Abstract
The main clinical challenge in the management of thyroid cancer is to avoid over-treatment and over-diagnosis in patients with lower-risk disease while promptly identifying those patients with more advanced or high-risk disease requiring aggressive treatment. In recent years, novel clinical and molecular data have emerged, allowing the development of new staging systems, predictive and prognostic tools, and treatment approaches. There has been a notable shift toward more conservative management of low- and intermediate-risk patients, characterized by less extensive surgery, more selective use of radioisotopes (for both diagnostic and therapeutic purposes), and less intensive follow-up. Furthermore, the histologic classification; tumor, node, and metastasis (TNM) staging; and American Thyroid Association risk stratification systems have been refined, and this has increased the number of patients in the low- and intermediate-risk categories. There is now a need for new, prospective data to clarify how these changing practices will impact long-term outcomes of patients with thyroid cancer, and new follow-up strategies and biomarkers are still under investigation. On the other hand, patients with more advanced or high-risk disease have a broader portfolio of options in terms of treatments and therapeutic agents, including multitarget tyrosine kinase inhibitors, more selective BRAF or MEK inhibitors, combination therapies, and immunotherapy.
Highlights
The incidence of differentiated thyroid cancer (DTC) continues to rise worldwide, mostly because of the growing use of powerful diagnostic tools that permit the discovery of an increasing number of small papillary thyroid cancers (PTCs)
Other relevant changes include the identification of 15 PTC variants and the distinction of follicular thyroid cancers (FTCs) into three subgroups, which reflect the prognostic relevance of vascular invasion
Recurrent laryngeal nerve [recurrent laryngeal nerve (RLN)], suspicion of extrathyroidal extension, and invasion of the RLN or trachea—all three of which can be difficult to exclude on neck ultrasound [US]—fine-needle aspiration [FNA] cytology findings suggestive of an aggressive histotype, and a documented increase in size of at least 3 mm in a confirmed PTC) or patient-related factors or physician-related factors or a combination of these factors[17]
Summary
The incidence of differentiated thyroid cancer (DTC) continues to rise worldwide, mostly because of the growing use of powerful diagnostic tools that permit the discovery of an increasing number of small papillary thyroid cancers (PTCs). Recurrent laryngeal nerve [RLN], suspicion of extrathyroidal extension, and invasion of the RLN or trachea—all three of which can be difficult to exclude on neck ultrasound [US]—fine-needle aspiration [FNA] cytology findings suggestive of an aggressive histotype, and a documented increase in size of at least 3 mm in a confirmed PTC) or patient-related factors (metastatic disease, age below 18 years, refusal of the surveillance-alone approach, poor adherence to the follow-up protocol) or physician-related factors (limited experience with thyroid cancer management or neck US or both) or a combination of these factors[17]. Radioiodine remnant ablation: selective use In the past, routine use of RAI ablation therapy after surgery was justified first by the need to eliminate residual normal thyroid tissue, to achieve an undetectable serum thyroglobulin (Tg) level It allowed the identification of persistent neoplastic tissue with a 131I whole-body scan (WBS) and was likely to destroy any occult nests of neoplastic cells, thereby improving long-term outcomes. Enrollment in clinical trials for patients with progressive metastatic disease should be considered and encouraged in order to improve both clinical case outcomes and medical knowledge in the field[71]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call