A Patient with Metastatic Medullary Thyroid Carcinoma (MTC) and Tumor-Related Diarrhea

Abstract

Medullary thyroid cancer (MTC) represents about 5 % of all thyroid tumors. While 75 % of the cases are sporadic, 25 % of them are hereditary and belong to genetic syndromes (multiple endocrine neoplasia, type 2A or type 2B, or familial MTC) based on a specific germline mutation in the RET proto-oncogene. Seventy-five to ninety-five percent of patients with MTC present with a solitary thyroid nodule. Fifty percent have clinically detectable cervical lymph node involvement, and 10–15 % of tumors have already metastasized to distant sites at diagnosis. In advanced disease, the hormonal secretion by the tumor cells of calcitonin or other active peptides can cause systemic symptoms such as diarrhea or facial flushing. Occasionally, MTCs release corticotropin (ACTH) causing ectopic Cushing’s syndrome. The specific management of disabling symptoms is essential to improve the quality of life of these patients. The case report describes the management of a man with MTC who suffered from diarrhea as his main symptom, from an oncological and a supportive care point of view.