From the Guidelines
Thyroid cancer is primarily categorized into several types, including papillary, follicular, medullary, anaplastic, and Hürthle cell carcinoma, with distinct characteristics and treatment approaches. The main types of thyroid cancer are:
- Papillary thyroid cancer (the most common, accounting for about 80% of cases)
- Follicular thyroid cancer (10-15% of cases)
- Medullary thyroid cancer (5-10%)
- Anaplastic thyroid cancer (less than 2%, but most aggressive)
- Hürthle cell carcinoma (a variant of follicular cancer) Symptoms may include a lump in the neck, voice changes, difficulty swallowing, neck pain, and swollen lymph nodes.
Treatment Approaches
Treatment typically involves surgery (thyroidectomy), often followed by radioactive iodine therapy for certain types, as recommended by the NCCN guidelines 1. Thyroid hormone replacement therapy is usually needed after thyroid removal. Targeted therapies and external beam radiation may be used for advanced cases.
Prognosis and Follow-up
Prognosis varies significantly by type, with papillary and follicular having excellent survival rates (over 95% five-year survival), while anaplastic thyroid cancer has a poor prognosis with median survival of only months, as reported in the study by 2. Regular follow-up monitoring is essential after treatment to check for recurrence, including physical examination, neck US, and basal serum thyroglobulin measurement, as suggested by the ESMO guidelines 3.
Key Recommendations
- Total thyroidectomy is the initial treatment for differentiated thyroid cancer (DTC), with radioactive iodine ablation indicated in high-risk patients 3.
- TSH suppressive therapy with L-T4 is beneficial in high-risk thyroid cancer patients 3.
- Molecular testing for DTC may be conducted for diagnostic, prognostic, and/or predictive purposes 1.
- Targeted therapy options, such as vandetanib, are available for patients with locally advanced or metastatic medullary thyroid cancer 3.
From the Research
Types of Thyroid Cancer
- Papillary thyroid cancer: the most common type, accounting for approximately 84% of all thyroid cancers 4
- Follicular thyroid cancer: approximately 4% of all thyroid cancers 4
- Oncocytic thyroid cancer: approximately 2% of all thyroid cancers 4
- Medullary thyroid cancer: approximately 4% of all thyroid cancers, arising from parafollicular C cells 4
- Poorly differentiated thyroid cancer: approximately 5% of all thyroid cancers 4
- Anaplastic thyroid cancer: approximately 1% of all thyroid cancers 4
Treatment Options
- Surgical removal of the entire thyroid gland (total thyroidectomy) 5
- Radioactive iodine therapy 5, 6
- Molecular-targeted therapies with tyrosine kinase inhibitors 5, 7
- Active surveillance or less aggressive initial surgical management for low-risk patients 8
- Targeted therapies such as dabrafenib and selpercatinib for patients with advanced thyroid carcinoma 4
Diagnosis and Prognosis
- Thyroid cancer is often detected incidentally during physical examination or diagnostic imaging studies 5, 4
- The prognosis and treatment of thyroid cancer depend on the tumor type and its stage at the time of diagnosis 5
- Five-year relative survival is approximately 98.5% 4
- Early diagnosis and appropriate treatment can improve prognosis and reduce mortality 5