Follicular thyroid cancer surgery: Difference between revisions
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* [[Surgical]] [[intervention]] is not recommended for the management of follicular thyroid cancer.<ref name="urlwww.nccn.org">{{cite web |url=https://www.nccn.org/professionals/physician_gls/pdf/thyroid_blocks.pdf |title=www.nccn.org |format= |work= |accessdate=}}</ref> | * [[Surgical]] [[intervention]] is not recommended for the management of follicular thyroid cancer.<ref name="urlwww.nccn.org">{{cite web |url=https://www.nccn.org/professionals/physician_gls/pdf/thyroid_blocks.pdf |title=www.nccn.org |format= |work= |accessdate=}}</ref> | ||
* [[Surgical]] [[intervention]] for the management of follicular thyroid cancer varies depending on the degree of [[tumor]] [[invasion]]. It includes: | * [[Surgical]] [[intervention]] for the management of follicular thyroid cancer varies depending on the degree of [[tumor]] [[invasion]]. It includes: | ||
** Total thyroidectomy | ** Total [[thyroidectomy]] | ||
** Lobectomy plus isthmusectomy | **[[Lobectomy]] plus isthmusectomy | ||
==Indications== | ==Indications== | ||
* Lobectomy plus isthmusectomy is indicated when the [[tumor]] is minimally invasive.<ref name="urlwww.nccn.org">{{cite web |url=https://www.nccn.org/professionals/physician_gls/pdf/thyroid_blocks.pdf |title=www.nccn.org |format= |work= |accessdate=}}</ref> | * Lobectomy plus isthmusectomy is indicated when the [[tumor]] is minimally invasive.<ref name="urlwww.nccn.org">{{cite web |url=https://www.nccn.org/professionals/physician_gls/pdf/thyroid_blocks.pdf |title=www.nccn.org |format= |work= |accessdate=}}</ref> | ||
| Line 15: | Line 15: | ||
** [[Metastatic]] | ** [[Metastatic]] | ||
* Patients'preference is another indication. | * Patients'preference is another indication. | ||
* Unilateral hemithyroidectomy is uncommon due to the aggressive nature of follicular thyroid cancer.<ref> Thyroid Cancer Cancer.gov | * Unilateral [[hemithyroidectomy]] is uncommon due to the aggressive nature of follicular thyroid cancer.<ref> Thyroid Cancer Cancer.gov | ||
(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#section/_6- Accessed on October, 29 2015</ref> | (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#section/_6- Accessed on October, 29 2015</ref> | ||
* Total thyroidectomy is the mainstay of treatment for follicular thyroid cancer. This is invariably followed by [[radioiodine]] treatment at levels from 50 to 200 millicuries following two weeks of a low iodine diet (LID). Occasionally treatment must be repeated if annual scans indicate remaining cancerous tissue. | * Total thyroidectomy is the mainstay of treatment for follicular thyroid cancer. This is invariably followed by [[radioiodine]] treatment at levels from 50 to 200 millicuries following two weeks of a low iodine diet (LID). Occasionally treatment must be repeated if annual scans indicate remaining cancerous tissue.<ref name="pmid8080485">{{cite journal |vauthors=Emerick GT, Duh QY, Siperstein AE, Burrow GN, Clark OH |title=Diagnosis, treatment, and outcome of follicular thyroid carcinoma |journal=Cancer |volume=72 |issue=11 |pages=3287–95 |date=December 1993 |pmid=8080485 |doi=10.1002/1097-0142(19931201)72:11<3287::aid-cncr2820721126>3.0.co;2-5 |url=}}</ref> | ||
===Stage I and II Follicular Thyroid Cancer=== | ===Stage I and II Follicular Thyroid Cancer=== | ||
====Total Thyroidectomy==== | ====Total Thyroidectomy==== | ||
* The objective of surgery is to completely remove the primary [[tumor]] while minimizing treatment-related morbidity and to guide postoperative treatment with radioactive iodine (RAI). The goal of radioactive iodine (RAI) is to ablate the remnant [[thyroid|thyroid tissue]] to improve the specificity of thyroglobulin assays, which allows the detection of persistent [[disease]] by follow-up whole-body scanning. For patients undergoing radioactive iodine (RAI), removal of all normal [[thyroid|thyroid tissue]] is an important surgical objective. Additionally, for accurate long-term surveillance, radioactive iodine (RAI) whole-body scanning and measurement of serum thyroglobulin are affected by residual, normal [[thyroid|thyroid tissue]], and in these situations, near-total or total thyroidectomy is required. This approach facilitates follow-up thyroid scanning. | * The objective of [[surgery]] is to completely remove the primary [[tumor]] while minimizing treatment-related [[morbidity]] and to guide postoperative treatment with [[radioactive iodine]] (RAI). The goal of radioactive iodine (RAI) is to ablate the remnant [[thyroid|thyroid tissue]] to improve the specificity of thyroglobulin assays, which allows the detection of persistent [[disease]] by follow-up whole-body scanning. For patients undergoing [[radioactive iodine]] (RAI), removal of all normal [[thyroid|thyroid tissue]] is an important surgical objective. Additionally, for accurate long-term surveillance, radioactive iodine (RAI) whole-body scanning and measurement of serum thyroglobulin are affected by residual, normal [[thyroid|thyroid tissue]], and in these situations, near-total or total [[thyroidectomy]] is required. This approach facilitates follow-up thyroid scanning. | ||
====Lobectomy==== | ====Lobectomy==== | ||
* Lobectomy is associated with a lower incidence of complications, but approximately 5% to 10% of patients will have a recurrence in the [[thyroid]] following lobectomy. Patients younger than 45 years will have the longest follow-up period and the greatest opportunity for recurrence. Follicular thyroid cancer commonly metastasizes to [[lung|lungs]] and [[bone]]; with a remnant lobe in place, use of I-131 as ablative therapy is compromised. Abnormal regional [[lymph node|lymph nodes]] should be biopsied at the time of [[surgery]]. Recognized nodal involvement should be removed at initial [[surgery]], but selective node removal can be performed, and radical neck dissection is usually not required. This results in a decreased recurrence rate but has not been shown to improve survival. | * Lobectomy is associated with a lower incidence of [[complications]], but approximately 5% to 10% of patients will have a recurrence in the [[thyroid]] following [[lobectomy]]. Patients younger than 45 years will have the longest follow-up period and the greatest opportunity for recurrence. Follicular thyroid cancer commonly metastasizes to [[lung|lungs]] and [[bone]]; with a remnant lobe in place, use of I-131 as ablative therapy is compromised. Abnormal regional [[lymph node|lymph nodes]] should be biopsied at the time of [[surgery]]. Recognized nodal involvement should be removed at initial [[surgery]], but selective node removal can be performed, and radical neck dissection is usually not required. This results in a decreased recurrence rate but has not been shown to improve survival. | ||
* Following the surgical procedure, patients should receive postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress [[thyroid-stimulating hormone]] (TSH); studies have shown a decreased incidence of recurrence when [[thyroid-stimulating hormone]] is suppressed. | * Following the surgical procedure, patients should receive postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress [[thyroid-stimulating hormone]] ([[TSH]]); studies have shown a decreased incidence of recurrence when [[thyroid-stimulating hormone]] is suppressed. | ||
===Stage III Follicular Thyroid Cancer=== | ===Stage III Follicular Thyroid Cancer=== | ||
====Standard Treatment Options==== | ====Standard Treatment Options==== | ||
* Total thyroidectomy and removal of involved [[lymph node|lymph nodes]] or other sites of extrathyroid disease. | * Total [[thyroidectomy]] and removal of involved [[lymph node|lymph nodes]] or other sites of extrathyroid disease. | ||
* I-131 ablation following [[ | * I-131 ablation following total [[thyroidectomy]] if the tumor demonstrates uptake of this isotope. | ||
* [[External-beam radiation]] therapy if I-131 uptake is minimal | * [[External-beam radiation]] therapy if I-131 uptake is minimal. | ||
===Stage IV Follicular Thyroid Cancer=== | ===Stage IV Follicular Thyroid Cancer=== | ||
* The most common sites of metastases are [[lymph node|lymph nodes]], [[lung]], and [[bone]]. Treatment of [[lymph node]] [[metastases]] alone are often curative. Treatment of distant [[metastases]] is usually not curative but may produce significant palliation. | * The most common sites of metastases are [[lymph node|lymph nodes]], [[lung]], and [[bone]]. Treatment of [[lymph node]] [[metastases]] alone are often curative. Treatment of distant [[metastases]] is usually not curative but may produce significant palliation. | ||
===Lymph Node Metastasis=== | ===Lymph Node Metastasis=== | ||
* For [[lymph node]] [[metastasis]], central neck dissection is recommended. | * For [[lymph node]] [[metastasis]], central neck dissection is recommended. | ||
* Central neck dissection includes the evacuation of fibrofatty and nodal tissue from the [[common carotid artery]] to hyoid | * Central neck dissection includes the evacuation of fibrofatty and nodal tissue from the [[common carotid artery]] to [[hyoid bone]]<nowiki/>s superiorly and inferiorly up to the [[innominate artery]]. | ||
* Modified neck dissection is reserved for [[lymph node|lymph nodes]] with macroscopic metastasis. In this procedure, all nodal and fibrofatty tissues are removed from levels II to level V in the neck. | * Modified neck dissection is reserved for [[lymph node|lymph nodes]] with macroscopic [[metastasis]]. In this procedure, all nodal and fibrofatty tissues are removed from levels II to level V in the neck. | ||
===Bone Metastasis=== | ===Bone Metastasis=== | ||
* [[Spine]] stabilization is reserved for [[bone]] [[metastasis]] with [[neurologic]] symptoms. | * [[Spine]] stabilization is reserved for [[bone]] [[metastasis]] with [[neurologic]] symptoms. | ||
* Percutaneous vertebroplasty is also recommended for [[bone]] [[metastasis]]. | * Percutaneous [[vertebroplasty]] is also recommended for [[bone]] [[metastasis]]. | ||
==Reference== | ==Reference== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 17:29, 29 October 2019
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Differentiating Follicular thyroid cancer from other Diseases |
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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
Surgery is the mainstay of treatment for follicular thyroid cancer.
Surgery
- Surgical intervention is not recommended for the management of follicular thyroid cancer.[1]
- Surgical intervention for the management of follicular thyroid cancer varies depending on the degree of tumor invasion. It includes:
- Total thyroidectomy
- Lobectomy plus isthmusectomy
Indications
- Lobectomy plus isthmusectomy is indicated when the tumor is minimally invasive.[1]
- Total thyroidectomy is indicated when the tumor is:
- Invasive (extensive vascular invasion is present)
- Metastatic
- Patients'preference is another indication.
- Unilateral hemithyroidectomy is uncommon due to the aggressive nature of follicular thyroid cancer.[2]
- Total thyroidectomy is the mainstay of treatment for follicular thyroid cancer. This is invariably followed by radioiodine treatment at levels from 50 to 200 millicuries following two weeks of a low iodine diet (LID). Occasionally treatment must be repeated if annual scans indicate remaining cancerous tissue.[3]
Stage I and II Follicular Thyroid Cancer
Total Thyroidectomy
- The objective of surgery is to completely remove the primary tumor while minimizing treatment-related morbidity and to guide postoperative treatment with radioactive iodine (RAI). The goal of radioactive iodine (RAI) is to ablate the remnant thyroid tissue to improve the specificity of thyroglobulin assays, which allows the detection of persistent disease by follow-up whole-body scanning. For patients undergoing radioactive iodine (RAI), removal of all normal thyroid tissue is an important surgical objective. Additionally, for accurate long-term surveillance, radioactive iodine (RAI) whole-body scanning and measurement of serum thyroglobulin are affected by residual, normal thyroid tissue, and in these situations, near-total or total thyroidectomy is required. This approach facilitates follow-up thyroid scanning.
Lobectomy
- Lobectomy is associated with a lower incidence of complications, but approximately 5% to 10% of patients will have a recurrence in the thyroid following lobectomy. Patients younger than 45 years will have the longest follow-up period and the greatest opportunity for recurrence. Follicular thyroid cancer commonly metastasizes to lungs and bone; with a remnant lobe in place, use of I-131 as ablative therapy is compromised. Abnormal regional lymph nodes should be biopsied at the time of surgery. Recognized nodal involvement should be removed at initial surgery, but selective node removal can be performed, and radical neck dissection is usually not required. This results in a decreased recurrence rate but has not been shown to improve survival.
- Following the surgical procedure, patients should receive postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress thyroid-stimulating hormone (TSH); studies have shown a decreased incidence of recurrence when thyroid-stimulating hormone is suppressed.
Stage III Follicular Thyroid Cancer
Standard Treatment Options
- Total thyroidectomy and removal of involved lymph nodes or other sites of extrathyroid disease.
- I-131 ablation following total thyroidectomy if the tumor demonstrates uptake of this isotope.
- External-beam radiation therapy if I-131 uptake is minimal.
Stage IV Follicular Thyroid Cancer
- The most common sites of metastases are lymph nodes, lung, and bone. Treatment of lymph node metastases alone are often curative. Treatment of distant metastases is usually not curative but may produce significant palliation.
Lymph Node Metastasis
- For lymph node metastasis, central neck dissection is recommended.
- Central neck dissection includes the evacuation of fibrofatty and nodal tissue from the common carotid artery to hyoid bones superiorly and inferiorly up to the innominate artery.
- Modified neck dissection is reserved for lymph nodes with macroscopic metastasis. In this procedure, all nodal and fibrofatty tissues are removed from levels II to level V in the neck.
Bone Metastasis
- Spine stabilization is reserved for bone metastasis with neurologic symptoms.
- Percutaneous vertebroplasty is also recommended for bone metastasis.
Reference
- ↑ 1.0 1.1 "www.nccn.org" (PDF).
- ↑ Thyroid Cancer Cancer.gov (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#section/_6- Accessed on October, 29 2015
- ↑ Emerick GT, Duh QY, Siperstein AE, Burrow GN, Clark OH (December 1993). "Diagnosis, treatment, and outcome of follicular thyroid carcinoma". Cancer. 72 (11): 3287–95. doi:10.1002/1097-0142(19931201)72:11<3287::aid-cncr2820721126>3.0.co;2-5. PMID 8080485.