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Staging and survival for papillary thyroid cancer is shown on Table 26 8 Papillary thyroid cancer carries a generally good prognosis, particularly for adults under age 45 years, despite the fact that about 15% of these patients are subsequently found to have metastases The following characteristics imply
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Table 26 8 Pathologic tumor-node-metastasis (pTNM) staging and tumor-related survival rates for adults with appropriately treated differentiated (papillary) thyroid carcinoma based upon patient age, primary tumor size and invasiveness (T), lymph node involvement (N), and distant metastases (M)1
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Description Under 45: any T, any N, no M Over 45: T 1 cm, no N, no M Under 45: any T, any N, any M Over 45: T > 1 cm limited to thyroid, no N, no M Over 45: T beyond thyroid capsule, no N, no M; or any T, regional N, no M Over 45: any T, any N, any M
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Five-Year Survival 99% 99% 95% 80%
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Ten-Year Survival 98% 85% 70% 61%
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Patients having a relatively worse prognosis include those with follicular thyroid carcinoma and those with familial differentiated thyroid carcinoma Adapted, with permission, from Alsanea O et al Surgery 2000 Dec;128(6):1043 50; Loh KC et al J Endocrinol Metab 1997 Nov;82(11):3553 62; and Hay ID Endocrinol Metab Clin North Am 1990 Sep;19(3):545 76
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a worse prognosis: older age, male sex, bone or brain metastases, large pulmonary metastases, and lack of 131I uptake into metastases Younger patients with pulmonary metastases tend to respond better to 131I therapy than do older adults Certain papillary histologic types are associated with a higher risk of recurrence: tall cell, columnar cell, and diffuse sclerosing types Brain metastases are detected in 1%; they reduce median survival to 12 months, but the patient's prognosis is improved by surgical resection Patients with a follicular variant of papillary carcinoma have a prognosis somewhere between that of papillary and follicular thyroid carcinoma Patients with follicular carcinoma have a cancer mortality rate that is 34 times higher than patients with papillary carcinoma The H rthle cell variant of follicular carcinoma is more aggressive Patients with primary tumors over 1 cm in diameter who undergo limited thyroid surgery (subtotal thyroidectomy or lobectomy) have a 22-fold increased mortality over those having total or near-total thyroidectomies Patients who have not received 131I ablation have mortality rates that are increased twofold by 10 years and threefold by 25 years (over those who have received ablation) The risk of cancer recurrence is twofold higher in men than in women and 17fold higher in multifocal than in unifocal tumors Medullary thyroid carcinoma is typically fairly indolent but more aggressive than differentiated thyroid cancer The overall 10-year survival rate is 90% when the tumor is confined to the thyroid, 70% for those with metastases to cervical lymph nodes, and 20% for those with distant metastases Patients with sporadic disease usually have lymph node involvement at the time of diagnosis, whereas distal metastases may not be noted for years Familial cases or those associated with MEN 2A tend to be less aggressive; the 10-year survival rate is higher, in part due to earlier detection Medullary thyroid carcinoma that is seen in MEN 2B is more aggressive, arises earlier in life, and carries a worse overall prognosis Women with medullary thyroid carcinoma who are under age 40 years have a better prognosis A better prognosis is also obtained in patients undergoing total thyroidectomy and neck dissection; radiation therapy reduces recurrence in patients with metastases to neck nodes The mortality rate is increased 45-fold when primary or metastatic tumor tissue stains heavily for myelomonocytic antigen M-1 Conversely, tumors with heavy immunoperoxidase staining for calcitonin are associated with prolonged survival even in the presence of significant metastases Anaplastic thyroid carcinoma has a 1-year survival rate of about 10% and a 5-year survival rate of about 5% Patients with fully localized tumors on MRI have a better prognosis Patients with localized lymphoma have nearly 100% 5year survival Those with disease outside the thyroid have a 63% 5-year survival However, the prognosis is better for those with the MALT type Patients presenting with stridor, pain, laryngeal nerve palsy, or mediastinal extension tend to fare worse
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Fernandes JK et al Overview of the management of differentiated thyroid cancer Curr Treat Options Oncol 2005 Jan;6(1):47 57 [PMID: 15610714] Hamady ZZ et al Surgical pathological second opinion in thyroid malignancy: impact on patients management and prognosis Eur J Surg Oncol 2005 Feb;31(1):74 7 [PMID: 15642429]
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