Skip to main content

Advertisement

SpringerLink
Log in

Changing Management in Patients with Papillary Thyroid Cancer

  • Endocrine Tumors
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The incidence of thyroid cancer has been increasing over the past 30 years, and it is now the seventh most common cancer in women. Papillary thyroid cancer is the most common subtype of thyroid cancer, occurring in 80% of cases. Its main pattern of spread is to cervical lymph nodes, with distant metastases occurring uncommonly. Initial treatment of papillary thyroid cancer involves resection of the primary tumor, with resection of regional lymph nodes if involved with metastatic disease. Postoperative adjuvant therapy consists of radioactive iodine ablation for most patients, followed by thyroid-stimulating hormone (TSH) suppression with thyroxine. An ongoing controversy in the surgical treatment of papillary thyroid cancer is that of extent of thyroid gland and nodal resection. Consensus guidelines recommend total or near-total thyroidectomy, rather than thyroid lobectomy, as the initial procedure of choice, given its advantages of treating potential multicentric disease, facilitating maximal uptake of adjuvant radioactive iodine, and facilitating the post-treatment follow-up by monitoring serum thyroglobulin (Tg) levels. In the hands of an experienced endocrine surgeon, complication rates are comparable to those for lobectomy. Major changes in the management of patients with papillary thyroid cancer over the last 10 years include the use of preoperative neck ultrasound, which can detect nonpalpable cervical lymph node metastases and potentially change the initial operation. In addition, neck ultrasound and measurement of serum Tg levels have taken the place of routine whole body radioactive iodine scans in the postoperative follow-up of patients with papillary thyroid cancer. Recurrent locoregional cervical lymph node disease should be treated by compartmental lymph node dissection, followed by another treatment dose of radioactive iodine. Chemotherapy is generally ineffective for the treatment of metastatic disease. For those patients whose tumor has become radioactive iodine resistant, emerging therapies include redifferentiation agents, antiangiogenic agents, and multi-tyrosine kinase inhibitors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2007. CA Cancer J Clin 2007, 57:43–66

    PubMed  Google Scholar 

  2. Sherman SI. Thyroid carcinoma. Lancet 2003, 361:501–511

    Article  PubMed  Google Scholar 

Excellent review of not only differentiated thyroid cancer, but medullary and anaplastic cancers as well.

  1. SEER Cancer Statistics Review, 1975–2001. National Cancer Institute. http://www.seer.cancer.gov/csr/1975_2001. Accessed August 10, 2007

  2. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006, 295:2164–2167

    Article  PubMed  CAS  Google Scholar 

  3. Clark OH Papillary thyroid carcinoma: rationale for total thyroidectomy. In: Clark OH, Duh QY, Kebebew E, eds. Textbook of Endocrine Surgery. 2 Philadelphia: Elsevier Saunders; 2005 110–114

    Google Scholar 

  4. Hay ID, Thompson GB, Grant CS, et al.: Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 2002, 26:879–885

    Article  PubMed  Google Scholar 

  5. Tollin SR, Mery GM, Jelveh N, et al. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid 2000, 10:235–241

    PubMed  CAS  Google Scholar 

  6. Al-Fehaily M, Clark OH Sporadic nontoxic goiter. In: Clark OH, Duh QY, Kebebew E, eds. Textbook of Endocrine Surgery. 2 Philadelphia: Elsevier Saunders; 2005: 24–33

    Google Scholar 

  7. Shibata Y, Yamashita S, Masyakin VB, et al.: 15 years after Chernobyl: new evidence of thyroid cancer. Lancet 2001, 358:1965–1966

    Article  PubMed  CAS  Google Scholar 

  8. Imaizumi M, Usa T, Tominaga T, et al.: Radiation dose-response relationships for thyroid nodules and autoimmune thyroid diseases in Hiroshima and Nagasaki atomic bomb survivors 55–58 years after radiation exposure. JAMA 2006, 295(9):1011–1022

    Article  PubMed  CAS  Google Scholar 

  9. Carling T, Udelsman R Thyroid tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 7 Philadelphia: Lippincott Williams & Wilkins; 2005: 1502–1519

    Google Scholar 

  10. Shoup M, Stojadinovic A, Nissan A, et al.: Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. J Am Coll Surg 2003, 197:191–197

    Article  PubMed  Google Scholar 

  11. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary yhyroidthyroid cancer. Ann Surg Oncol 2005, 12:81–89

    Article  PubMed  Google Scholar 

  12. Bilimoria KY, Bentrem DJ, Ko CY, et al.: Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 2007, 246(3):375–384

    Article  PubMed  Google Scholar 

The first study to demonstrate that total thyroidectomy for papillary thyroid cancers >1 cm is associated with lower rates of recurrence and improved survival.

  1. Leboulleux S, Rubino C, Baudin E, et al.: Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 2005, 90:5723–5729

    Article  PubMed  CAS  Google Scholar 

  2. Thyroid. AJCC Cancer Staging Manual, 6th ed. Edited by Greene F, Page D, Fleming I, et al. Chicago, IL: Springer; 2002:77

  3. Comparison Guide: AJCC Staging Manual, Fifth versus Sixth edition. http://www.cancerstaging.org/products/ajccproducts.html#guide. Accessed August 10, 2007

  4. Cooper DS, Doherty GM, Haugen BR, et al.: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines taskforce. Thyroid 2006, 16(2):109–142

    PubMed  Google Scholar 

Major consensus guideline for the treatment of differentiated thyroid cancer from the American Thyroid Association.

  1. Sywak M, Pasieka JL, Ogilvie T. A review of thyroid cancer with intermediate differentiation. J Surg Oncol 2004, 86:44–54

    Article  PubMed  Google Scholar 

  2. Xing M, Westra WH, Tufano RP, et al.: BRAF mutation predicts a poorer clinical prognosis for papillary thyroid cancer. J Clin Endocrinol Metab 2005, 90:6373–6379

    Article  PubMed  CAS  Google Scholar 

  3. Stulak JM, Grant CS, Farley DR, et al.: Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 2006, 141:489–496

    Article  PubMed  Google Scholar 

  4. Kouvaraki MA, Shapiro SE, Fornage BD, et al.: Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 2003, 134:946–955

    Article  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Thyroid Carcinoma v.2.2007. http://www.nccn.org/professionals/physician_gls/PDF/thyroid.pdf. Accessed August 10, 2007

Major consensus guideline for the treatment of thyroid cancer from the National Comprehensive Cancer Network.

  1. Van Nostrand D, Wartofsky L. Radioiodine in the treatment of thyroid cancer. Endocrinol Metab Clin North Am 2007, 36(3):807–822

    Article  PubMed  Google Scholar 

  2. Meier DA, Brill DR, Becker DV, et al.: Procedure guideline for therapy of thyroid disease with 131Iodine. J Nucl Med 2002, 43:856–861

    PubMed  CAS  Google Scholar 

  3. Biondi B, Filetti S, Schlumberger M. Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab 2005, 1(1):32–40

    Article  PubMed  CAS  Google Scholar 

  4. Leaf AN, Wolf BC, Kirkwood JM, Haselow RE. Phase II study of etoposide (VP-16) in patients with thyroid cancer with no prior chemotherapy: an Eastern Cooperative Oncology Group Study (E1385). Med Oncol 2000, 17:47–51

    PubMed  CAS  Google Scholar 

  5. Mittendorf EA, Wang X, Perrier ND, et al.: Followup of patients with papillary thyroid cancer: in search of the optimal algorithm. J Am Coll Surg 2007, 205:239–247

    Article  PubMed  Google Scholar 

  6. Robbins RJ, Srivastava S, Shaha A, et al.: Factors influencing the basal and recombinant human thyrotropin-stimulated serum thyroglobulin in patients with metastatic thyroid carcinoma. J Clin Endocrinol Metab 2004, 89:6010–6016

    Article  PubMed  CAS  Google Scholar 

  7. Shammas A, Degirmenci B, Mountz JM, et al.: 18F-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer. J Nucl Med 2007, 48(2):221–226

    PubMed  CAS  Google Scholar 

  8. Braga-Basaria M, Ringel MD Beyond radioiodine: a review of potential new therapeutic approaches for thyroid cancer. J Clin Endocrinol Metab 2003, 88(5):1947–1960

    Article  PubMed  CAS  Google Scholar 

  9. Kebebew E, Reiff E, Greenspan FS, et al.: Rosiglitazone treatment induces radioiodine uptake in some patients with radioiodine-negative thyroglobulin-positive differentiated thyroid cancer [abstract]. The Endocrine Society’s 87th Annual Meeting 2005, A-P3-573

  10. Smit JW, Shroder-van der Elst JP, Karperien M, et al.: Reestablishment of in vitro and in vivo iodide uptake by transfection of the human sodium iodide symporter (hNIS) in a hNIS defective human thyroid carcinoma cell line. Thyroid 2000, 10:939–943

    Article  PubMed  CAS  Google Scholar 

  11. Smit JW, Schroder-van der Elst JP, Karperien M, et al.: Expression of the human sodium/iodide symporter (hNIS) in xenotransplanted human thyroid carcinoma. Exp Clin Endocrinol Diabetes 2001, 109:52–55

    Article  PubMed  CAS  Google Scholar 

  12. ClinicalTrials.gov: Linking patients to medical research. http://www.clinicaltrials.gov. Accessed August 10, 2007

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Dina M. Elaraj MD

  2. Department of Surgery, UCSF/Mt. Zion Medical Center, 1600 Divisadero Street, Rm C347, San Francisco, CA, 94115, USA

    Orlo H. Clark MD

Authors
  1. Dina M. Elaraj MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Orlo H. Clark MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Orlo H. Clark MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elaraj, D.M., Clark, O.H. Changing Management in Patients with Papillary Thyroid Cancer. Curr. Treat. Options in Oncol. 8, 305–313 (2007). https://doi.org/10.1007/s11864-007-0040-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-007-0040-2

Keywords

Search

Navigation