Skip to main content
SpringerLink
Log in

Incidentally Found Medullary Thyroid Cancer: Treatment Rationale for Small Tumors

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The object of this study was to assess the extent of surgery required for small sporadic medullary thyroid cancers (sMTCs). We retrospectively studied 261 patients with MTCs treated in our institution between 1986 and 2002 and identified 15 patients with small pT1 or pT2 sMTCs. The tumors were diagnosed incidentally, so surgical therapy was less than total thyroidectomy. Total thyroidectomy with or without neck dissection was applied to all other patients as standard surgical treatment of care. Patients were systematically followed up by postoperative ultrasonography, calcitonin, carcinoembryonic antigen levels, and pentagastrin stimulation tests. On long-term follow-up over a period of 4.6 years, the rate of biochemical cure in these patients who underwent less than total thyroidectomy for a sporadic incidentally diagnosed tumor was 100%. We concluded that completion thyroidectomy and neck dissection are not mandatory in patients in whom a solitary small sMTC is incidentally discovered by histologic diagnosis following operation so long as a genetic background is excluded. Nevertheless, such patients require systematic careful long-term follow-up.

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

Fig. 1.

Similar content being viewed by others

References

  1. MF Saad NG Ordonez RK Rashid et al. (1984) ArticleTitleMedullary carcinoma of the thyroid: a study of clinical features and prognostic factors in 161 patients Medicine (Baltimore). 63 319–342 Occurrence Handle1:STN:280:BiqD28%2FjvFU%3D

    CAS  Google Scholar 

  2. F Raue (1992) ArticleTitleEpidemiology of medullary thyroid carcinoma: recent results Cancer Res. 125 47–54 Occurrence Handle1:STN:280:ByyD2sbktF0%3D

    CAS  Google Scholar 

  3. D Giuffrida H Gharib (1998) ArticleTitleCurrent diagnosis and management of medullary thyroid carcinoma Ann. Oncol. 9 695–701 Occurrence Handle10.1023/A:1008242302749 Occurrence Handle1:STN:280:DyaK1cvhtFOmsg%3D%3D Occurrence Handle9739433

    Article  CAS  PubMed  Google Scholar 

  4. E Kebebew PHG Ituarte AE Siperstein et al. (2000) ArticleTitleMedullary thyroid carcinoma Cancer 0 1139–1148 Occurrence Handle10.1054/bjoc.2000.1410 Occurrence Handle1:CAS:528:DC%2BD3cXot1SqsLs%3D Occurrence Handle11027426

    Article  CAS  PubMed  Google Scholar 

  5. JF Moley WG Dilley MK DeBenedetti (1997) ArticleTitleImproved results of cervical reoperation for medullary thyroid carcinoma Ann. Surg. 225 734–743 Occurrence Handle10.1097/00000658-199706000-00011 Occurrence Handle1:STN:280:ByiA2svjs1E%3D Occurrence Handle9230814

    Article  CAS  PubMed  Google Scholar 

  6. O Gimm T Sutter H Dralle (2001) ArticleTitleDiagnosis and therapy of sporadic and familial medullary thyroid carcinoma J. Cancer Res. Clin. Oncol. 127 156–165 Occurrence Handle10.1007/s004320000173 Occurrence Handle1:CAS:528:DC%2BD3MXhtVGgsbY%3D Occurrence Handle11260860

    Article  CAS  PubMed  Google Scholar 

  7. LM Mulligan JB Kwok CS Healey et al. (1993) ArticleTitleGerm-line mutations of the RET proto-oncogene in multiple endocrine neoplasia type 2A Nature 363 458–460 Occurrence Handle1:CAS:528:DyaK3sXksVKms7s%3D Occurrence Handle8099202

    CAS  PubMed  Google Scholar 

  8. RM Hofstra RM Landsvater I Ceccherini et al. (1994) ArticleTitleA mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B and sporadic medullary thyroid carcinoma Nature 367 375–376 Occurrence Handle1:CAS:528:DyaK2cXhs1Shu78%3D Occurrence Handle7906866

    CAS  PubMed  Google Scholar 

  9. JF Moley (1995) ArticleTitleMedullary thyroid cancer Surg. Clin. North Am. 75 405–420 Occurrence Handle1:STN:280:ByqB28ngs1Y%3D Occurrence Handle7747249

    CAS  PubMed  Google Scholar 

  10. SA Wells SuffixJr C Franz (2000) ArticleTitleMedullary carcinoma of the thyroid gland World J. Surg. 24 952–956 Occurrence Handle10.1007/s002680010166 Occurrence Handle10865039

    Article  PubMed  Google Scholar 

  11. K Kaserer C Scheuba N Neuhold et al. (1998) ArticleTitleC-cell hyperplasia and medullary thyroid carcinoma in patients routinely screened for serum calcitonin Am. J. Surg. Pathol. 22 722–728 Occurrence Handle10.1097/00000478-199806000-00009 Occurrence Handle1:STN:280:DyaK1c3pt1Wgsw%3D%3D Occurrence Handle9630179

    Article  CAS  PubMed  Google Scholar 

  12. H Dralle (2002) ArticleTitleLymph node dissction and medullary thyroid carcinoma Br. J. Surg. 89 1073–1075 Occurrence Handle10.1046/j.1365-2168.2002.02160.x Occurrence Handle1:STN:280:DC%2BD38vjsVWjtw%3D%3D Occurrence Handle12190669

    Article  CAS  PubMed  Google Scholar 

  13. M Colombo-Benkmann J Raff F Raue et al. (1998) ArticleTitleEffect of primary surgical therapy on the course of C-cell carcinoma of the thyroid gland Langenbecks Arch. Chir. Suppl. Kongressbd. 115 1041–1043 Occurrence Handle1:STN:280:DyaK1M7jtVGktA%3D%3D Occurrence Handle9931784

    CAS  PubMed  Google Scholar 

  14. DL Marsh DL Learoyd BG Robinson (1995) ArticleTitleMedullary thyroid carcinoma: recent advances and management update Thyroid 5 407–424 Occurrence Handle1:STN:280:BymC2Mrht1Y%3D Occurrence Handle8563482

    CAS  PubMed  Google Scholar 

  15. HM Heshmati H Gharib JA Heerden Particlevan et al. (1997) ArticleTitleAdvances and controversies in the diagnosis and management of medullary thyroid carcinoma Am. J. Med. 103 60–69 Occurrence Handle10.1016/S0002-9343(97)00024-7 Occurrence Handle1:STN:280:ByiA2sbmvVw%3D Occurrence Handle9236487

    Article  CAS  PubMed  Google Scholar 

  16. O Gimm J Ukkat H Dralle (1998) ArticleTitleDeterminative factors of biochemical cure after primary and reoperative surgery for sporadic medullary thyroid carcinoma World J. Surg. 22 562–568 Occurrence Handle10.1007/s002689900435 Occurrence Handle1:STN:280:DyaK1c3mtVahsg%3D%3D Occurrence Handle9597929

    Article  CAS  PubMed  Google Scholar 

  17. N Beressi JM Campos JP Beressi et al. (1998) ArticleTitleSporadic medullary microcarcinoma of the thyroid: a retrospective analysis of eight cases Thyroid 8 1039–1044 Occurrence Handle1:STN:280:DyaK1M%2FmtlCltA%3D%3D Occurrence Handle9848720

    CAS  PubMed  Google Scholar 

  18. E Grundmann P Hermanek G Wagner (1997) ArticleTitleTumor histological key: the new 1997 edition; German language morphological section of the ICD-O Pathologe 18 493–498 Occurrence Handle1:STN:280:DyaK1c7htlOisw%3D%3D Occurrence Handle9451742

    CAS  PubMed  Google Scholar 

  19. I Berndt M Reuter B Saller et al. (1998) ArticleTitleA new hotspot for mutations in the ret protooncogene causing familial medullary thyroid carcinoma and multiple neoplasia type 2A J. Clin. Endocrinol. Metab. 83 770–774 Occurrence Handle10.1210/jc.83.3.770 Occurrence Handle1:CAS:528:DyaK1cXivFOhurk%3D Occurrence Handle9506724

    Article  CAS  PubMed  Google Scholar 

  20. A Miyauchi F Matsuzuka K Hirai et al. (2000) ArticleTitleUnilateral surgery supported by germline RET oncogene mutation analysis in patients with sporadic medullary thyroid carcinoma World J. Surg. 24 1367–1372 Occurrence Handle10.1007/s002680010226 Occurrence Handle1:STN:280:DC%2BD3M%2FlslKgtg%3D%3D Occurrence Handle11038208

    Article  CAS  PubMed  Google Scholar 

  21. K Cupisti D Simon A Wolf et al. (2000) ArticleTitleSurgical treatment of postoperative, incidentally diagnosed small sporadic C-cell carcinomas of the thyroid Langenbecks Arch. Surg. 385 526–530 Occurrence Handle10.1007/s004230000166 Occurrence Handle1:STN:280:DC%2BD3M7lsVCmtQ%3D%3D Occurrence Handle11201009

    Article  CAS  PubMed  Google Scholar 

  22. A Miyauchi F Matsuzuka H Keisuke et al. (2002) ArticleTitleProspective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations World J. Surg. 26 1023–1028 Occurrence Handle10.1007/s00268-002-6665-1 Occurrence Handle12016484

    Article  PubMed  Google Scholar 

  23. F Kallinowski HJ Buhr H Meybier et al. (1993) ArticleTitleMedullary carcinoma of the thyroid—therapeutic strategy derived from fifteen years of experience Surgery 114 491–496 Occurrence Handle1:STN:280:ByyA2sjhslU%3D Occurrence Handle8367802

    CAS  PubMed  Google Scholar 

  24. F Pacini M Fontanelli L Fugazolla et al. (1994) ArticleTitleRoutine measurement of serum calcitonin in nodular thyroid diseases allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma J. Clin. Endocrinol. Metab. 78 826–829 Occurrence Handle10.1210/jc.78.4.826 Occurrence Handle1:STN:280:ByuB3cbjs1I%3D Occurrence Handle8157706

    Article  CAS  PubMed  Google Scholar 

  25. HE Wagner C Ruchti M Studer et al. (1996) ArticleTitleLangzeitverlauf des medullôren Schilddrüsenkarzinoms Swiss Surg. 2 181–186 Occurrence Handle1:STN:280:ByiD2c%2FjtVM%3D Occurrence Handle8963841

    CAS  PubMed  Google Scholar 

  26. P Niccoli N Wion-Barbot P Caron et al. (1997) ArticleTitleInterest of routine measurement of serum calcitonin: study in a large series of thyroidectomized patients J. Clin. Endocrinol. Metab. 82 338–341 Occurrence Handle10.1210/jc.82.2.338 Occurrence Handle1:CAS:528:DyaK2sXhtVWqtL8%3D Occurrence Handle9024213

    Article  CAS  PubMed  Google Scholar 

  27. JF Henry A Denziot M Puccini et al. (1998) ArticleTitleLatent subclinical medullary thyroid carcinoma: diagnosis and treatment World J. Surg. 22 752–757 Occurrence Handle10.1007/s002689900464 Occurrence Handle1:STN:280:DyaK1c3ntV2rtg%3D%3D Occurrence Handle9606293

    Article  CAS  PubMed  Google Scholar 

  28. PE Goretzki D Simon A Frilling et al. (1993) ArticleTitleSurgical reintervention for differentiated thyroid cancer Br. J. Surg. 80 1009–1012 Occurrence Handle1:STN:280:ByuD3crls1M%3D Occurrence Handle8402050

    CAS  PubMed  Google Scholar 

  29. L Pezullo P Delrio NS Losito et al. (1997) ArticleTitlePost-operative complications after completion thyroidectomy for differentiated thyroid cancer Eur. J. Surg. Oncol. 23 215–218 Occurrence Handle9236894

    PubMed  Google Scholar 

  30. O Gimm H Dralle (1997) ArticleTitleReoperation in metastasizing medullary thyroid carcinoma: is a tumor stage-oriented approach justified? Surgery 122 1124–1131 Occurrence Handle1:STN:280:DyaK1c%2Foslyjug%3D%3D Occurrence Handle9426428

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Trauma Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany

    Andreas Raffel M.D., Kenko Cupisti M.D., Markus Krausch M.D., Achim Wolf M.D., Klaus-Martin Schulte M.D. & Hans-Dietrich Röher M.D

Authors
  1. Andreas Raffel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenko Cupisti M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Markus Krausch M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Achim Wolf M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Klaus-Martin Schulte M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hans-Dietrich Röher M.D
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Raffel M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raffel, A., Cupisti, K., Krausch, M. et al. Incidentally Found Medullary Thyroid Cancer: Treatment Rationale for Small Tumors. World J. Surg. 28, 397–401 (2004). https://doi.org/10.1007/s00268-003-7121-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-003-7121-6

Keywords

Search

Navigation