Medullary thyroid cancer natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, patients with medullary thyroid cancer may progress to develop metastasis. Common complications of medullary thyroid cancer include vocal cord compression, dysphagia, and dyspnea. The presence of metastasis is associated with a particularly poor prognosis among patients with medullary thyroid cancer. The 5 year event free survival rate is 80%. | If left untreated, patients with medullary thyroid cancer may progress to develop [[metastasis]]. Common complications of medullary thyroid cancer include [[vocal cord compression]], [[dysphagia]], and [[dyspnea]]. The presence of [[metastasis]] is associated with a particularly poor prognosis among patients with medullary thyroid cancer. The 5 year event free survival rate is 80%. | ||
==Natural History== | ==Natural History== | ||
The symptoms of medullary thyroid cancer usually develop in the third decade of life, and start with symptoms such as swelling in the neck. Without treatment, the patient will develop symptoms of metastasis such as cushing's syndrome and diarrhea, which will/ may eventually lead to death. | The symptoms of medullary thyroid cancer usually develop in the third decade of life, and start with symptoms such as swelling in the neck. Without treatment, the patient will develop symptoms of [[metastasis]] such as [[cushing's syndrome]] and [[diarrhea]], which will/ may eventually lead to death. | ||
==Complications== | ==Complications== | ||
* Metastases to lung, | * [[Metastases]] to [[lung]], [[bone]]s, [[liver]], and [[brain]] | ||
* Hypopcalcemia after surgery due to parathyroid removal | * [[Hypopcalcemia]] after [[surgery]] due to [[parathyroid]] removal | ||
* Dysphagia | * [[Dysphagia]] | ||
* Hoarseness of symptoms | * Hoarseness of symptoms | ||
* Diarrhea | * [[Diarrhea]] | ||
* Cushing's syndrome | * [[Cushing's syndrome]] | ||
==Prognosis== | ==Prognosis== | ||
* 86% of medullary thyroid cancer live atleast 5 years of survival | * 86% of medullary thyroid cancer live atleast 5 years of survival | ||
* 65% of medullary thyroid cancer live upto 10 years. | * 65% of medullary thyroid cancer live upto 10 years. | ||
Depending on source, the overall [[5-year survival rate]] for medullary thyroid cancer is 80%,<ref name=american/> 83%<ref>{{Cite journal | last1 = Barbet | first1 = J. | last2 = Campion | first2 = L. | last3 = Kraeber-Bodere | first3 = F. | last4 = Chatal | first4 = J. -F. | last5 = Group | first5 = T. G. T. E. S. | title = Prognostic Impact of Serum Calcitonin and Carcinoembryonic Antigen Doubling-Times in Patients with Medullary Thyroid Carcinoma | doi = 10.1210/jc.2005-0044 | journal = Journal of Clinical Endocrinology & Metabolism | volume = 90 | issue = 11 | pages = 6077–6084 | year = 2005 | pmid = 16091497| pmc = }}</ref> or 86%,<ref>[http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional/page7 National Cancer Institute > Medullary Thyroid Cancer] Last Modified: 12/22/2010</ref> and the 10-year survival rate is 75%.<ref name=american>Numbers from National Cancer Database in the US, from [http://books.google.se/books?id=u1aFpF-EcgwC&pg=PA10 Page 10] in: {{cite book|author=F. Grünwald; Biersack, H. J.; Grںunwald, F. |title=Thyroid cancer |publisher=Springer |location=Berlin |year=2005|pages= |isbn=3-540-22309-6 |oclc= |doi= |accessdate=}}</ref> | * Depending on source, the overall [[5-year survival rate]] for medullary thyroid cancer is 80%,<ref name=american/> 83%<ref>{{Cite journal | last1 = Barbet | first1 = J. | last2 = Campion | first2 = L. | last3 = Kraeber-Bodere | first3 = F. | last4 = Chatal | first4 = J. -F. | last5 = Group | first5 = T. G. T. E. S. | title = Prognostic Impact of Serum Calcitonin and Carcinoembryonic Antigen Doubling-Times in Patients with Medullary Thyroid Carcinoma | doi = 10.1210/jc.2005-0044 | journal = Journal of Clinical Endocrinology & Metabolism | volume = 90 | issue = 11 | pages = 6077–6084 | year = 2005 | pmid = 16091497| pmc = }}</ref> or 86%,<ref>[http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional/page7 National Cancer Institute > Medullary Thyroid Cancer] Last Modified: 12/22/2010</ref> and the 10-year survival rate is 75%.<ref name=american>Numbers from National Cancer Database in the US, from [http://books.google.se/books?id=u1aFpF-EcgwC&pg=PA10 Page 10] in: {{cite book|author=F. Grünwald; Biersack, H. J.; Grںunwald, F. |title=Thyroid cancer |publisher=Springer |location=Berlin |year=2005|pages= |isbn=3-540-22309-6 |oclc= |doi= |accessdate=}}</ref> | ||
* By overall [[cancer staging]] into stages I to IV, the [[5-year survival rate]] is 100% at [[cancer staging|stage]] I, 98% at stage II, 81% at stage III and 28% at stage IV.<ref name=acc>[http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-survival-rates cancer.org > Thyroid Cancer] By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).</ref> The prognosis of MTC is poorer than that of follicular and papillary thyroid cancer when it has metastasized (spread) beyond the thyroid gland. | |||
By overall [[cancer staging]] into stages I to IV, the [[5-year survival rate]] is 100% at [[cancer staging|stage]] I, 98% at stage II, 81% at stage III and 28% at stage IV.<ref name=acc>[http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-survival-rates cancer.org > Thyroid Cancer] By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).</ref> The prognosis of MTC is poorer than that of follicular and papillary thyroid cancer when it has metastasized (spread) beyond the thyroid gland. | * The prognostic value of measuring [[calcitonin]] and [[carcinoembryonic antigen]] (CEA) concentrations in the blood was studied in 65 MTC patients who had abnormal [[calcitonin]] levels after [[surgery]] (total [[thyroidectomy]] and [[lymph node]] dissection).<ref name=Barbet>{{cite journal |author=Barbet J, Campion L, Kraeber-Bodéré F, Chatal JF |title=Prognostic impact of serum calcitonin and carcinoembryonic antigen doubling-times in patients with medullary thyroid carcinoma |journal=J. Clin. Endocrinol. Metab. |volume=90 |issue=11 |pages=6077–84 |year=2005 |pmid=16091497 |doi=10.1210/jc.2005-0044|url=http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=16091497}}</ref> The prognosis correlated with the rate at which the postoperative calcitonin concentration doubles, termed the calcitonin doubling time (CDT), rather than the pre- or postoperative absolute calcitonin level: | ||
The prognostic value of measuring [[calcitonin]] and [[carcinoembryonic antigen]] (CEA) concentrations in the blood was studied in 65 MTC patients who had abnormal calcitonin levels after surgery (total thyroidectomy and lymph node dissection).<ref name=Barbet>{{cite journal |author=Barbet J, Campion L, Kraeber-Bodéré F, Chatal JF |title=Prognostic impact of serum calcitonin and carcinoembryonic antigen doubling-times in patients with medullary thyroid carcinoma |journal=J. Clin. Endocrinol. Metab. |volume=90 |issue=11 |pages=6077–84 |year=2005 |pmid=16091497 |doi=10.1210/jc.2005-0044|url=http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=16091497}}</ref> The prognosis correlated with the rate at which the postoperative calcitonin concentration doubles, termed the calcitonin doubling time (CDT), rather than the pre- or postoperative absolute calcitonin level: | |||
*'''CDT less than 6 months:''' 3 patients out of 12 (25%) survived 5 years. 1 patient out of 12 (8%) survived 10 years. All died within 6 months to 13.3 years. | *'''CDT less than 6 months:''' 3 patients out of 12 (25%) survived 5 years. 1 patient out of 12 (8%) survived 10 years. All died within 6 months to 13.3 years. |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
If left untreated, patients with medullary thyroid cancer may progress to develop metastasis. Common complications of medullary thyroid cancer include vocal cord compression, dysphagia, and dyspnea. The presence of metastasis is associated with a particularly poor prognosis among patients with medullary thyroid cancer. The 5 year event free survival rate is 80%.
Natural History
The symptoms of medullary thyroid cancer usually develop in the third decade of life, and start with symptoms such as swelling in the neck. Without treatment, the patient will develop symptoms of metastasis such as cushing's syndrome and diarrhea, which will/ may eventually lead to death.
Complications
- Metastases to lung, bones, liver, and brain
- Hypopcalcemia after surgery due to parathyroid removal
- Dysphagia
- Hoarseness of symptoms
- Diarrhea
- Cushing's syndrome
Prognosis
- 86% of medullary thyroid cancer live atleast 5 years of survival
- 65% of medullary thyroid cancer live upto 10 years.
- Depending on source, the overall 5-year survival rate for medullary thyroid cancer is 80%,[1] 83%[2] or 86%,[3] and the 10-year survival rate is 75%.[1]
- By overall cancer staging into stages I to IV, the 5-year survival rate is 100% at stage I, 98% at stage II, 81% at stage III and 28% at stage IV.[4] The prognosis of MTC is poorer than that of follicular and papillary thyroid cancer when it has metastasized (spread) beyond the thyroid gland.
- The prognostic value of measuring calcitonin and carcinoembryonic antigen (CEA) concentrations in the blood was studied in 65 MTC patients who had abnormal calcitonin levels after surgery (total thyroidectomy and lymph node dissection).[5] The prognosis correlated with the rate at which the postoperative calcitonin concentration doubles, termed the calcitonin doubling time (CDT), rather than the pre- or postoperative absolute calcitonin level:
- CDT less than 6 months: 3 patients out of 12 (25%) survived 5 years. 1 patient out of 12 (8%) survived 10 years. All died within 6 months to 13.3 years.
- CDT between 6 months and 2 years: 11 patients out of 12 (92%) survived 5 years. 3 patients out of 8 (37%) survived 10 years. 4 patients out of 12 (25%) survived to the end of the study.
- CDT more than 2 years: 41 patients out of 41 (100%) were alive at the end of the study. These included 1 patient whose calcitonin was stable, and 11 patients who had decreasing calcitonin levels.
The calcitonin doubling time was a better predictor of MTC survival than CEA[5] but following both tests is recommended.[6][7]
References
- ↑ 1.0 1.1 Numbers from National Cancer Database in the US, from Page 10 in: F. Grünwald; Biersack, H. J.; Grںunwald, F. (2005). Thyroid cancer. Berlin: Springer. ISBN 3-540-22309-6.
- ↑ Barbet, J.; Campion, L.; Kraeber-Bodere, F.; Chatal, J. -F.; Group, T. G. T. E. S. (2005). "Prognostic Impact of Serum Calcitonin and Carcinoembryonic Antigen Doubling-Times in Patients with Medullary Thyroid Carcinoma". Journal of Clinical Endocrinology & Metabolism. 90 (11): 6077–6084. doi:10.1210/jc.2005-0044. PMID 16091497.
- ↑ National Cancer Institute > Medullary Thyroid Cancer Last Modified: 12/22/2010
- ↑ cancer.org > Thyroid Cancer By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).
- ↑ 5.0 5.1 Barbet J, Campion L, Kraeber-Bodéré F, Chatal JF (2005). "Prognostic impact of serum calcitonin and carcinoembryonic antigen doubling-times in patients with medullary thyroid carcinoma". J. Clin. Endocrinol. Metab. 90 (11): 6077–84. doi:10.1210/jc.2005-0044. PMID 16091497.
- ↑ Thyroid Carcinoma. NCCN guidelines. http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
- ↑ ASCO SEP 3rd edition