General Information
Note: A separate PDQ summary on Genetics of Medullary Thyroid Cancer is also available and information on thyroid cancer in children is available in the PDQ summary on Unusual Cancers of Childhood.
Note: Estimated new cases and deaths from thyroid cancer in the United States in 2008:[1]
- New cases: 37,340.
- Deaths: 1,590.
Carcinoma of the thyroid gland is an uncommon cancer but is the
most common malignancy of the endocrine system.[2] Differentiated tumors
(papillary or follicular) are highly treatable and usually curable. Poorly differentiated tumors (medullary or anaplastic) are much less common, are
aggressive, metastasize early, and have a much poorer prognosis. Thyroid
cancer affects women more often than men and usually occurs in
people between the ages of 25 and 65 years. The incidence of this malignancy has
been increasing over the last decade. Thyroid cancer commonly presents
as a cold nodule. The overall incidence of cancer in a cold nodule is 12% to
15%, but it is higher in people younger than 40 years and in people with calcifications present on preoperative ultrasonography.[3,4]
Risk factors
Patients with a history of radiation administered in infancy and childhood for
benign conditions of the head and neck, such as enlarged thymus, acne, or
tonsillar or adenoidal enlargement, have an increased risk of cancer as well as
other abnormalities of the thyroid gland. In this group of patients,
malignancies of the thyroid gland first appear beginning as early as 5 years
following radiation and may appear 20 or more years later.[5] Radiation exposure as a consequence of nuclear fallout has also been associated with a high risk of thyroid cancer, especially in children.[6-8] Other risk
factors for the development of thyroid cancer include a history of goiter,
family history of thyroid disease, female gender, and Asian race.[9]
Prognostic factors
The prognosis for differentiated
carcinoma is better for patients younger than 40 years without
extracapsular extension or vascular invasion.[10-14] Age appears to be the
single most important prognostic factor.[12] The prognostic significance of lymph node status is controversial. One
retrospective surgical series of 931 previously untreated patients with
differentiated thyroid cancer found that female gender, multifocality, and
regional node involvement are favorable prognostic factors.[15] Adverse factors
included age older than 45 years, follicular histology, primary tumor larger than 4
cm (T2–T3), extrathyroid extension (T4), and distant metastases.[15,16]
Other studies, however, have shown that regional lymph node involvement had no
effect [17,18] or even an adverse effect on survival.[13,14,19] Diffuse, intense
immunostaining for vascular endothelial growth factor in patients with
papillary cancer has been associated with a high rate of local recurrence and
distant metastases.[20] An elevated serum thyroglobulin level correlates
strongly with recurrent tumor when found in patients with differentiated
thyroid cancer during postoperative evaluations.[21,22] Serum thyroglobulin
levels are most sensitive when patients are hypothyroid and have elevated serum
thyroid-stimulating hormone levels.[23] Expression of the tumor suppressor
gene p53 has also been associated with an adverse prognosis for patients with
thyroid cancer.[24]
Patients considered to be low risk by the age, metastases, extent, and size
(AMES) risk criteria include women younger than 50 years and men younger
than 40 years without evidence of distant metastases. Also included in
the low-risk group are older patients with primary tumors smaller than 5
cm and papillary cancer without evidence of gross extrathyroid
invasion or follicular cancer without either major capsular invasion or blood
vessel invasion.[11] Using these criteria, a retrospective study of 1,019
patients showed that the 20-year survival rate is 98% for low-risk patients and
50% for high-risk patients.[11] The 10-year overall relative survival rates for patients in the United States are 93% for papillary cancer, 85% for follicular cancer, 75% for medullary cancer, and 14% for undifferentiated/anaplastic cancer.[2]
The
thyroid gland may occasionally be the site of other primary tumors, including
sarcomas, lymphomas, epidermoid carcinomas, and teratomas and may be the site
of metastasis from other cancers, particularly of the lung, breast, and kidney.
References
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American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. Last accessed October 1, 2008.
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Hundahl SA, Fleming ID, Fremgen AM, et al.: A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see comments] Cancer 83 (12): 2638-48, 1998.
[PUBMED Abstract]
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Tennvall J, Biörklund A, Möller T, et al.: Is the EORTC prognostic index of thyroid cancer valid in differentiated thyroid carcinoma? Retrospective multivariate analysis of differentiated thyroid carcinoma with long follow-up. Cancer 57 (7): 1405-14, 1986.
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Khoo ML, Asa SL, Witterick IJ, et al.: Thyroid calcification and its association with thyroid carcinoma. Head Neck 24 (7): 651-5, 2002.
[PUBMED Abstract]
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Carling T, Udelsman R: Thyroid tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1502-19.
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Pacini F, Vorontsova T, Molinaro E, et al.: Prevalence of thyroid autoantibodies in children and adolescents from Belarus exposed to the Chernobyl radioactive fallout. Lancet 352 (9130): 763-6, 1998.
[PUBMED Abstract]
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Cardis E, Kesminiene A, Ivanov V, et al.: Risk of thyroid cancer after exposure to 131I in childhood. J Natl Cancer Inst 97 (10): 724-32, 2005.
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Tronko MD, Howe GR, Bogdanova TI, et al.: A cohort study of thyroid cancer and other thyroid diseases after the chornobyl accident: thyroid cancer in Ukraine detected during first screening. J Natl Cancer Inst 98 (13): 897-903, 2006.
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Iribarren C, Haselkorn T, Tekawa IS, et al.: Cohort study of thyroid cancer in a San Francisco Bay area population. Int J Cancer 93 (5): 745-50, 2001.
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Grant CS, Hay ID, Gough IR, et al.: Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important? Surgery 104 (6): 954-62, 1988.
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Sanders LE, Cady B: Differentiated thyroid cancer: reexamination of risk groups and outcome of treatment. Arch Surg 133 (4): 419-25, 1998.
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Mazzaferri EL: Treating differentiated thyroid carcinoma: where do we draw the line? Mayo Clin Proc 66 (1): 105-11, 1991.
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Staunton MD: Thyroid cancer: a multivariate analysis on influence of treatment on long-term survival. Eur J Surg Oncol 20 (6): 613-21, 1994.
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Mazzaferri EL, Jhiang SM: Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97 (5): 418-28, 1994.
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Shah JP, Loree TR, Dharker D, et al.: Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164 (6): 658-61, 1992.
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Andersen PE, Kinsella J, Loree TR, et al.: Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg 170 (5): 467-70, 1995.
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Coburn MC, Wanebo HJ: Prognostic factors and management considerations in patients with cervical metastases of thyroid cancer. Am J Surg 164 (6): 671-6, 1992.
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Voutilainen PE, Multanen MM, Leppäniemi AK, et al.: Prognosis after lymph node recurrence in papillary thyroid carcinoma depends on age. Thyroid 11 (10): 953-7, 2001.
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Sellers M, Beenken S, Blankenship A, et al.: Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer. Am J Surg 164 (6): 578-81, 1992.
[PUBMED Abstract]
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Lennard CM, Patel A, Wilson J, et al.: Intensity of vascular endothelial growth factor expression is associated with increased risk of recurrence and decreased disease-free survival in papillary thyroid cancer. Surgery 129 (5): 552-8, 2001.
[PUBMED Abstract]
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van Herle AJ, van Herle KA: Thyroglobulin in benign and malignant thyroid disease. In: Falk SA: Thyroid Disease: Endocrinology, Surgery, Nuclear Medicine, and Radiotherapy. Philadelphia, Pa: Lippincott-Raven, 1997, pp 601-618.
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Ruiz-Garcia J, Ruiz de Almodóvar JM, Olea N, et al.: Thyroglobulin level as a predictive factor of tumoral recurrence in differentiated thyroid cancer. J Nucl Med 32 (3): 395-8, 1991.
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Duren M, Siperstein AE, Shen W, et al.: Value of stimulated serum thyroglobulin levels for detecting persistent or recurrent differentiated thyroid cancer in high- and low-risk patients. Surgery 126 (1): 13-9, 1999.
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Godballe C, Asschenfeldt P, Jørgensen KE, et al.: Prognostic factors in papillary and follicular thyroid carcinomas: p53 expression is a significant indicator of prognosis. Laryngoscope 108 (2): 243-9, 1998.
[PUBMED Abstract]
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