Management Options

1. Introduction
2. Recurrence rates and the need for follow-up
3. Thyrogen in follow-up
4. Summary
5. About the Author

Testing and Management: Importance of early detection of recurrent disease

By Ernest L. Mazzaferri, MD MACP

Adjunct Professor of Medicine, University of Florida and
Emiritus Professor & Chairman of Internal Medicine, The Ohio State University

Thyroid cancer mortality rates in women living in the United States have improved greatly during the past 30 years. Their 5-year thyroid cancer survival rates from 1974 to 2001 increased significantly from 92.7% to 97.4%; however, during this time the rates of distant metastases at diagnosis were more than twofold higher in men than women (9% vs. 4%). Thus during 1992-2000 period, the annual percent change in thyroid cancer mortality in men significantly increased by 2.4%, the largest percent increase of any type cancer.(1) On average, men are 10 to 20 years older than women at the time of diagnosis, which accounts for their more advanced tumor stage at the time the disease is first recognized, which undoubtedly accounts for the poor outcome in men.

Papillary and follicular cancers (well-differentiated thyroid cancers [WDTC]) are the most common thyroid cancers, and have the best outcomes providing they are diagnosed early. Yet death from WDTC is still a concern. One large study of nearly 54,000 patients with thyroid cancer who underwent surgery in the United States between 1985 and 1995 found that papillary and follicular cancers–the two typically slow-growing cancers with the "best" prognosis–represented approximately 75% of thyroid cancer deaths, and were especially dangerous when the tumor was advanced at the time of diagnosis.(2;3) Overall, 10-year cancer mortality rates were about 7% for papillary and 15% for follicular thyroid cancer.(2;3) Overall, 10-year cancer mortality rates were about 7% for papillary and 15% for follicular thyroid cancer. (2;3)

In the past few decades, thyroid cancer has been diagnosed earlier, providing an opportunity for treatment before the cancer has spread beyond the thyroid, and improving survival rates in women. Proper therapy-in most cases this means surgical removal of the tumor along with the entire thyroid gland, followed by radioactive iodine (I-131) ablation and thyroid hormone therapy-has the potential to reduce recurrence and mortality rates.

Please click on the links below for more information.

1. Introduction
2. Recurrence rates and the need for follow-up
3. Thyrogen in follow-up
4. Summary
5. About the Author

REFERENCES:

1. Mazzaferri EL. Manageing small thyroid cancers. JAMA 2006 295:2179-82.

2. Hundahl, SA, Fleming ID, Fremgen, AM, Menck, HR. 1998 A National Cancer Data Base Report on 53,856 cases of thyroid carcinoma treated in the US, 1985-1995. Cancer. 1998;83:2638-48.

3. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, Caillou B, Ricard M, Lumbroso JD, De Vathaire F, Schlumberger M. Long term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 2006;92:450-5.

4. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C. Extent of Surgery Affects Survival for Papillary Thyroid Cancer. Ann Surg 2007;246:375-84.