Thyroid cancer
Thyroid cancer | |
---|---|
Five year survival rates 98% (US)[5] | |
Frequency | 3.2 million (2015)[6] |
Deaths | 31,900 (2015)[7] |
Thyroid cancer is
Risk factors include
Treatment options may include
Globally as of 2015, 3.2 million people have thyroid cancer.
Signs and symptoms
Most often, the first symptom of thyroid cancer is a nodule in the thyroid region of the neck.[13] However, up to 65% of adults have small nodules in their thyroids, but typically under 10% of these nodules are found to be cancerous.[14] Sometimes, the first sign is an enlarged lymph node. Later symptoms that can be present are pain in the anterior region of the neck and changes in voice due to an involvement of the recurrent laryngeal nerve.[15]
Thyroid cancer is usually found in a
Causes
Thyroid cancers are thought to be related to a number of environmental and genetic predisposing factors, but significant uncertainty remains regarding their causes.[16]
Environmental exposure to
Genetic causes include multiple endocrine neoplasia type 2, which markedly increases rates, particularly of the rarer medullary form of the disease.[21]
Diagnosis
After a
After diagnosis, to understand potential for spread of disease, or for follow up monitoring after surgery, a whole body I-131 or I-123 radioactive iodine scan may be performed.[27]
In adults without symptoms, screening for thyroid cancer is not recommended.[28]
Classification
Thyroid cancers can be classified according to their
These variants can be distinguished (distribution over various subtypes may show regional variation):- Papillary thyroid cancer (75 to 85% of cases[32]) – is more often diagnosed in young females compared to other types of thyroid cancer and has an excellent prognosis. It may occur in women with familial adenomatous polyposis and in patients with Cowden syndrome. A follicular variant of papillary thyroid cancer also exists.[33]
- Newly reclassified variant: noninvasive follicular thyroid neoplasm with papillary-like nuclear featuresis considered an indolent tumor of limited biologic potential.
- Medullary thyroid cancer (5[32] to 8% of cases) – cancer of the parafollicular cells, often part of multiple endocrine neoplasia type 2.[35]
- Poorly differentiated thyroid cancer
- Anaplastic thyroid cancer (1 to 2%[36]) is not responsive to treatment and can cause pressure symptoms.
- Others
- Thyroid lymphoma
- Squamous cell thyroid carcinoma
- Sarcoma of thyroid
- Hürthle cell carcinoma
The follicular and papillary types together can be classified as "differentiated thyroid cancer".[37] These types have a more favorable prognosis than the medullary and undifferentiated types.[38]
- Papillary microcarcinoma is a subset of papillary thyroid cancer defined as a nodule measuring less than or equal to 1 cm.[39] 43% of all thyroid cancers and 50% of new cases of papillary thyroid carcinoma are papillary microcarcinoma.[40][41] Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to lobectomy or observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having cancer. Woolner et al. first arbitrarily coined the term "occult papillary carcinoma", in 1960, to describe papillary carcinomas ≤ 1.5 cm in diameter.[42]
Staging
Cancer staging is the process of determining the extent of the development of a cancer. The TNM staging system is usually used to classify stages of cancers, but not of the brain.[43]
-
Stage M1 thyroid cancer
-
Stage N1a thyroid cancer
-
Stage N1b thyroid cancer
-
Stage T1a thyroid cancer
-
Stage T1b thyroid cancer
-
Stage T2 thyroid cancer
-
Stage T3 thyroid cancer
-
Stage T4a thyroid cancer
-
Stage T4b thyroid cancer
Metastases
Detection of differentiated thyroid cancer metastases may be detected by performing a full-body scintigraphy using iodine-131.[44][45]
Spread
Thyroid cancer can spread directly, via lymphatics or blood. Direct spread occurs through infiltration of the surrounding tissues. The tumor infiltrates into
Treatment
Thyroidectomy and dissection of central neck compartment is the initial step in treatment of thyroid cancer in the majority of cases.[13] Thyroid-preserving operations may be applied in cases, when thyroid cancer exhibits low biological aggressiveness (e.g. well-differentiated cancer, no evidence of lymph-node metastases, low MIB-1 index, no major genetic alterations like BRAF mutations, RET/PTC rearrangements, p53 mutations etc.) in patients younger than 45 years.[47] If the diagnosis of well-differentiated thyroid cancer (e.g. papillary thyroid cancer) is established or suspected by
Radioactive iodine-131 is used in people with papillary or follicular thyroid cancer for ablation of residual thyroid tissue after surgery and for the treatment of thyroid cancer.[50] Patients with medullary, anaplastic, and most Hurthle-cell cancers do not benefit from this therapy.[13]
External irradiation may be used when the cancer is unresectable, when it recurs after resection, or to relieve pain from bone metastasis.[13]
Sorafenib and lenvatinib are approved for advanced metastatic thyroid cancer.[51] Numerous agents are in phase II and III clinical trials.[51]
Post surgical monitoring for recurrence or metastasis may include routine ultrasound, CT scans, FDG-PET/CT, radioactive iodine whole body scans, and routine laboratory blood tests for changes in thyrogolubin, thyroglobuilin antibodies, or calcitonin, depending on the variant of thyroid cancer.[52][53][54]
Prognosis
This section needs additional citations for verification. (October 2014) |
The prognosis of thyroid cancer is related to the type of cancer and the stage at the time of diagnosis. For the most common form of thyroid cancer, papillary, the overall prognosis is excellent. Indeed, the increased incidence of papillary thyroid carcinoma in recent years is likely related to increased and earlier diagnosis. One can look at the trend to earlier diagnosis in two ways. The first is that many of these cancers are small and not likely to develop into aggressive malignancies. A second perspective is that earlier diagnosis removes these cancers at a time when they are not likely to have spread beyond the thyroid gland, thereby improving the long-term outcome for the patient. No consensus exists at present on whether this trend toward earlier diagnosis is beneficial or unnecessary.
The argument against early diagnosis and treatment is based on the logic that many small thyroid cancers (mostly papillary) will not grow or metastasize. This view holds the overwhelming majority of thyroid cancers are
Thyroid cancer is three times more common in women than in men, but according to European statistics,
The table below highlights some of the challenges with decision making and prognostication in thyroid cancer. While general agreement exists that stage I or II papillary, follicular, or medullary cancer have good prognoses, when evaluating a small thyroid cancer to determine which ones will grow and metastasize and which will not is not possible. As a result, once a diagnosis of thyroid cancer has been established (most commonly by a fine needle aspiration), a total thyroidectomy likely will be performed.
This drive to earlier diagnosis has also manifested itself on the European continent by the use of serum calcitonin measurements in patients with goiter to identify patients with early abnormalities of the parafollicular or calcitonin-producing cells within the thyroid gland. As multiple studies have demonstrated, the finding of an elevated serum calcitonin is associated with the finding of a medullary thyroid carcinoma in as high as 20% of cases.
In Europe where the threshold for thyroid surgery is lower than in the United States, an elaborate strategy that incorporates serum calcitonin measurements and stimulatory tests for calcitonin has been incorporated into the decision to perform a thyroidectomy; thyroid experts in the United States, looking at the same data, have for the most part not incorporated calcitonin testing as a routine part of their evaluations, thereby eliminating a large number of thyroidectomies and the consequent morbidity. The European thyroid community has focused on prevention of metastasis from small medullary thyroid carcinomas; the North American thyroid community has focused more on prevention of complications associated with thyroidectomy (see American Thyroid Association guidelines below). As demonstrated in the table below, individuals with stage III and IV disease have a significant risk of dying from thyroid cancer. While many present with widely metastatic disease, an equal number evolve over years and decades from stage I or II disease. Physicians who manage thyroid cancer of any stage recognize that a small percentage of patients with low-risk thyroid cancer will progress to metastatic disease.
Improvements have been made in thyroid cancer treatment during recent years. The identification of some of the molecular or DNA abnormalities has led to the development of therapies that target these molecular defects. The first of these agents to negotiate the approval process is
Prognosis is better in younger people than older ones.[58]
Prognosis depends mainly on the type of cancer and
Thyroid cancer type |
5-year survival | 10-year survival | ||||
---|---|---|---|---|---|---|
Stage I | Stage II | Stage III | Stage IV | Overall | Overall | |
Papillary | 100%[60] | 100%[60] | 93%[60] | 51%51%[60] | 96%[61] or 97%[62] | 93%[61] |
Follicular | 100%[60] | 100%[60] | 71%[60] | 50%[60] | 91%[61] | 85%[61] |
Medullary | 100%[60] | 98%[60] | 81%[60] | 28%[60] | 80%,[61] 83%[63] or 86%[64] | 75%[61] |
Anaplastic | (always stage IV)[60] | 7%[60] | 7%[60] or 14%[61] | (no data) |
Epidemiology
Thyroid cancer, in 2010, resulted in 36,000 deaths globally up from 24,000 in 1990.[65] Obesity may be associated with a higher incidence of thyroid cancer, but this relationship remains the subject of much debate.[66]
Thyroid cancer accounts for less than 1% of cancer cases and deaths in the UK. Around 2,700 people were diagnosed with thyroid cancer in the UK in 2011, and around 370 people died from the disease in 2012.[67]
However, in South Korea, thyroid cancer was the 5th most prevalent cancer, which accounted for 7.7% of new cancer cases in 2020.[68]
Notable cases
- Callum Ainley, English footballer[69]
- Ann-Katrin Berger, German women footballer
- Emre Can, German footballer[70]
- Jerry Dipoto, former Major League Baseball pitcher[71]
- Roger Ebert, American film critic
- Jennifer Grey, American actress
- Uhm Jung-hwa, South Korean singer, actress and dancer [72]
- Lee Moon-sae, South Korean ballad singer[73]
- Joe Piscopo, American actor
- Vladimir Putin, president of Russia[77]
- William Rehnquist, Chief Justice of the United States (1986–2005) died September 3, 2005, from anaplastic thyroid cancer[78]
- Katee Sackhoff, American actress
- Karen Smyers, American swimmer
- Daniel Snyder, American owner of the Washington Football Team[79]
- Rod Stewart, British singer
- Scott Thompson, American businessman
- Sofía Vergara, American actress
- Julia Volkova, Russian singer
- April Winchell, American actress
References
- ^ a b c d e f g h i j "Thyroid Cancer Treatment". National Cancer Institute. 27 April 2017. Archived from the original on 15 July 2017. Retrieved 18 July 2017.
- ^ PMID 24274180.
- ^ PMID 34915752.
- ^ a b c d e f "Thyroid Cancer Treatment". National Cancer Institute. 12 May 2017. Archived from the original on 16 July 2017. Retrieved 18 July 2017.
- ^ a b c d "Cancer of the Thyroid - Cancer Stat Facts". seer.cancer.gov. Archived from the original on 15 July 2017. Retrieved 18 July 2017.
- ^ PMID 27733282.
- ^ PMID 27733281.
- ^ "Cancer Fact sheet N°297". World Health Organization. February 2014. Archived from the original on 29 December 2010. Retrieved 10 June 2014.
- ^ "Defining Cancer". National Cancer Institute. 17 September 2007. Archived from the original on 25 June 2014. Retrieved 10 June 2014.
- S2CID 205091526.
- ^ ISBN 978-9283204299.
- S2CID 244033542.
- ^ ISBN 978-1-891483-62-2. Archived from the originalon 28 February 2010.
- S2CID 5042725.
- ^ "Thyroid Cancer". Herbert Irving Comprehensive Cancer Center (HICCC) - New York. 1 February 2021. Archived from the original on 5 February 2023. Retrieved 5 February 2023.
- ^ "Thyroid Cancer Overview - Signaling Pathway. Diagnosis. Targeted Therapy - Creative Biolabs". www.creativebiolabs.net. Archived from the original on 5 February 2023. Retrieved 5 February 2023.
- ^ "Radioactive I-131 from Fallout". National Cancer Institute. Archived from the original on 19 May 2014. Retrieved 9 June 2014.
- ^ PMID 8431362.
- ^ "Experts link higher incidence of children's cancer to Fukushima radiation". ScienceAlert. 12 October 2015. Archived from the original on 19 January 2016. Retrieved 15 January 2016.
- PMID 20555084.
- ^ "Genetics of Endocrine and Neuroendocrine Neoplasias". National Cancer Institute. 1 January 1980. Archived from the original on 4 July 2014. Retrieved 9 June 2014.
- PMID 31559190.
- S2CID 21514672.
- ^ "Thyroid scan: MedlinePlus Medical Encyclopedia". medlineplus.gov. Archived from the original on 27 January 2021. Retrieved 5 February 2021.
- ^ "Vol 7 Issue 6 p.3-4". American Thyroid Association. Archived from the original on 4 December 2020. Retrieved 5 February 2021.
- PMID 24294568.
- S2CID 22871325.
- S2CID 205091526.
- PMID 30264938.
- ^ "Thyroid Cancer Treatment". National Cancer Institute. 1 January 1980. Archived from the original on 21 April 2008. Retrieved 22 December 2007.
- ^ "Thyroid cancer". National Cancer Institute. Archived from the original on 20 December 2007. Retrieved 22 December 2007.
- ^ ISBN 978-1-4160-2973-1. 8th edition.
- PMID 23477346.
- S2CID 24129533.
- S2CID 25818628.
- ^ "Anaplastic Thyroid Cancer". Columbia Thyroid Center. Archived from the original on 23 December 2019. Retrieved 30 March 2020.
- from the original on 20 May 2013.
- S2CID 11825588.
- S2CID 23121159.
- PMID 26870138.
- PMID 21268762.
- PMID 13845950.
- ^ "Cancer Staging - NCI". www.cancer.gov. 9 March 2015. Archived from the original on 19 March 2015. Retrieved 5 February 2023.
- PMID 17914109.
- PMID 3183748.
- ISBN 978-8190568128.
- ^ PMID 19860577.
- ISBN 9781860163098. Archived from the original(PDF) on 26 December 2011. Retrieved 12 July 2013.
- ISBN 9780807022009. Retrieved 7 October 2012.
- PMID 24989897.
- ^ PMID 29399330.
- PMID 26462967.
- PMID 25810047.
- PMID 23130564.
- ^ ISBN 978-0-8070-2200-9.
- S2CID 5660811.
- ^ "Thyroid Cancer". MedicineNet.com. Archived from the original on 20 October 2011. Retrieved 26 October 2011.
- ^ ISBN 978-3-540-22309-2.
- ^ "FDA approves new treatment for rare form of thyroid cancer" (Press release). U.S. Food and Drug Administration. 6 April 2011. Archived from the original on 10 April 2011. Retrieved 7 April 2011.
- ^ a b c d e f g h i j k l m n o cancer.org Thyroid Cancer Archived 18 October 2013 at the Wayback Machine By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).
- ^ ISBN 978-3-540-22309-2. (Note:Book also states that the 14% 10-year survival for anaplastic thyroid cancer was overestimated)
- ^ Rounded up to nearest natural number from 96.7% as given by Santacroce L, Gagliardi S, Kennedy AS (28 September 2010). "Thyroid, Papillary Carcinoma". eMedicine. Archived from the original on 28 July 2010.
- PMID 16091497.
- ^ "Medullary Thyroid Cancer". National Cancer Institute. 4 February 2016. Archived from the original on 30 May 2016. Retrieved 11 May 2016.
- S2CID 1541253.
- from the original on 11 November 2014.
- ^ "Thyroid cancer statistics". Cancer Research UK. Archived from the original on 17 October 2014. Retrieved 28 October 2014.
- ^ "Republic of Korea Cancer Rates" (PDF). Global Cancer Observatory (GCO). World Health Organization. 2020. Archived (PDF) from the original on 11 November 2022. Retrieved 5 February 2022.
- ^ "Callum Ainley: Grimsby Town midfielder diagnosed with thyroid cancer". BBC Sport. 16 January 2024. Retrieved 17 January 2024.
- ^ Hunsley, James (27 January 2023). "'I am so grateful' - ex-Liverpool midfielder Emre Can opens up on battle with cancer". Goal.com. Archived from the original on 28 January 2023. Retrieved 29 January 2023.
- ^ Bamberger, Michael (27 May 2002). "Survivors". Sports Illustrated. Archived from the original on 1 March 2014. Retrieved 11 August 2013.
- ^ "Uhm Jung-hwa had Thyroid cancer op". The Korean Herald. 20 October 2010. Archived from the original on 5 February 2022. Retrieved 5 February 2022.
- ^ "Lee Moon-se risks cancer relapse to keep singing". The Korean Herald. 31 March 2015.
- ^ "Thyroid surgeon Dr. Gary Clayman teaches Danny about his cancer diagnosis". WFLA. 25 January 2021. Archived from the original on 20 February 2021. Retrieved 6 February 2021.
- ^ "Danny shares he has thyroid cancer, advocates for awareness". WFLA. 25 January 2021. Archived from the original on 1 February 2021. Retrieved 6 February 2021.
- ^ "Danny New is heading back to the Sunshine State". WWLP. 3 December 2019. Archived from the original on 8 August 2020. Retrieved 6 February 2021.
- ^ Jacobs E (3 April 2022). "Putin under care of cancer doctor, bathing in deer antler blood: Report". Washington Examiner. Archived from the original on 3 April 2022. Retrieved 3 April 2022.
- ^ Lane C (8 September 2005). "Rehnquist Eulogies Look Beyond Bench". The Washington Post. Archived from the original on 4 March 2016. Retrieved 11 May 2016.
- ^ "Celebrities with Thyroid problems". Alexander Shifrin. Archived from the original on 26 August 2013. Retrieved 11 August 2013.
External links
- Thyroid cancer at Curlie
- Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer—The American Thyroid Association Guidelines Taskforce (2015)