Table Of ContentUPDATES IN THE
UNDERSTANDING AND
MANAGEMENT OF
THYROID CANCER
Edited by Thomas J. Fahey
Updates in the Understanding and Management of Thyroid Cancer
Edited by Thomas J. Fahey
Published by InTech
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First published March, 2012
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Updates in the Understanding and Management of Thyroid Cancer,
Edited by Thomas J. Fahey
p. cm.
ISBN 978-953-51-0299-1
Contents
Chapter 1 An Epidemiological Analysis
of Thyroid Cancer in a Spanish Population:
Presentation, Incidence and Survival 1
A. Rego-Iraeta, L. Pérez-Mendez and R.V. García-Mayor
Chapter 2 The Functionality of p53 in Thyroid Cancer 33
Debolina Ray, Matthew T. Balmer and Susannah Gal
Chapter 3 Glycosylation and Glycoproteins in Thyroid Cancer:
A Potential Role for Diagnostics 53
Anna Krześlak, Paweł Jóźwiak and Anna Lipińska
Chapter 4 Insulin-Like Growth Factor Receptor
Signaling in Thyroid Cancers:
Clinical Implications and Therapeutic Potential 91
Geetika Chakravarty and Debasis Mondal
Chapter 5 Principles and Application of Microarray
Technology in Thyroid Cancer Research 119
Walter Pulverer, Christa Noehammer,
Klemens Vierlinger and Andreas Weinhaeusel
Chapter 6 Evaluation and Management
of Pediatric Thyroid Nodules 147
Melanie Goldfarb and John I. Lew
Chapter 7 Papillary Thyroid Cancer in Childhood
and Adolescence with Specific Consideration
of Patients After Radiation Exposure 163
Yuri Demidchik, Mikhail Fridman,
Kurt Werner Schmid, Christoph Reiners,
Johannes Biko and Svetlana Mankovskaya
Chapter 8 Thyroid Cancer in the Pediatric Population 189
Silva Frieda, Nieves-Rivera Francisco and Laguna Reinaldo
VI Contents
Chapter 9 Current Innovations and Opinions
in the Surgical Management
of Differentiated Thyroid Carcinoma 199
Brian Hung-Hin Lang
Chapter 10 Sentinel Lymph Node Biopsy in
Well Differentiated Thyroid Cancer 217
Tamara Mijovic, Keith Richardson,
Richard J. Payne and Jacques How
Chapter 11 Preparing Patients for Radioiodine Treatment:
Increasing Thyroid Cell Uptake and Accelerating
the Excretion of Unbound Radioiodine 235
Milovan Matović
Chapter 12 Differentiation Therapy in Thyroid Carcinoma 251
Eleonore Fröhlich and Richard Wahl
Chapter 13 Using γ-Camera to Evaluate the In Vivo
Biodistributions and Internal Medical Dosimetries
of Iodine-131 in Thyroidectomy Patients 283
Sheng-Pin Changlai, Tom Changlai and Chien-Yi Chen
Chapter 14 Thyroid Cancer:
The Evolution of Treatment Options 295
Hitoshi Noguchi
1
An Epidemiological Analysis of Thyroid
Cancer in a Spanish Population:
Presentation, Incidence and Survival
A. Rego-Iraeta, L. Pérez-Mendez and R.V. García-Mayor
Department of Endocrinology, Diabetes, Nutrition and Metabolism,
University Hospital of Vigo
Spain
1. Introduction
Accurate statistics on cancer occurrence and outcome are essential both for the purposes of
research and for planning and evaluation programmes for cancer control (Parkin, 2006).
Although tumours of thyroid account for only 1% of the overall human cancer burden, they
represent the most common malignancies of the endocrine system and pose a significant
challenge to pathologists, surgeons and endocrinologists. Among epithelial tumors,
carcinomas of follicular cell origin far outnumber those of C-cell origin. The vast majority of
carcinomas of follicular cell origin are indolent malignancies with 10 year survivals in excess
of 90 %.
1.1 Classification
Thyroid follicular epithelial-derived cancers are divided into three categories: papillary
cancer, follicular cancer and anaplastic cancer. Papillary and follicular cancers are
considered differentiated cancers, and patients with these tumours are often treated
similarly despite numerous biologic differences. Most anaplastic (undifferentiated) cancers
appear to arise from differentiated cancers. Other malignant diseases of the thyroid include
medullary thyroid cancer (which can be familial, either as part of the multiple endocrine
neoplasia type 2 syndrome or isolated familial medullary thyroid cancer), primary thyroid
lymphoma, or metastases from breast, colon, or renal cancer or melanoma. In countries with
adequate iodine intake, differentiated thyroid cancer accounts for more than 85% of all
cases, being the most common type papillary (60-80%). Tumor histology is a critical
determinant of patient outcomes; differentiated thyroid cancer is associated with the best
survival rate and medullary and anaplastic have significantly poorer outcomes (Hundahl et
al., 1998). Certain subtypes, such as the tall and columnar cell variants of papillary cancer
and the insular variant of follicular cancer are more common in older patients with higher
stage disease and have a worse prognosis than usual forms of thyroid cancer. The
traditional separation of thyroid cancer into the major groups of papillary, follicular,
medullary and undifferentiated (anaplastic) carcinoma, based on morphology and clinical
2 Updates in the Understanding and Management of Thyroid Cancer
features, is strongly supported by advances in molecular studies showing the involvement
of distinct genes in these four groups, with little overlap (DeLellis & Williams, 2004).
1.2 Staging and prognostic factors
Numerous staging systems have been created in an attempt to accurately prognosticate
outcomes for individual patients; two careful studies have compared the efficacy of the
various staging systems and found that none is superior (Brierley et al., 1997; Sherman et al.,
1998). Consequently, the European Thyroid Association (ETA) (Pacini et al., 2006) and the
American Thyroid Association (ATA) (Cooper et al., 2009) have recommended the use of
the Tumour, Node, Metastasis (TNM) classification of the American Joint Commission on
Cancer (AJCC) and the International Union Against Cancer because it is universally
available and widely accepted for other disease sites. An interesting feature of the TNM
staging system compared to other classifications is the age factor. While the staging of head
and neck cancers relies exclusively in the anatomical extent of disease, it is not possible to
follow this pattern for the particular group of malignant tumors that arise in the thyroid
gland. The effect of age is such significance in behavior and prognosis, that both the
histologic diagnosis and the age of the patient are included in the staging system for these
tumors. The AJCC classification is based on the TNM system, which relies on assessing three
components: (1) extent of the primary tumour (T), (2) absence or presence of regional lymph
node metastases (N), and (3) absence or presence of distant metastases (M). The fifth edition
(Fleming et al., 1997), (Table 1) was revised as the sixth edition (Greene et al., 2002), (Table 2).
A major alteration was the reclassification of tumour staging (T). For differentiated
(papillary and follicular) and medullary tumours confined to the parenchyma of the thyroid
gland without extrathyroidal extension, there is no evidence to suggest that using a size cut-
off of 1 cm provides better prognostic stratification compared with the 2-cm cut-off used for
Papillary or Follicular Medullary Anaplastic
Stage Age < 45 years Age > 45 years Any age
Any T Any N
I T1 N0 M0 T1 N0 M0
M0
T2 N0 M0
Any T Any N T2 N0 M0
II T3 N0 M0
M1 T3 N0 M0
T4 N0 M0
T4 N0 M0 Any T N1 M0
III
Any T N1 M0
Any T Any N Any T Any N
IV Any T Any N M0
M1 Any M
Table 1. AJCC TNM classification for thyroid cancer (fifth edition). T1 - Tumor 1 cm or less
in greatest dimension limited to the thyroid. T2 - Tumour more than 1 cm, but not more
than 4 cm, in greatest dimension limited to the thyroid. T3 - Tumour more than 4 cm in
greatest dimension limited to the thyroid. T4 - Tumour of any size extending beyond the
thyroid capsule. T4a - Excluded. T4b - Excluded. Regional lymph nodes are the cervical and
upper mediastinal lymph nodes. N1a - Metastasis in ipsilateral cervical lymph node(s).
N1b - Metastasis in bilateral, midline, or contralateral cervical or mediastinal lymph node
(s). M0- no distance metastases; M1- distance metastases.
