Surgical Management of Thyroid Carcinoma

Authors:
Maria A. Kouvaraki Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

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 MD, PhD
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Suzanne E. Shapiro Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

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Jeffrey E. Lee Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

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Douglas B. Evans Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

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Nancy D. Perrier Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

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Volume/Issue:
Volume 3: Issue 3
Online Publication Date:
May 2005
DOI:
https://doi.org/10.6004/jnccn.2005.0022
Full access

Thyroid carcinoma has a unique biologic behavior characterized by early spread to regional lymph nodes and occasional extrathyroidal soft tissue extension but a low incidence of distant metastasis and infrequent disease-related death. Therefore, controversy exists over the proper extent of thyroidectomy and regional lymph node dissection in patients with differentiated thyroid carcinoma (DTC) and medullary thyroid carcinoma (MTC). The modest disease-specific mortality makes it unlikely that the extent of surgery will ever be the subject of a prospective randomized trial. Although more extensive cervical surgery may have only a limited effect on the duration of survival in patients with DTC, it may significantly improve quality of life by minimizing cervical recurrence. The high rates of cervical recurrence in patients with DTC and MTC have alerted physicians to the importance of fine-needle aspiration biopsy and ultrasonography for the diagnosis, preoperative staging, and follow-up of thyroid cancer. In patients with MTC, death caused by disease is uncommon in the absence of radiographically evident distant metastasis at the time of thyroidectomy. Cervical recurrence is even more common with MTC, and the need for compartment-oriented lymphadenectomy is accepted as standard surgical treatment to minimize disease recurrence. Postoperatively, calcitonin (CT) levels can be used to guide clinical management, but basal CT levels should not be used to direct the timing of prophylactic thyroidectomy in affected high-risk patients with familial MTC.

Correspondence: Nancy D. Perrier, MD, FACS, Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 301402, Houston, TX 77230-1402. E-mail: nperrier@mdanderson.org
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2005 by the National Comprehensive Cancer Network 2005
Page Numbers:
9
Article Category:
Research Article
Received:
11 Mar 2005
Accepted:
04 Apr 2005
Print Publication Date:
01 May 2005
Online Publication Date:
May 2005
Keywords:
Medullary thyroid carcinoma; differentiated thyroid carcinoma; papillary; fine-needle aspiration

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