The Basics of Medullary Thyroid Cancer

Cancer comes in many forms and one of these forms would be thyroid cancer. Thyroid cancer is deemed to be uncommon in comparison to other types or forms of cancers. In the US alone, about 64 000 new cases of cancer of the thyroid was estimated in 2016 while other cancers like colon cancer yields about 135 000 and breast cancer pushes to more than 240 000.[1] Thyroid cancer has its own forms. One of these is Medullary Thyroid Cancer.

What is medullary thyroid cancer?

Medullary Thyroid Cancer is listed as a type of thyroid carcinoma that stems from the C cells or the parafollicular cells. These are the cells responsible for producing a hormone called calcitonin.[2] Medullary Thyroid Cancer is a rare form of thyroid carcinoma. Only about 3% of thyroid cancers are recorded to be under Medullary Thyroid Cancer.[3]

Causes of Medullary Thyroid Cancer

The causes of Medullary Thyroid Cancer varies, but roughly 20% is caused by one’s genes, specifically a RET proto-oncogene mutation.[4] Once gene is the cause of this cancer, it is will be categorized as Inherited / Familial Medullary Thyroid Cancer. When MTC is developed on its own, it will be classified as Sporadic Medullary Thyroid Cancer. On the other hand, if MTC occurs with pheochromocytoma as well as parathyroid gland tumors, it will be termed as MEN-II or Multiple Endocrine Neoplasia Type 2.[5]

Symptoms of Medullary Thyroid Cancer

Signs and symptoms of Medullary Thyroid Cancer include the following:

Those with advanced stage Medullary Thyroid Cancer may also experience:

Possible Treatment for Medullary Thyroid Cancer

The standard treatment of choice for those with Medullary Thyroid Cancer would be surgery that will remove the patient’s whole thyroid gland. This surgery is called total thyroidectomy. This treatment method is considered as an absolute means curing patients who do not have extensive nodal involvement. Since this surgery will remove the thyroid gland fully, patient will then be undergoing permanent replacement of thyroid hormones via medications.

If the tumor has already spread to places outside of the neck or the thyroid, surgery may be helpful albeit not totally eliminating the cancer. It will be more of a palliative treatment approach. In this case, other possible treatment choices that should be performed with surgery include chemotherapy or external beam radiation.

Managing Medullary Thyroid Cancer in patients who are gene carriers would depend on certain conditions, as recommended by the European Society of Endocrine Surgeons.[7] Surgery timing would be dependent on the form of mutation that is present in the genes. For patients who are under the highest risk cluster, surgery will be highly recommended within the patients “first year of life”. If the patient belongs to the lower risk cluster, surgery can be possibly delayed up to when the patient is at age 10. For the latter, precise surgery timing will be reliant on other factors as well as the mutation of the gene.

 

[1] Cancer of the Thyroid. American Thyroid Association. https://www.thyroid.org/medullary-thyroid-cancer/

[2] Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. "Thyroid and Parathyroid Cancers" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.

[3] Stamatakos M, Paraskeva P, Stefanaki C, Katsaronis P, Lazaris A, Safioleas K, Kontzoglou K (January 2011). "Medullary thyroid carcinoma: The third most common thyroid cancer reviewed". Oncol Lett. 2 (1): 49–53. doi:10.3892/ol.2010.223. PMC 3412473. PMID 22870127.

[4] Thyroid cancer: Medullary Thyroid Cancer (MTC). American Association of Endocrine Surgeons. http://endocrinediseases.org/thyroid/cancer_medullary.shtml

[5] Medullary Thyroid Cancer: Overview - A rare form of thyroid cancer. Clayman G. EndocrineWeb. https://www.endocrineweb.com/conditions/thyroid-cancer/thyroid-cancer-medullary-cancer

[6] Goldman, Lee (2011). Goldman's Cecil Medicine (24th ed.). Philadelphia: Elsevier Saunders. pp. e76. ISBN 1437727883.

[7] Niederle B, Sebag F, Brauckhoff M (2013) Timing and extent of thyroid surgery for gene carriers of hereditary C cell disease-a consensus statement of the European Society of Endocrine Surgeons (ESES).Langenbecks Arch Surg

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