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New Approaches in the Management of Thyroid Cancer

  • Savvas Frangos
  • Ioannis Iakovou
Chapter

Abstract

With 98.1% 5-year survival rate, differentiated thyroid carcinoma is one of the best in prognosis among all cancers. The primary treatment of thyroid cancer is the surgical removal of thyroid, in most of the cases total thyroidectomy, which is followed by iodine-131 ablation therapy. Last years’ new trends apply in small thyroid carcinomas: Hemithyroidectomy is suggested, and even in cases of total thyroidectomy iodine-131 therapy should not be used. In localized thyroid carcinoma, the 5-year survival rate is more than 99% This is the main reason of choosing lobectomy and for not using the iodine-131 therapy for thyroid cancers less than 1 cm. Nevertheless, the 5-year relative survival rate in patient with distant metastasis is 55.3%. Approximately 1.2% of men and women in the USA will be diagnosed with thyroid cancer at some point during their lifetime, based on 2011–2013 data. The estimated new cases in the USA for 2017 are 56,870 individuals. Out of them about 2275 (4%) will have distant metastasis. From them about 1150 will not survive until 2022. Even though we do not have exact numbers, the same situation should be in Europe. In other parts of the world, given the situation that the diagnosis comes later, the numbers of metastatic patients should be in a higher percent. These numbers are a challenge in the management of thyroid cancer, and the progress is not impressive. The scope of the chapter is to show how these difficult cases should be managed starting on the possibility to recognize the people who will develop thyroid cancer, the initial surgical treatment of the disease, and if any progress in diagnosis and therapy has been made in the last years. The questions that we will try to answer in the next paragraphs are the following: Is there any possibility to find out the patients that will develop thyroid cancer? Can the details of the histopathology reports add information about the patient at risk to improve their management? Is the initial surgery a predictive factor in the prognosis of each patient and how this could be improved? Are the new methods of surgery adding in value regarding the managements of thyroid cancer patient? How and when surgery should be used in relapses of thyroid cancer? Localization of distant metastasis is very important. What is the role of PET/CT? What is the role of systemic therapy in treating metastatic thyroid cancer? Is there any role of external beam radiation in the management of thyroid cancer?

Keywords

Thyroid cancer Guidelines Surgeon experience Kinase inhibitor therapy PET/CT Histopathology External beam radiation 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nuclear MedicineBank of Cyprus Oncology CentreNicosiaCyprus
  2. 2.Department of Nuclear MedicineAristotle University, Papageorgiou HospitalThessalonikiGreece

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