Thyroid carcinoma

The University of Texas M.D. Anderson Cancer Center, USA.
Journal of the National Comprehensive Cancer Network: JNCCN (Impact Factor: 4.18). 08/2007; 5(6):568-621.
Source: PubMed


Although thyroid carcinoma is relatively uncommon, approximately 33,550 new cases will be diagnosed in the United States in 2007. It occurs 2 to 3 times more often in women than in men, and with the incidence increasing by 4% per year, it is currently the eighth most common malignancy diagnosed in women. Although it occurs more often in women, mortality rates are higher for men, probably because they are usually older at the time of diagnosis (65-69 years vs. 50-54 years in women). Interestingly, the incidence of thyroid carcinoma increased almost 240% between 1950 and 2000, but mortality rates decreased more than 44%. Important updates to the 2007 guidelines include revised criteria for categorizing disease, revised recommendation for thyroid-stimulating hormone-stimulated thyroglobulin in some cases, and expanded CT recommendations for anaplastic carcinoma.

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    • "Table 1 shows the characteristics of the 522 enrolled PTC patients. Though we generally tried to keep the indications for thyroid lobectomy in ATA [1] and NCCN [2] guidelines, there were some additional inclusions in our study. One hundred ninety-three patients (37.0%) over 45 years of age and with incidentally detected 11 (2.1%) multiple thyroid cancer were included. "
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    ABSTRACT: There are no guidelines for the optimal timing of the decision of when to perform completion thyroidectomy, and controversy exists regarding how the timing of completion thyroidectomy impacts survival patterns. We investigated the legitimacy of an observational strategy in central node metastasis after thyroid lobectomy for papillary thyroid cancer (PTC). We retrospectively evaluated 522 consecutive patients who underwent thyroid lobectomy. Of the 69 patients with central metastasis, 61 patients (88.4%) were included in an observational study under cautious evaluation with informed consent by the patients, and compared with an observation arm of 180 postlobectomy N0 (node negative proven) patients. Of the 522 patients, six (1.1%) thyroid, five (0.9%) central, and two (0.4%) lateral recurrences were observed. Lateral recurrences occurred in the immediate completion N0 and Nx groups but not in the N1a observation arms. There were two (3.3%) central recurrences without thyroid or lateral recurrence on the observation arm of N1a observation patients. But two (1.1%) thyroid and three (1.7%) central recurrences were on the observation arm of N0 patients. In Kaplan-Meier survival curves for central or lateral recurrences between observation arms for the N1a and N0 groups, no significant difference was found between the N1a and N0 observation arms (P = 0.365). The timing of when to perform completion thyroidectomy in central metastases-proven patients after lobectomy for PTC should be based on the patient's risk category.
    Full-text · Article · Oct 2012
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    • "Several guidelines for the diagnosis and management of S-MTC and MTC/MEN2 have been published by different medical authorities such as the International MEN2 Consortium (1), the NIH Workshop on MEN (5), the American Society of Clinical Oncology (ASCO) (22), the ATA (MTC Clinical Guidelines) (15), and the Brazilian Guidelines-MTC (23), among others. The recommendations are broadly similar, although small variations may be present. "
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    ABSTRACT: We briefly review the surgical approaches to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2 (medullary thyroid carcinoma/multiple endocrine neoplasia type 2). The recommended surgical approaches are usually based on the age of the affected carrier/patient, tumor staging and the specific rearranged during transfection codon mutation. We have focused mainly on young children with no apparent disease who are carrying a germline rearranged during transfection mutation. Successful management of medullary thyroid carcinoma in these cases depends on early diagnosis and treatment. Total thyroidectomy should be performed before 6 months of age in infants carrying the rearranged during transfection 918 codon mutation, by the age of 3 years in rearranged during transfection 634 mutation carriers, at 5 years of age in carriers with level 3 risk rearranged during transfection mutations, and by the age of 10 years in level 4 risk rearranged during transfection mutations. Patients with thyroid tumor >5 mm detected by ultrasound, and basal calcitonin levels >40 pg/ml, frequently have cervical and upper mediastinal lymph node metastasis. In the latter patients, total thyroidectomy should be complemented by extensive lymph node dissection. Also, we briefly review our data from a large familial medullary thyroid carcinoma genealogy harboring a germline rearranged during transfection Cys620Arg mutation. All 14 screened carriers of the rearranged during transfection Cys620Arg mutation who underwent total thyroidectomy before the age of 12 years presented persistently undetectable serum levels of calcitonin (<2 pg/ml) during the follow-up period of 2-6 years. Although it is recommended that preventive total thyroidectomy in rearranged during transfection codon 620 mutation carriers is performed before the age of 5 years, in this particular family the surgical intervention performed before the age of 12 years led to an apparent biochemical cure.
    Full-text · Article · Apr 2012 · Clinics (São Paulo, Brazil)
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    ABSTRACT: Hereditary medullary thyroid carcinoma (MTC) is caused by specific autosomal dominant gain-of-function mutations in the RET proto-oncogene. Genotype-phenotype correlations exist that help predict the presence of other associated endocrine neoplasms as well as the timing of thyroid cancer development. MTC represents a promising model for targeted cancer therapy, as the oncogenic event responsible for initiating malignancy has been well characterized. The RET proto-oncogene has become the target for molecularly designed drug therapy. Tyrosine kinase inhibitors targeting activated RET are currently in clinical trials for the treatment of patients with MTC. This review will provide a brief overview of MTC and the associated RET oncogenic mutations, and will summarize the therapies designed to strategically interfere with the pathologic activation of the RET oncogene.
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