Adelbert G.

Santos, MD
No disclosure
 Thyroid cancer issues
 Incidence  Risk group stratification
 Pathology  Selection of therapy
 Exploiting biology  Follow up
 Practice patterns  Future directions
 Prognostic factors
•Fifth most common cancer in women
•incidence rates of thyroid cancer in both women and men have been increasing in
recent years
•the most rapidly increasing cancer diagnosis in the United States
•Thyroid cancer ranks 7th overall, 4th in females and 17th in males. Thyroid cancer
is the most common cancer of women at age 15-24.
Trends in incidence of Thyroid cancer and
papillary tumors by size in the United States

Increasing Incidence of Thyroid Cancer in the United States, 1973-2002

Louise Davies, MD, MS; H. Gilbert Welch, MD, MPH

JAMA. 2006;295(18):2164-2167. doi:10.1001/jama.295.18.2164 .

Thyroid cancer
 Biologicaly unique neoplasm
 Multifocal microscopic foci of carcinoma are common
(60-80%)
 Micrometastasis to regional lymph nodes are common
(>50%)
 Clinical significance?????
Contemporary thinking of thyroid
cancer pathology
 Nearly 80% are papillary carcinomas
 Pure follicular carcinomas are rare
 Approximately 12-15% are poorly differentiated
carcinomas
 Approximately 5-7% are medullary carcinomas
 Less than 2% are anaplastic carcinomas
 Thyroid Cancer
5
10

Papillary
20 Follicular
Medullary
Anaplastic
65
 Papillary

Tall Cell
Thyroid Poorly
Insular Anaplastic
Follicular differentiated
Cell etc

Follicular

Good 85% Bad 10-15% Ugly <2%

Prognosis in thyroid cancer

Great majority after initial

WDTC Cured
treatment

A small proportion (~10%) will develop local/regional recurrence

without negative impact on survival

Mortality is exceedingly rare (<2%)

Prognosis in thyroid cancer
A very small proportion will undergo progression to
aggressive variants

PTC Tall cell Poorly diff Anaplastic

Mortality
Exploiting Biology for Management

PTC Tall cell Poorly diff Anaplastic

Thyroglobulin & TTF

Differentiation
Exploiting Biology for Management

PTC Tall cell Poorly diff Anaplastic

Glucose metabolism & PET Scan

Differentiation
Iodine avidity & RAI scan
Prognosis in thyroid cancer

PTC Tall cell Poorly diff Anaplastic

Genomic instability, size, ETE, DM, mortality

 Follow Up
Lobectomy Total Aggressive Surgery
Thyroidectomy

T4 Suppression RAI RAI +/- RT

TGb, UTZ TGb, UTZ TGb, UTX, PET