Follicular thyroid cancer staging: Difference between revisions

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__NOTOC__
__NOTOC__
{{Follicular thyroid cancer}}
{{Follicular thyroid cancer}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{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 follicular 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- cancer staging Accessed on October, 29 2015</ref> there are 4 stages of follicular 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 follicular 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
|-
|-
! style="background: #DCDCDC;" |TX
| align="center" style="background:#f0f0f0;" |'''Node involvement'''
! style="background: #F5F5F5;" |Primary tumor cannot be assessed
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #DCDCDC;" |T0
| N0
! style="background: #F5F5F5;" |No evidence of primary tumor
| ||
* No [[lymph node]] involvement
|
|-
|-
! style="background: #DCDCDC;" |T1
|N0
! style="background: #F5F5F5;" |Tumor ≤2 cm in greatest dimension limited to the thyroid
|a
|
* One or more cytologically or [[histologically]] confirmed benign [[lymph nodes]]
|
|-
|-
! style="background: #DCDCDC;" |T1a
|N0
! style="background: #F5F5F5;" |Tumor ≤1 cm, limited to the thyroid
|b
|
* No [[Radiological|radiologic]] or clinical evidence of locoregional [[lymph node]] [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" |T1b
| N1
! style="background: #F5F5F5;" |Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid
| ||
* [[Metastasis]] to regional nodes
|
|-
|-
! style="background: #DCDCDC;" |T2
| N1
! style="background: #F5F5F5;" |Tumor >2 cm but ≤4 cm in greatest dimension, 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;" |T3
| N1
! 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)
| 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;" rowspan=2|T4a
| NX
! style="background: #F5F5F5;" |Moderately advanced disease
|  ||
* Regional [[lymph node]] cannot be assessed
|
|-
|-
! style="background: #F5F5F5;" |Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve
|+
 
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Distant metastasis
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4b
| align="center" style="background:#f0f0f0;" |'''Presence of metastasis'''
! style="background: #F5F5F5;" |Very advanced disease
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #F5F5F5;" |Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessel
| M0
| ||
* No distant [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" |T4a
| M1
! style="background: #F5F5F5;" |Intrathyroidal anaplastic carcinoma
| IV||
* Distant [[metastasis]]
|[[Image:Stage M1 Thyroid cancer.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T4b
! style="background: #F5F5F5;" |Anaplastic carcinoma with gross extrathyroid extension
|}
|}
<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 nodes 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="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Follicular thyroid carcinoma'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Follicular thyroid carcinoma'''
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''YOUNGER THAN 45 YEARS'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''YOUNGER THAN 55 YEARS'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
Line 110: Line 199:


|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''45 YEARS AND OLDER'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''55 YEARS AND OLDER'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M1
! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #DCDCDC;" |II
! rowspan="4" style="background: #DCDCDC;" |II
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
|-
 
! style="background: #F5F5F5;" |T2
! style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3a
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3b
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


Line 152: Line 235:


! style="background: #DCDCDC;" |IVA
! style="background: #DCDCDC;" |IVA
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-


! style="background: #DCDCDC;" |
! rowspan="6" style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |Any T
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M1


|-
|-
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3a
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3b
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T4
! style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
Line 200: Line 273:
|-
|-


! style="background: #DCDCDC;" |Stage 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  
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|}
|}


===Papillary and Follicular Thyroid Cancer===
====Stage I Papillary Thyroid Cancer====
* Stage I papillary carcinoma is localized to the thyroid gland. In as many as 50% of cases, there are multifocal sites of papillary adenocarcinomas throughout the gland. Most papillary cancers have some follicular elements, and these may sometimes be more numerous than the papillary formations, but this does not change the prognosis. The 10-year survival rate is slightly better for patients younger than 45 years than for patients older than 45 years
====Stage II Papillary Thyroid Cancer====
Stage II papillary carcinoma is defined as either: (1) tumor that has spread distantly in patients younger than 45 years, or (2) tumor that is larger than 2 cm but 4 cm or smaller and is limited to the thyroid gland in patients older than 45 years. In as many as 50% to 80% of cases, there are multifocal sites of papillary adenocarcinomas throughout the gland. Most papillary cancers have some follicular elements, and these may sometimes be more numerous than the papillary formations, but this does not appear to change the prognosis.
====Stage III Papillary Thyroid Cancer====
* Stage III is papillary carcinoma in patients older than 45 years that is larger than 4 cm and is limited to the thyroid or with minimal extrathyroid extension, or positive lymph nodes limited to the pretracheal, paratracheal, or prelaryngeal/Delphian nodes. Papillary carcinoma that has invaded adjacent cervical tissue has a worse prognosis than tumors confined to the thyroid.
====Stage IV Papillary Thyroid Cancer====
* Stage IV is papillary carcinoma in patients older than 45 years with extension beyond the thyroid capsule to the soft tissues of the neck, cervical lymph node metastases, or distant metastases. The lungs and bone are the most frequent distant sites of spread, though such distant spread is rare in this type of thyroid cancer. Papillary carcinoma more frequently metastasizes to regional lymph nodes than to distant sites. The prognosis for patients with distant metastases is poor.
====Stage I Follicular Thyroid Cancer====
* Stage I follicular carcinoma is localized to the thyroid gland. Follicular thyroid carcinoma must be distinguished from follicular adenomas, which are characterized by their lack of invasion through the capsule into the surrounding thyroid tissue. While follicular cancer has a good prognosis, it is less favorable than that of papillary carcinoma. The 10-year survival is better for patients with follicular carcinoma without vascular invasion than it is for patients with vascular invasion.
====Stage II Follicular Thyroid Cancer====
* Stage II follicular carcinoma is defined as either tumor that has spread distantly in patients younger than 45 years, or tumor that is larger than 2 cm but 4 cm or smaller and is limited to the thyroid gland in patients older than 45 years. The presence of lymph node metastases does not worsen the prognosis among patients younger than 45 years. Follicular thyroid carcinoma must be distinguished from follicular adenomas, which are characterized by their lack of invasion through the capsule into the surrounding thyroid tissue. While follicular cancer has a good prognosis, it is less favorable than that of papillary carcinoma; the 10-year survival is better for patients with follicular carcinoma without vascular invasion than for patients with vascular invasion.
====Stage III Follicular Thyroid Cancer====
* Stage III is follicular carcinoma in patients older than 45 years, larger than 4 cm and limited to the thyroid or with minimal extrathyroid extension, or positive lymph nodes limited to the pretracheal, paratracheal, or prelaryngeal/Delphian nodes. Follicular carcinoma invading cervical tissue has a worse prognosis than tumors confined to the thyroid gland. The presence of vascular invasion is an additional poor prognostic factor. Metastases to lymph nodes do not worsen the prognosis in patients younger than 45 years.
====Stage IV Follicular Thyroid Cancer====
* Stage IV is follicular carcinoma in patients older than 45 years with extension beyond the thyroid capsule to the soft tissues of the neck, cervical lymph node metastases, or distant metastases. The lungs and bone are the most frequent sites of spread. Follicular carcinomas more commonly have blood vessel invasion and tend to metastasize hematogenously to the lungs and to the bone rather than through the lymphatic system. The prognosis for patients with distant metastases is poor.
<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 T1b thyroid cancer CRUK 251.svg.png|Stage T2 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}}
Line 254: Line 289:
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Hereditary cancers]]
[[Category:Hereditary cancers]]
[[Category:Thyroid disease]]

Latest revision as of 21:46, 29 July 2020

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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

According to the American Joint Committee on Cancer (AJCC) there are 4 stages of follicular 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 follicular 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
Follicular thyroid carcinoma
YOUNGER THAN 55 YEARS
I Any T Any N M0
II Any T Any N M1
55 YEARS AND OLDER
I T1 Any N M0
II T1 N1 M0
T2 N1 M0
T3a Any N M0
T3b Any N M0
III T4a Any N M0
IVA T4b Any N M0
IVB Any T Any N M1
T1 N1 M0
T2 N1 M0
T3a N1 M0
T3b Any N M0
T4 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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