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Controversies in the Surgical Management of Medullary Thyroid Carcinoma

  • Victoria M. Gershuni
  • Jennifer Yu
  • Jeffrey F. MoleyEmail author

Abstract

Medullary thyroid carcinoma (MTC) comprises approximately 5 % of all thyroid cancers. While the majority of cases are sporadic, as many as 25 % of cases are attributed to inherited mutations in the REarranged during Transfection (RET) proto-oncogene. Primary treatment is thyroidectomy and removal of involved nodal basins. Preventative thyroidectomy is recommended in at-risk RET mutation carriers. Due to the lack of randomized trials and limited widespread clinical expertise, certain aspects of treatment remain controversial. This chapter aims to elucidate the best practices based on the existing literature, the most current published guidelines, and expert surgeon recommendations. Clarification of controversial issues, including, but not limited to, age of surgery in at-risk gene carriers, extent of lymphadenectomy and parathyroid management in preventative thyroidectomy, extent of thyroidectomy and lymphadenectomy in primary and reoperations for MTC, usefulness of radiation therapy, and timing of systemic treatment, will be discussed in this chapter.

Keywords

Medullary thyroid carcinoma Thyroid cancer Multiple endocrine neoplasia type 2A Multiple endocrine neoplasia type 2B RET proto-oncogene Preoperative evaluation Surgical management Postoperative surveillance 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Victoria M. Gershuni
    • 1
  • Jennifer Yu
    • 2
  • Jeffrey F. Moley
    • 3
    Email author
  1. 1.Department of General SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of SurgeryBarnes-Jewish HospitalSt. LouisUSA
  3. 3.Department of SurgeryWashington University School of MedicineSt. LouisUSA

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