Thyroid cancer is the most common endocrine malignancy and is divided into four major categories: papillary, follicular, medullary, and undifferentiated carcinomas. The following are the staging options for common thyroid cancers:
Stage I and II papillary and follicular carcinomas
- Total or near-total thyroidectomy, with radioactive iodine (RAI) treatment considered by the physician depending on the situation.
- Thyroidectomy with lymph node dissection followed by hormone therapy. Postoperative RAI therapy may be performed.
Stage III papillary and follicular carcinoma
Usually a total thyroidectomy is performed, and tissue and lymph nodes that have spread are removed at the same time. Postoperatively, RAI therapy or external radiation therapy (i.e., “radiotherapy”) is considered.
Stage IV papillary and follicular carcinoma
Stage IV papillary and follicular cancers can still be cured if the cancer has only metastasized to the lymph nodes. However, if the cancer has metastasized to other parts of the body, such as the lungs and bones, it is very difficult to cure and can only relieve symptoms and improve the patient’s quality of life.
For cancerous tissue that has taken up iodine, RAI therapy is used.
For cancerous tissues that do not take up iodine, the following approaches can be taken:
- Hormone therapy.
- Targeted therapy with sorafenib (sorafenib).
- Surgery to remove cancerous tissue from the metastatic site.
- External radiation therapy.
- Clinical trials of chemotherapy and targeted therapy.
Medullary carcinoma of the thyroid
- If there is no metastasis, total thyroidectomy can be performed.
- Removal of lymph nodes containing cancer cells.
- Patients with recurrence may be treated with external radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
- Treat cancerous tissue that has metastasized to other sites with the targeted drug vandetanib.
- Chemotherapy may also be considered as palliative therapy when metastasis has already occurred and can provide symptom relief and improve quality of life.
Undifferentiated cancer
- The use of tracheotomy to relieve symptoms and improve quality of life.
- Total thyroidectomy can also be used to relieve symptoms and improve quality of life in patients who have not yet metastasized.
- External radiation therapy.
- Chemotherapy.
- Chemotherapy.
- After total thyroidectomy, chemotherapy and radiotherapy are also available through clinical trials.