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__NOTOC__
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{{Medullary thyroid cancer}}
{{Medullary thyroid cancer}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{Sahar}} {{Ammu}}
==Overview==
==Overview==
According to the American Joint Committee on Cancer (AJCC)<ref> Stage Information for Thyroid Cancer  Cancer.gov
According to the American Joint Committee on Cancer (AJCC) there are 4 stages of medullary thyroid cancer based on the [[clinical features]] and findings on [[imaging]]. Each stage is assigned a letter and a number that designate the [[tumor]] size, number of involved [[lymph node]] regions, and [[metastasis]].
(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015</ref> there are 4 stages of medullary thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of involved [[lymph node]] regions, and [[metastasis]].
==Staging==
==Staging==
<br>
* According to the American Joint Committee on Cancer (AJCC) there are 4 stages of medullary thyroid cancer based on the [[clinical features]] and findings on [[imaging]].<ref name="urlThyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#_441_toc |title=Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
* Each stage is assigned a letter and a number that designate the [[tumor]] size, number of involved [[lymph node]] regions, and [[metastasis]].
|+'''''Thyroid TNM staging'''''
{| class="wikitable"
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
|+
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
 
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Primary tumor
|-
| align="center" style="background:#f0f0f0;" |'''Tumor size'''
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
| T0
|  ||
* No evidence of primary [[tumor]]
|
|-
| T1
|  ||
* [[Tumor]] ≤2 cm in greatest dimension limited to the [[thyroid]]
|
|-
| T1
| a||
* [[Tumor]] ≤1 cm, limited to the [[thyroid]]
| [[Image:Diagram showing stage T1a thyroid cancer CRUK 250.png|200px|thumb|none]]
|-
| T1
| b||
* [[Tumor]] >1 cm but ≤2 cm in greatest dimension, limited to the [[thyroid]]
| [[Image:Diagram showing stage T1b thyroid cancer CRUK 251.svg.png|200px|thumb|none]]
|-
| T2
|  ||
* [[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
|
|-
| T3
|  ||
* [[Tumor]] >4 cm limited to the [[thyroid]], or gross extrathyroidal extension invading only strap [[muscles]]
| [[Image:Diagram showing stage T3 thyroid cancer CRUK 265.png|200px|thumb|none]]
|-
|T3
|a
|
* [[Tumor]] >4 cm limited to the [[thyroid]]
|
|-
|T3
|b
|
* Gross extrathyroidal extension invading only strap [[muscles]] ([[sternohyoid]], [[sternothyroid]], [[thyrohyoid]], or [[Omohyoid muscle|omohyoid muscles]]) from a [[tumor]] of any size
|
|-
| T4
|  ||
* [[Tumor]] includes gross extrathyroidal extension beyond the strap [[muscles]]
|
|-
| T4
| a||
* [[Tumor]] with gross extrathyroidal extension invading subcutaneous [[Soft tissue|soft tissues]], [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]] from a [[tumor]] of any size
|[[Image:Diagram showing stage T4a thyroid cancer CRUK 272.png|200px|thumb|none]]
|-
| T4
| b||
* [[Tumor]] with gross extrathyroidal extension invading [[prevertebral fascia]] or encasing the [[carotid artery]] or [[mediastinal]] vessels from a [[tumor]] of any size.
|[[Image:Diagram showing stage T4b thyroid cancer CRUK 273.png|200px|thumb|none]]
|-
| TX
|  ||
* Primary [[tumor]] cannot be assessed
|
|-
|+
 
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Regional lymph node involvement
|-
| align="center" style="background:#f0f0f0;" |'''Node involvement'''
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
| N0
| ||
* No [[lymph node]] involvement
|
|-
|-
! style="background: #DCDCDC;" |TX
|N0
! style="background: #F5F5F5;" |Primary [[tumor]] cannot be assessed
|a
|
* One or more cytologically or [[histologically]] confirmed benign [[lymph nodes]]
|
|-
|-
! style="background: #DCDCDC;" |T0
|N0
! style="background: #F5F5F5;" |No evidence of primary [[tumor]]
|b
|
* No [[Radiological|radiologic]] or clinical evidence of locoregional [[lymph node]] [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" |T1
| N1
! style="background: #F5F5F5;" |[[Tumor]] ≤2 cm in greatest dimension limited to the [[thyroid]]
| ||
* [[Metastasis]] to regional nodes
|
|-
|-
! style="background: #DCDCDC;" |T1a
| N1
! style="background: #F5F5F5;" |[[Tumor]] ≤1 cm, limited to the [[thyroid]]
| a||
* [[Metastasis]] to level VI or VII ([[Pretracheal lymph nodes|pretracheal]], [[Paratracheal lymph nodes|paratracheal]], or [[Prelaryngeal lymph nodes|prelaryngeal]]/Delphian, or upper mediastinal) [[lymph nodes]]. This can be unilateral or bilateral [[disease]]
|[[Image:Diagram showing stage N1a thyroid cancer CRUK 242.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T1b
| N1
! style="background: #F5F5F5;" |[[Tumor]] >1 cm but ≤2 cm in greatest dimension, limited to the [[thyroid]]
| b||
* [[Metastasis]] to unilateral, bilateral, or contralateral [[Cervical lymph nodes|cervical]] neck [[lymph nodes]] (levels I, II, III, IV, or V) or [[retropharyngeal lymph nodes]]
|[[Image:Diagram showing stage N1b thyroid cancer CRUK 243.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T2
| NX
! style="background: #F5F5F5;" |[[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
| ||
* Regional [[lymph node]] cannot be assessed
|
|-
|-
! style="background: #DCDCDC;" |T3
|+
! style="background: #F5F5F5;" |[[Tumor]] >4 cm in greatest dimension limited to the [[thyroid]] or any [[tumor]] with minimal extrathyroid extension (e.g., extension to [[sternothyroid muscle]] or perithyroid soft tissues)
 
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Distant metastasis
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4a
| align="center" style="background:#f0f0f0;" |'''Presence of metastasis'''
! style="background: #F5F5F5;" |Moderately advanced [[disease]]
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #F5F5F5;" |[[Tumor]] of any size extending beyond the thyroid capsule to invade subcutaneous [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
| M0
| ||
* No distant [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4b
| M1
! style="background: #F5F5F5;" |Very advanced [[disease]]
| IV||
* Distant [[metastasis]]
|[[Image:Stage M1 Thyroid cancer.png|200px|thumb|none]]
|-
|-
! style="background: #F5F5F5;" |[[Tumor]] invades prevertebral fascia or encases [[carotid artery]] or mediastinal vessel
|}
|}
<br>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Regional Lymph Nodes (N)'''''
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
 
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|-
 
|-
 
|-
 
|-
|-
! style="background: #DCDCDC;" |NX
 
! style="background: #F5F5F5;" |Regional [[lymph node]] cannot be assessed
|-
|-
! style="background: #DCDCDC;" |N0
 
! style="background: #F5F5F5;" |No regional lymph node metastasis
|-
|-
! style="background: #DCDCDC;" |N1
 
! style="background: #F5F5F5;" |Regional [[lymph node]] metastasis
|-
|-
! style="background: #DCDCDC;" |N1a
 
! style="background: #F5F5F5;" |[[Metastases]] to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
|-
|-
! style="background: #DCDCDC;" |N1b
! style="background: #F5F5F5;" |[[Metastases]] to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)
|}


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Distant Metastasis (M)'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|-
|-
! style="background: #DCDCDC;" |M0
 
! style="background: #F5F5F5;" |No distant [[metastasis]]
|-
|-
! style="background: #DCDCDC;" |M1
! style="background: #F5F5F5;" |Distant [[metastasis]]
|}


|-


|}
<br />
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Anatomic Stage/Prognostic Groups'''''
|+'''''Anatomic Stage/Prognostic Groups'''''
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! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|M}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Medullary carcinoma (all age groups)'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Medullary thyroid carcinoma'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
Line 94: Line 189:
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #DCDCDC;" rowspan=2|II
! rowspan="2" style="background: #DCDCDC;" |II
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |T2


Line 102: Line 197:
|-
|-
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #DCDCDC;" rowspan=3|III
! rowspan="3" style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0


! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
! style="background: #DCDCDC;" rowspan=7|IVa
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |N0


! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #DCDCDC;" |IVA
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |T4a
 
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |N1a
 
! style="background: #F5F5F5;" |M0
 
|-
! style="background: #F5F5F5;" |T1
 
! style="background: #F5F5F5;" |N1b
 
! style="background: #F5F5F5;" |M0
|-
! style="background: #F5F5F5;" |T2
 
! style="background: #F5F5F5;" |N1b
 
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
! style="background: #F5F5F5;" |T3


! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |M0
|-
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |M0
|-
! style="background: #F5F5F5;" |Stage IVb
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |Any N
|-
! style="background: #DCDCDC;" |IVB
! style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #DCDCDC;" |IVC
! style="background: #DCDCDC;" |IVC
! style="background: #F5F5F5;" |Any T
! style="background: #F5F5F5;" |Any T
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |M1
! style="background: #F5F5F5;" |M1
|}
|}
===Medullary Thyroid Cancer===
* Several staging systems have been employed to correlate extent of [[disease]] with long-term survival in medullary thyroid cancer. The clinical staging system of the AJCC correlates survival to size of the primary tumor, presence or absence of [[lymph node]] metastases, and presence or absence of distance metastasis. Patients with the best prognosis are those who are diagnosed by provocative screening, prior to the appearance of palpable disease.
====Stage 0 Medullary Thyroid Cancer====
* Clinically occult disease detected by provocative biochemical screening
====Stage I Medullary Thyroid Cancer====
* Tumor smaller than 2 cm
====Stage II Medullary Thyroid Cancer====
* Tumor larger than 2 cm but 4 cm or smaller with no [[metastases]] or larger than 4 cm with minimal extrathyroid extension
====Stage III Medullary Thyroid Cancer====
* Tumor of any size with [[metastases]] limited to the pretracheal, paratracheal, or prelaryngeal/Delphian [[lymph node]]s.
====Stage IV Medullary Thyroid Cancer====
* Stage IV medullary thyroid cancer is divided into the following categories:
:* Stage IVA (moderately advanced with or without lymph node metastases [for T4a] but without distant metastases).
:* Stage IVB (very advanced with or without lymph node metastases but no distant metastases).
:* Stage IVC (distant metastases)
<gallery>
File:Stage M1 Thyroid cancer.png|Stage M1 thyroid cancer
File:Diagram showing stage N1a thyroid cancer CRUK 242.png|Stage N1a thyroid cancer
File:Diagram showing stage N1b thyroid cancer CRUK 243.png|Stage N1b thyroid cancer
File:Diagram showing stage T1a thyroid cancer CRUK 250.png|Stage T1a thyroid cancer
File:Diagram showing stage T1b thyroid cancer CRUK 251.svg.png|Stage T1b thyroid cancer
File:Diagram showing stage T3 thyroid cancer CRUK 265.png|Stage T3 thyroid cancer
File:Diagram showing stage T4a thyroid cancer CRUK 272.png|Stage T4a thyroid cancer
File:Diagram showing stage T4b thyroid cancer CRUK 273.png|Stage T4b thyroid cancer
</gallery>
==Reference==
==Reference==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 18:39, 19 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Ammu Susheela, M.D. [3]

Overview

According to the American Joint Committee on Cancer (AJCC) there are 4 stages of medullary thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of involved lymph node regions, and metastasis.

Staging

  • According to the American Joint Committee on Cancer (AJCC) there are 4 stages of medullary thyroid cancer based on the clinical features and findings on imaging.[1]
  • Each stage is assigned a letter and a number that designate the tumor size, number of involved lymph node regions, and metastasis.
Primary tumor
Tumor size Sub-stage Finding Image
T0
  • No evidence of primary tumor
T1
T1 a
T1 b
  • Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid
T2
  • Tumor >2 cm but ≤4 cm in greatest dimension, limited to the thyroid
T3
  • Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles
T3 a
T3 b
T4
  • Tumor includes gross extrathyroidal extension beyond the strap muscles
T4 a
T4 b
TX
  • Primary tumor cannot be assessed
Regional lymph node involvement
Node involvement Sub-stage Finding Image
N0
N0 a
N0 b
N1
N1 a
N1 b
NX
Distant metastasis
Presence of metastasis Sub-stage Finding Image
M0
M1 IV


Anatomic Stage/Prognostic Groups
Stage T N M
Medullary thyroid carcinoma
I T1 N0 M0
II T2 N0 M0
T3 N0 M0
III T1 N1a M0
T2 N1a M0
T3 N1a M0
IVA T4a Any N M0
IVB T4b Any N M0
IVC Any T Any N M1

Reference

  1. ↑ "Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute".
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