Risk Staging in Thyroid Cancer in Post-thyroidectomy Patients

Knowing that even well-differentiated thyroid cancer (WDTC) has some chance of recurrence leading to mortality, it is important to maintain the right case management strategy for each patient. It can be difficult, however, to balance the need for adequate monitoring with the desire to be minimally invasive in a patient’s life.

One tool that can aid in management determinations is risk stratification. There are several key factors that can help to stratify risk in your post-thyroidectomy patients:^[1,2]

Age

Recurrence rates are highest (~40%) when WDTC is diagnosed in patients under 20 years or over 60 years.

Gender

Men with WDTC are twice as likely as women to die from thyroid cancer.

Radiation exposure

There is an increased risk of recurrence among patients exposed to radiation.

Family history

There is an increased risk of recurrence among patients with a family history of thyroid cancer.

Tumor size

In both papillary and follicular thyroid cancer, there is a linear relationship between tumor size, recurrence, and rate of death.

Invasiveness

When small (< 1.5 cm) papillary and follicular tumors are confined to the thyroid and minimally invasive, patients’ prognoses are generally excellent.

TNM staging in post-thyroidectomy patients

It is helpful to weigh the prognostic factors described above with a staging system. There are several of these, the most widely used in the United States being tumor-node-metastases, or TNM, staging.^[3] TNM staging is described by the American Association of Clinical Endocrinologists as “a ‘shorthand notation’ for describing the clinical extent of thyroid carcinoma.” ^[4] Click here to download a tool that may help you to stage your patients and assess patient risk.

References:

1. Mazzaferri EL. NCCN thyroid carcinoma practice guidelines. Oncology. 1999;13:391-442.

2. National Comprehensive Cancer Network. NCCN Practice Guidelines for Thyroid Cancer. 2000.

3. American Cancer Society. How is thyroid cancer staged? Available at http://www.cancer.org/eprise/main/docroot/CRI/content/ CRI_2_4_3X_How_is_thyroid_cancer_staged_43?sitearea=CRI. Accessed August 7, 2002.

4. American Association of Clinical Endocrinologists. AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. Endocr Pract. 2001;7:202-220.