Advances in the Diagnosis and Management of Differentiated Thyroid Cancer

Abstract

Thyroid cancer accounts for fewer than 1% of all human tumors and is much more prevalent among females than males. The incidence of thyroid cancer (mainly differentiated) is one of the most rapidly increasing among human cancers, at least in the US. 1 This phenomenon is mainly due to an increase in the papillary histotype, which showed a 2.9-fold increase per year. The increase is attributable to better detection of small papillary carcinomas as a result of improved diagnostic accuracy (neck ultrasound and fine-needle aspiration cytology [FNAC]). It is a common experience in thyroid cancer referral centers that nearly 60‐80% of thyroid carcinomas detected nowadays are micropapillary thyroid carcinomas (less than 1cm in size) carrying an excellent long-term prognosis. 2,3 Despite an increasing incidence, the mortality from thyroid cancer in general and from papillary thyroid cancer in particular has remained stable (0.5 deaths per 100,000 in both 1973 and 2002). 1 In addition, in recent decades the clinical presentation of differentiated thyroid cancer (DTC) has been changing from advanced cases requiring intense treatment and surveillance to cancer detected by fortuitous neck ultrasonography requiring less aggressive treatment and follow-up. Diagnostic and treatment tools have also improved in recent years (sensitive assays for serum thyroglobulin measurement, neck ultrasound, and recombinant human thyroid stimulating hormone [rhTSH]), thus allowing for less invasive procedures for the patients. Altogether, these considerations dictate the need for applying the more effective and less expensive procedures able to guarantee the best management and the best quality of life for a cancer that, despite having an intrinsic low mortality, requires life-long follow-up.