Thyroid Cancer, Papillary

• • History of radiation to the neck in some patients

  • Painless or enlarging nodule, dysphagia, or hoarseness

  • Firm or hard, fixed thyroid nodule; cervical lymphadenopathy

  • Normal thyroid function; nodule stippled with calcium (x-ray), solid (US), cold (radioiodine scan), positive or suspicious cytologic studies

  • Family history of thyroid cancer

Epidemiology

• • Usually occurs in young adults

  • 80-85% of all thyroid cancers

  • 80% of children and 20% of adults present with clinically positive lymph node metastases

  • Psammoma bodies are seen on pathologic analysis in 60% of cases

Symptoms and Signs

• • Solitary thyroid nodule

  • Enlarged or hard cervical lymph nodes

  • Pain in the thyroid or paralaryngeal neck

  • Hoarseness

  • Dyspnea

  • Stridor

  • Dysphagia

Laboratory Findings

• • Normal thyroid-stimulating hormone (TSH) level

Imaging Findings

• • US: Solid or cystic nodule

  • Radioiodine scan: Nonfunctioning (cold)

• • Grows slowly, and metastasizes through lymph nodes

  • Rate of growth may be stimulated by TSH

  • Often multifocal or bilobar

Rule Out

• • Concurrent hyperparathyroidism (so that it can be treated at the same operation if necessary)

• • Complete history and physical, with attention to risk factors, family history, palpable characteristics of the nodule or lymphadenopathy

  • Serum TSH and calcium levels

  • Cervical ultrasound to assess the thyroid glad and cervical adenopathy

  • Fine-needle aspiration biopsy

• • Treatment starts with operative removal

  • External beam radiation may palliate nonresectable metastases that are resistant to radioiodine

Surgery

Indications

• • All papillary thyroid cancers should be excised

  • Total thyroidectomy for most patients; thyroid lobectomy adequate for some

  • Bulky or palpable nodal recurrences

Medications

• • Suppressive doses of thyroid hormone after thyroid ablation or thyroidectomy

  • Radioactive iodine therapy for remnant, recurrent, or metastatic disease

Treatment Monitoring

• • Semiannual or yearly serum thyroglobulin, thyroglobulin antibodies, and whole body radioiodine scan

Complications

• • Neck hematoma

  • Superior laryngeal nerve injury

  • Recurrent laryngeal nerve injury

  • Transient or permanent hypoparathyroidism

  • Wound infection

Prognosis

• • Very good even in the presence of metastases

  • 10-year survival rate after operation for papillary cancer is over 80%

References

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.NCCN.org/