14 (2): 73-81, 1993 Mar-Apr.
Lips CJ, Landsvater RM, Höppener JW, et al.: Clinical screening as compared with DNA analysis in families with multiple endocrine neoplasia type 2A. N Engl J Med 331 (13): 828-35, 1994.
Decker RA, Peacock ML, Borst MJ, et al.: Progress in genetic screening of multiple endocrine neoplasia type 2A: is calcitonin testing obsolete? Surgery 118 (2): 257-63; discussion 263-4, 1995.
Skinner MA, Moley JA, Dilley WG, et al.: Prophylactic thyroidectomy in multiple endocrine neoplasia type 2A. N Engl J Med 353 (11): 1105-13, 2005.
Neff RL, Farrar WB, Kloos RT, et al.: Anaplastic thyroid cancer. Endocrinol Metab Clin North Am 37 (2): 525-38, xi, 2008.
Surgery is the therapy of choice for all primary lesions. Surgical options
include total thyroidectomy or lobectomy. The choice of procedure is
influenced mainly by the age of the patient and the size of the nodule.
Survival results may be similar; the difference between them lies in the rates
of surgical complications and local recurrences.
Standard treatment options:
This procedure is advocated because of the high
incidence of multicentric involvement of both lobes of the gland and the
possibility of dedifferentiation of any residual tumor to the anaplastic cell
From the National Cancer Center Data Base (NCDB) registry of 52,173 patients, 43,227 (82.9%) underwent total thyroidectomy, and 8,946 (17.1%) underwent lobectomy. For a papillary thyroid cancer measuring less than 1 cm, the extent of surgery did not impact recurrence or survival (P = .24 and P = .83, respectively). For tumors measuring 1 cm or larger, lobectomy resulted in higher risk of recurrence and death (P = .04 and P = .009, respectively). To minimize the influence of larger tumors, 1-cm to 2-cm lesions were examined separately; lobectomy again resulted in a higher risk of recurrence and death (P = .04 and P = .04, respectively). In this study, total thyroidectomy resulted in lower recurrence rates and improved survival for patients with papillary thyroid cancer measuring 1 cm or larger compared with lobectomy.[Level of evidence: 3iiA]
Furthermore, in a pattern of care study, using the NCDB registry from 1985 to 2003, 57,243 papillary thyroid cancer patients with tumors measuring 1 cm or larger underwent total thyroidectomy or lobectomy. Trends in the extent of surgery were examined for patients with papillary thyroid cancer over 2 decades. Logistic regression was used to identify factors that predict the use of total thyroidectomy compared with lobectomy. Use of total thyroidectomy increased from 70.8% in 1985 to 90.4% in 2003 (P < .0001). Patients treated at high-volume medical facilities or academic centers were more likely to undergo total thyroidectomy than were patients examined at low-volume medical facilities or community hospitals (P < .0001).[Level of evidence: 3i]
The objective of surgery is to completely remove the primary tumor, while minimizing treatment-related morbidity, and to guide postoperative treatment with radioactive iodine (RAI). The goal of RAI is to ablate the remnant thyroid tissue to improve the specificity of thyroglobulin assays, which allows the detection of persistent disease by follow-up whole-body scanning. For patients undergoing RAI, removal of all normal thyroid tissue is an important surgical objective. Additionally, for accurate long-term surveillance, RAI whole-body scanning and measurement of serum thyroglobulin are affected by residual, normal thyroid tissue, and in these situations, near total or total thyroidectomy is required. This approach facilitates follow-up thyroid scanning.
I131: Studies have shown that a postoperative course of therapeutic
(ablative) doses of I131 results in a decreased recurrence rate among high-risk patients with papillary
and follicular carcinomas. It may be given in addition to exogenous thyroid
hormone but is not considered routine. Patients presenting with papillary
thyroid microcarcinomas (tumors <10 mm) have an excellent prognosis when
treated surgically, and additional therapy with I131 would not be expected to
improve the prognosis.
Thyroid lobectomy alone may be sufficient treatment for small (<1 cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of prior head and neck irradiation or radiologically or clinically involved cervical nodal metastases. This procedure is associated with a lower incidence of
complications, but approximately 5% to 10% of patients will have a recurrence
in the thyroid following lobectomy. Patients younger than 45 years will have the longest follow-up period and the greatest opportunity for
recurrence. Follicular thyroid cancer commonly metastasizes to lungs and bone; with a remnant lobe in place, use of I131 as ablative therapy is compromised. Abnormal regional lymph nodes should be biopsied at the time of
surgery. Recognized nodal involvement should be removed at initial surgery, but
selective node removal can be performed, and radical neck dissection is usually not
results in a decreased recurrence rate but has not been shown to improve
Following the surgical procedure, patients should receive postoperative
treatment with exogenous thyroid hormone in doses sufficient to suppress
thyroid-stimulating hormone (TSH); studies have shown a decreased incidence of
recurrence when TSH is suppressed.
I131: Studies have shown that a postoperative course of therapeutic
(ablative) doses of I131 results in a decreased recurrence rate among high-risk patients with papillary
and follicular carcinomas. For optimal treatment with RAI, total thyroidectomy is recommended with minimal thyroid remnant remaining. With a large thyroid remnant, a low thyroglobulin level cannot be achieved, which increases the chance of requiring multiple doses of RAI.
Consideration of RAI for remnant ablation is based on pathological risk features including:
RAI may be given with one of two methods of thyrotropin stimulation: withdrawal of thyroid hormone or recombinant human thyrotropin (rhTSH). Administered rhTSH maintains quality of life and reduces the radiation dose delivered to the body compared with thyroid hormone withdrawal. Patients presenting with papillary
thyroid microcarcinomas (tumors <10 mm), which are considered to be very low risk, have an excellent prognosis when
treated surgically, and additional therapy with I131 would not be expected to
improve the prognosis.
The role of RAI in low-risk patients is not clear because disease-free survival (DFS) or overall survival (OS) benefits have not been demonstrated. One study reviewed 1,298 patients from the French Thyroid Cancer Registry. Patients were identified as having low-risk papillary or follicular cancer as they are defined by the American Thyroid Association and the European Thyroid Association criteria:
Of the 1,298 patients, 911 patients received RAI after surgery, and 387 patients did not receive RAI after surgery. Follow-up period was 10.3 years; in multivariate analyses, there were no differences in OS (P = .243) or DFS (P = .2659), according to RAI use.
Long-term complications of RAI using I131 include second malignancies, sialadenitis, and lacrimal and salivary gland dysfunction. Options for reducing the amount of radiation exposure by reducing the amount of RAI in each dose and also to give RAI in combination with rhTSH injections have been explored for low-risk thyroid cancer patients.
Two phase III, randomized, noninferiority studies of patients with low-risk thyroid cancer using a comparison of two thyrotropin-stimulation methods (thyroid hormone withdrawal or use of rhTSH) and two doses of radioiodine I131 1.1GBq [30mCi] and 3.7GBq [100mCi] using a 2 × 2 factorial design showed equivalent thyroid ablation rates between high and low dose I131 at 6 to 10 months after administration of I131.[Levels of evidence: 3iA and3iDii] However, differences in the inclusion criteria in one study  consisted of a low-risk, homogeneous cohort in which all of the patients underwent total thyroidectomy, and had pathological TNM stage pT1 ( ≤1 cm) and N1 or Nx, pT1 (>1–2cm) and any N stage, or pT2N0 without thyroid capsule extension/distant metastases. Complete thyroid ablation rate in this study was 92%. Patients undergoing thyroid hormone withdrawal had greater symptoms of hypothyroidism associated with deterioration in quality of life compared with the rhTSH group.
In the other study, patients with more advanced T stage (T1–T3, N0–1) and with less than a total thyroidectomy were included with a lower overall ablation rate of 85%. Neither study assessed the effect of low-dose RAI on long-term recurrences or survival. The studies also did not address whether RAI could be safely omitted in specific low-risk groups.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I papillary thyroid cancer, stage I follicular thyroid cancer, stage II papillary thyroid cancer and stage II follicular thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Cady B, Rossi R: An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 104 (6): 947-53, 1988.
Tollefsen HR, Shah JP, Huvos AG: Follicular carcinoma of the thyroid. Am J Surg 126 (4): 523-8, 1973.
Edis AJ: Surgical treatment for thyroid cancer. Surg Clin North Am 57 (3): 533-42, 1977.
Bilimoria KY, Bentrem DJ, Ko CY, et al.: Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 246 (3): 375-81; discussion 381-4, 2007.
Bilimoria KY, Bentrem DJ, Linn JG, et al.: Utilization of total thyroidectomy for papillary thyroid cancer in the United States. Surgery 142 (6): 906-13; discussion 913.e1-2, 2007.
Beierwaltes WH, Rabbani R, Dmuchowski C, et al.: An analysis of "ablation of thyroid remnants" with I-131 in 511 patients from 1947-1984: experience at University of Michigan. J Nucl Med 25 (12): 1287-93, 1984.
Hay ID, Grant CS, van Heerden JA, et al.: Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 112 (6): 1139-46; discussion 1146-7, 1992.
Hay ID, Grant CS, Bergstralh EJ, et al.: Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery 124 (6): 958-64; discussion 964-6, 1998.
Hänscheid H, Lassmann M, Luster M, et al.: Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 47 (4): 648-54, 2006.
Schvartz C, Bonnetain F, Dabakuyo S, et al.: Impact on overall survival of radioactive iodine in low-risk differentiated thyroid cancer patients. J Clin Endocrinol Metab 97 (5): 1526-35, 2012.
Schlumberger M, Catargi B, Borget I, et al.: Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366 (18): 1663-73, 2012.
Mallick U, Harmer C, Yap B, et al.: Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 366 (18): 1674-85, 2012.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III papillary thyroid cancer and stage III follicular thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Simpson WJ, Carruthers JS: The role of external radiation in the management of papillary and follicular thyroid cancer. Am J Surg 136 (4): 457-60, 1978.
The most common sites of metastases are lymph nodes, lung, and bone. Treatment
of lymph node metastases alone is often curative. Treatment of distant
metastases is usually not curative but may produce significant palliation.
Patients unresponsive to I131 should also be considered candidates for
clinical trials testing new approaches to this disease.
Treatment options under clinical evaluation:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV papillary thyroid cancer and stage IV follicular thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Gottlieb JA, Hill CS Jr, Ibanez ML, et al.: Chemotherapy of thyroid cancer. An evaluation of experience with 37 patients. Cancer 30 (3): 848-53, 1972.
Harada T, Nishikawa Y, Suzuki T, et al.: Bleomycin treatment for cancer of the thyroid. Am J Surg 122 (1): 53-7, 1971.
Shimaoka K, Schoenfeld DA, DeWys WD, et al.: A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 56 (9): 2155-60, 1985.
Sherman SI, Wirth LJ, Droz JP, et al.: Motesanib diphosphate in progressive differentiated thyroid cancer. N Engl J Med 359 (1): 31-42, 2008.
Medullary thyroid cancer (MTC) comprises 3% to 4% of all thyroid cancers.
These tumors usually present as a mass in the neck or thyroid, often associated
with lymphadenopathy, or they may be diagnosed through screening family
members. MTC can also be diagnosed by fine-needle aspiration biopsy. Cytology
typically reveals hypercellular tumors with spindle-shaped cells and poor
The overall survival of patients with MTC is 86% at 5 years and 65% at 10 years. Poor prognostic
factors include advanced age, advanced stage, prior neck surgery, and
associated multiple endocrine neoplasia (MEN) 2B.
Approximately 25% of reported cases of MTC are familial.
Familial MTC syndromes include MEN 2A, which is
the most common; MEN 2B; and familial non-MEN syndromes. (Refer to the PDQ summary on Genetics of Endocrine and Neuroendocrine Neoplasias for more information.) Any patient with a
familial variant should be screened for other associated endocrine tumors,
particularly parathyroid hyperplasia and pheochromocytoma. MTC can secrete
calcitonin and other peptide substances. Determining the level of calcitonin
is useful for diagnostic purposes and for following the results of treatment.
Family members should be screened for calcitonin elevation and/or for the RET proto-oncogene mutation to identify other individuals at risk for developing
familial MTC. All patients with MTC (whether familial or sporadic) should be
tested for RET mutations, and if they are positive, family members should
also be tested. Whereas modest elevation of calcitonin may lead to a false-positive diagnosis of medullary carcinoma, DNA testing for the RET mutation is
the optimal approach. Family members who are gene carriers should undergo
prophylactic thyroidectomy at an early age.
Treatment options for localized disease:
Patients with MTC should be treated with a total
thyroidectomy, unless there is evidence of distant metastasis. In patients
with clinically palpable MTC, the incidence of
microscopically positive nodes is more than 75%; routine central and bilateral
modified neck dissections have been recommended. When cancer is confined to
the thyroid gland, the prognosis is excellent.
External radiation therapy has been used for palliation of locally recurrent
tumors; however, no evidence exists that it provides any survival advantage. Radioactive iodine has no place in the treatment of patients with MTC.
Treatment options for locally advanced and metastatic disease:
Vandetanib is an oral inhibitor of RET kinase, vascular endothelial growth-factor receptor, and epidermal growth-factor receptor signaling. It was tested in a placebo-controlled, prospective trial (NCT00410761) in 331 patients with locally advanced and metastatic disease with a 2:1 ratio in assignment to the study drug. With a median follow-up of 24 months, progression-free survival (PFS) favored vandetanib (hazard ratio = 0.46; 95% confidence interval, 0.31–0.69; P < .001) with a median PFS estimated at 30.5 months for vandetanib versus 19.3 months for placebo.[Level of evidence: 1iiDiii]
Overall survival (OS) was not different at 24 months; longer follow-up will be required since only 47 patients had died at the time of analysis, and there was a crossover to the study drug on progression from placebo, making analysis of OS problematic. Vandetanib has significant side effects, including diarrhea, rash, hypertension, and QT prolongation. Quality of life was not formally assessed in this trial.
Palliative chemotherapy has been reported to produce occasional responses in
patients with metastatic disease. No single drug regimen can be
considered standard. Some patients with distant metastases will experience
prolonged survival and can be managed expectantly until they become
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with thyroid gland medullary carcinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Soh EY, Clark OH: Surgical considerations and approach to thyroid cancer. Endocrinol Metab Clin North Am 25 (1): 115-39, 1996.
Giuffrida D, Gharib H: Current diagnosis and management of medullary thyroid carcinoma. Ann Oncol 9 (7): 695-701, 1998.
Saad MF, Ordonez NG, Rashid RK, et al.: Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. Medicine (Baltimore) 63 (6): 319-42, 1984.
Bergholm U, Bergström R, Ekbom A: Long-term follow-up of patients with medullary carcinoma of the thyroid. Cancer 79 (1): 132-8, 1997.
Moley JF, DeBenedetti MK: Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg 229 (6): 880-7; discussion 887-8, 1999.
Brierley JD, Tsang RW: External radiation therapy in the treatment of thyroid malignancy. Endocrinol Metab Clin North Am 25 (1): 141-57, 1996.
Wells SA Jr, Robinson BG, Gagel RF, et al.: Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind phase III trial. J Clin Oncol 30 (2): 134-41, 2012.
De Besi P, Busnardo B, Toso S, et al.: Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. J Endocrinol Invest 14 (6): 475-80, 1991.
Wu LT, Averbuch SD, Ball DW, et al.: Treatment of advanced medullary thyroid carcinoma with a combination of cyclophosphamide, vincristine, and dacarbazine. Cancer 73 (2): 432-6, 1994.
Orlandi F, Caraci P, Berruti A, et al.: Chemotherapy with dacarbazine and 5-fluorouracil in advanced medullary thyroid cancer. Ann Oncol 5 (8): 763-5, 1994.
Standard treatment options:
Tracheostomy is frequently necessary. If the disease is confined to the local area, which is rare, total thyroidectomy is warranted to
reduce symptoms caused by the tumor mass.
External-beam radiation therapy may be used in patients who are not surgical candidates or whose tumor cannot be surgically
Anaplastic thyroid cancer is not responsive to I131 therapy;
treatment with individual anticancer drugs has been reported to produce partial
remissions in some patients. Approximately 30% of patients achieve a partial
remission with doxorubicin. The combination of doxorubicin plus cisplatin
appears to be more active than doxorubicin alone and has been reported to
produce more complete responses.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with anaplastic thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Goldman JM, Goren EN, Cohen MH, et al.: Anaplastic thyroid carcinoma: long-term survival after radical surgery. J Surg Oncol 14 (4): 389-94, 1980.
Aldinger KA, Samaan NA, Ibanez M, et al.: Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. Cancer 41 (6): 2267-75, 1978.
Haigh PI, Ituarte PH, Wu HS, et al.: Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival. Cancer 91 (12): 2335-42, 2001.
De Crevoisier R, Baudin E, Bachelot A, et al.: Combined treatment of anaplastic thyroid carcinoma with surgery, chemotherapy, and hyperfractionated accelerated external radiotherapy. Int J Radiat Oncol Biol Phys 60 (4): 1137-43, 2004.
Patients treated for differentiated thyroid cancer should be followed carefully
with physical examinations, serum quantitative thyroglobulin levels, and radiologic studies based
on individual risk for recurrent disease. Approximately 10% to 30% of
patients thought to be disease free after initial treatment will develop
recurrence and/or metastases. Of these patients, approximately 80% develop recurrence
with disease in the neck alone, and 20% develop recurrence with distant metastases. The most
common site of distant metastasis is the lung. In a single series of 289
patients who developed recurrences after initial surgery, 16% died of cancer at
a median time of 5 years following recurrence.
The prognosis for patients
with clinically detectable recurrences is generally poor, regardless of cell
type. Those patients who recur with local or regional tumor
detected only by I131 scan, however, have a better prognosis. The selection of
further treatment depends on many factors, including cell type, uptake of
I131, prior treatment, site of recurrence, and individual patient
considerations. Surgery with or without I131 ablation can be useful in
controlling local recurrences, regional node metastases, or, occasionally,
metastases at other localized sites. Approximately 50% of the patients
operated on for recurrent tumors can be rendered free of disease with a second
operation. Local and regional recurrences detected by I131 scan and not
clinically apparent can be treated with I131 ablation and have an excellent
Up to 25% of recurrences and metastases from well-differentiated thyroid cancer
may not show I131 uptake. For these patients, other imaging techniques shown
to be of value include imaging with thallium-201, magnetic resonance imaging,
and pentavalent dimercaptosuccinic acid. When recurrent disease does not
concentrate I131, external-beam or intraoperative radiation therapy can be
useful in controlling symptoms related to local tumor recurrences. Systemic
chemotherapy can be considered. Chemotherapy has been reported to produce
occasional objective responses, usually of short duration.
A phase II study (NCT00654238) looked at the activity of sorafenib, an orally active, multityrosine kinase inhibitor that affects tumor cell proliferation and angiogenesis, administered to 30 patients with advanced iodine-refractory thyroid cancer. Among 25 assessable patients, there were 7 patients with partial responses and 16 patients with stable disease. The progression-free survival for differentiated thyroid cancer patients was 84 weeks.[Level of evidence: 3iiDiii] Further investigation of this approach is warranted.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Ross DS: Long-term management of differentiated thyroid cancer. Endocrinol Metab Clin North Am 19 (3): 719-39, 1990.
Goretzki PE, Simon D, Frilling A, et al.: Surgical reintervention for differentiated thyroid cancer. Br J Surg 80 (8): 1009-12, 1993.
Pak H, Gourgiotis L, Chang WI, et al.: Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. J Surg Oncol 82 (1): 10-8, 2003.
Coburn M, Teates D, Wanebo HJ: Recurrent thyroid cancer. Role of surgery versus radioactive iodine (I131) Ann Surg 219 (6): 587-93; discussion 593-5, 1994.
Mallin WH, Elgazzar AH, Maxon HR 3rd: Imaging modalities in the follow-up of non-iodine avid thyroid carcinoma. Am J Otolaryngol 15 (6): 417-22, 1994 Nov-Dec.
Vikram B, Strong EW, Shah JP, et al.: Intraoperative radiotherapy in patients with recurrent head and neck cancer. Am J Surg 150 (4): 485-7, 1985.
Gupta-Abramson V, Troxel AB, Nellore A, et al.: Phase II trial of sorafenib in advanced thyroid cancer. J Clin Oncol 26 (29): 4714-9, 2008.
This information was last updated on July 11, 2014.
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