The treatment of thyroid cancer always
involves removing the thyroid gland. In patients who are under 45 years of
age with a very small tumor which is not diagnosed at the time of surgery -
observation and thyroid suppression with thyroxin is sometimes considered.
If cancer is known to be present at the time of surgery, a total thyoidectomy is
usually performed. A subtotal resection will not allow the patient to be
followed with serum thyroglobulins and if I-131 treatment is indicated a larger
dosage must be given.
Thyroglobulin is produced by the thyroid. In patients who have had a total
thyroidectomy, the value of this blood test should be zero. If it is not,
thyroid cancer may be somewhere in the patient. (Note: If the
patient has thyroid antibodies, they will bind to thyroglobulin and invalidate
The thyroid gland uses iodine to make thyroid hormone. The gland binds iodine.
If a patient is given radioactive iodine, the gland will uptake the compound and
concentrate thyroxin in the thyroid cells. The same is true for
differentiated thyroid cancer. This delivers a highly concentrated and
localized dosage of irradiation that kills both normal thyroid cells and cancer
cells. However, normal cells take up I-131 much more readily than
the cancer. If any part of the thyroid gland is left, it must first be
ablated. This increases the total dosage which the patient is given.
I-131 is used to treat advanced differentiated thyroid cancer and cancer
with distant metastasis. In lower doses it is also used to scan the
patient for distant metastases.
There is a total lifetime dosage of I-131 which can be given to the patient.
In addition, I-131 may rarely cause the cancer to dedifferentiate and become
more aggressive. Some patients who receive I-131 may developed a dry cough and
A modified neck dissection involves the removal of
lymph nodes from around the thyroid gland, the carotid artery, and posterior
neck. It should be done if:
The patient has known lateral disease.
The patient has medullary carcinoma. Medullary carcinoma has a very high rate of neck metastasis.
A modified neck dissection should be considered
Patients older than 60 years.
Patients whose cancer has spread beyond the
capsule of the thyroid gland.
Primary tumors whose size is greater than 4 cm.
Aggressive tumors -- Hurthle cell, insular
and poorly differentiated. Some feel surgery is not indicated for anaplastic
tumors because of the very poor prognosis.
Thyroid Cancer Staging:
Thyroid cancer is the only cancer where the patient's age is a variable in
determining the stage or extent of the disease.
Thyroid cancer can be divided into three types:
Differentiated Cancers (papillary or follicular), Medullary Carcinoma,
Differentiated (Papillary and Follicular)
If the patient's age is below 45 there is
no Stage III or IV, even with spread to the lungs there is a 95% survival
-- Stage I: Any size tumor with any number and size of lymph nodes --
No distant spread.
-- Stage II: Distant spread or metastasis.
If the patient is 45 years of age or older:
-- Stage I: Tumor is less than 2 cm and has not spread to lymph nodes
-- Stage II: Tumor is 2 to 4 cm and has not spread to lymph nodes
-- Stage III: Tumor is larger than 4 cm and confined to the thyroid or has
spread to neck nodes next to the thyroid (T3,N0,M0; T1-3, N1b, M0)
-- Stage IV: IVa: Tumor spread beyond the thyroid or tumor spread to
nodes in the lateral neck or upper chest;
IVb: Tumor grown into the spine or nearby major blood vessels (carotid or
IVc: Tumor has distant metastasis
Staging is the same as Differentiated
Carcinoma in a 45 year old patient.
All are Stage IV
Thyroid Cancer Survival: The five year survival
rates are the percentage of patients who survive 5 years after diagnosis of
thyroid cancer. These rates do not include patients who die from unrelated
* Patients under 45 years of age are only Stage
I and II.
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