Table Of ContentEndocrine Updates
Series Editor: Shlomo Melmed, M.D.
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Glenn D. Braunstein, MD
Editor
Thyroid Cancer
Editor
Glenn D. Braunstein, MD
Professor and Chairman, Department of Medicine
The James R. Klinenberg MD Chair in Medicine
Director of the Thyroid Cancer Center of Excellence
Cedars-Sinai Medical Center
Los Angeles, CA, USA
[email protected]
ISSN 1566-0729
ISBN 978-1-4614-0874-1 e-ISBN 978-1-4614-0875-8
DOI 10.1007/978-1-4614-0875-8
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011938203
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Preface
The American Cancer Society has estimated that in 2011, 48,020 new cases
of thyroid cancer will be diagnosed in the United States, with three-quarters
occurring in women. About two-thirds of the patients will be between the
ages of 20 and 55. The disease will cause close to 1,740 deaths, of which 43%
will be men. The overall 5-year survival rate is 97%, making it one of the
least lethal cancers. The incidence of thyroid cancer has more than doubled
over the last three decades, rising from 4.85 cases per hundred thousand
people in 1975 to almost 12 cases per hundred thousand in 2007. This increase
is seen exclusively in the well-differentiated thyroid cancers, which account
for the vast majority of patients and carry the best prognosis. A good portion
of this rise is due to increased detection of small tumors (microcarcinomas
measuring less than 1 cm) because of the increased use of neck ultrasounds,
CT scans, MRI, and PET scans, which detect these “incidentalomas.” This
may account for the rise in the incidence of microcarcinomas, but does not
adequately explain the fact that the incidence of larger tumors also is increas-
ing, and this increase is occurring around the world. The rise does not appear
to be related to the two known causative factors for well-differentiated thy-
roid cancer: radiation exposure or genetic predisposition. Thus, it is likely
that environmental factors such as the amount of iodine intake, industrial
toxins (e.g., plasticizers, fire retardants, and pesticides), and other unknown
exposures may contribute to the rising incidence of thyroid cancer.
Although numerically less frequent than the differentiated thyroid cancers,
medullary cancer of the thyroid, anaplastic carcinoma, and thyroid lymphoma
are important tumors to know about because their prognosis is less favorable
and their treatment generally requires a more aggressive approach.
The management of thyroid cancer has changed greatly over the last
several decades with the advent of new imaging techniques, the improved
detection of biomarkers, a marked increase in our understanding of the genetic
abnormalities that result in or accompany oncogenesis, and the development
of targeted therapies that take advantage of the known molecular defects that
result in thyroid cancer. One of the positive developments has been the emer-
gence of multidisciplinary teams devoted to the management of the disease.
The Cedars-Sinai Thyroid Cancer Center residing in our Samuel Oschin
Comprehensive Cancer Institute is composed of endocrinologists, surgeons,
oncologists, radiation therapists, nuclear medicine physicians, pathologists,
radiologists, nurses, speech therapists, and psychiatrists all of whom have a
subspecialty interest in thyroid cancer. The team has developed protocols for
v
vi Preface
the surgical management of patients and for determining who should or
should not receive radioactive iodine or external beam radiotherapy, and have
active clinical trials for patient management. Patients with complex or aggres-
sive disease are presented at our monthly Thyroid Cancer tumor board, and
continuing education is accomplished through a monthly Thyroid Cancer
Grand Rounds. Since our Center is the only one for a wide geographic area,
we see a large number of patients with thyroid nodules and cancer. Therefore,
our medical students, residents, and fellows have extensive exposure to all
aspects of thyroid disease. Both basic and clinical research is carried out
under the Center’s auspices.
When Shlomo Melmed, MD, Editor of the E ndocrine Updates Series , and
Springer Science+Business Media, LLC, invited me to edit a book on thyroid
cancer, I readily agreed because I knew that I had a group of experts readily
available within our Thyroid Cancer Center. Each was requested to write a
chapter in their area of expertise, which together provides a broad overview
and in-depth analysis of the current thinking in the diagnosis and manage-
ment of differentiated, medullary, and anaplastic thyroid carcinoma, as well
as thyroid lymphoma.
We appreciate the professionalism and excellence of the people who have
been involved with this project from Springer, especially Ellen C. Green,
Developmental Editor, and Richard Lansing, Executive Editor, Medicine.
Also, we are grateful for the support of Boris Catz, MD, the Levy family and
all of the staff of our Thyroid Cancer Center and, of course, to all of our
patients who teach us many lessons daily about the complexity and natural
history of thyroid cancer.
Los Angeles, CA, USA Glenn D. Braunstein, M.D.
Contents
1 Pathology and Classification of Thyroid Tumors ...................... 1
Gretchen E. Galliano and David P. Frishberg
2 Molecular Biology of Thyroid Cancer ....................................... 35
Wenwen Chien and H. Phillip Koeffler
3 Thyroid Nodules ........................................................................... 45
Glenn D. Braunstein and Wendy Sacks
4 Ultrasound Imaging of Thyroid Cancer .................................... 63
Michelle Melany
5 Fine Needle Aspiration of the Thyroid ....................................... 93
Shikha Bose
6 Staging Systems for Differentiated Thyroid Carcinomas ........ 109
Ronnie Meiyi Wong and Glenn D. Braunstein
7 Papillary Thyroid Carcinoma ..................................................... 133
Wendy Sacks and Glenn D. Braunstein
8 Follicular Thyroid Carcinoma .................................................... 155
Jerome Hershman and Adam Lyko
9 Medullary Thyroid Carcinoma ................................................... 171
Nicole M. Tyer and Run Yu
10 Anaplastic Thyroid Carcinoma .................................................. 189
Marina Vaysburd
11 Thyroid Lymphoma ..................................................................... 201
Basil Rapoport and Sandra M. McLachlan
12 Surgical Management of Thyroid Cancer ................................. 207
C. Suzanne Cutter, Kenneth W. Adashek, Michel Babajanian,
and Babak Larian
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viii Contents
13 Radioactive Iodine Therapy ........................................................ 243
Wendy Sacks and Alan D. Waxman
14 External Beam Radiation Therapy in the Treatment
of Differentiated Thyroid Cancers ............................................. 271
C. Michele Burnison
15 Targeted Therapy of Thyroid Cancer ........................................ 301
Stephen W. Lim
Index ...................................................................................................... 317
Contributors
Kenneth W. Adashek, MD, FACS Department of Surgery,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
Michel Babajanian, MD, FACS Department of Surgery,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
Shikha Bose, MD Department of Pathology and Lab Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
Glenn D. Braunstein, MD Divison of Endocrinology,
Diabetes, and Metabolism, Department of Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
C. Michele Burnison, MD Department of Radiation Oncology,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
Wenwen Chien, PhD Division of Oncology/Hematology,
Department of Medicine, Cedars-Sinai Medical Center,
Los Angeles, CA, USA
C. Suzanne Cutter, MD Department of Surgery, Cedars-Sinai Medical
Center, Los Angeles, CA, USA
David P. Frishberg, MD Department of Pathology and Lab Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
Gretchen E. Galliano, MD Department of Pathology and Lab Medicine,
Cedars-Sinai Medical Center, Los Angeles, CA, USA
Jerome Hershman, MD, MS Divisions of Endocrinology, Diabetes and
Metabolism, Greater Los Angeles VA and Cedars–Sinai Medical Center,
Los Angeles, CA, USA
H. Phillip Koeffler, MD Division of Oncology/Hematology, Department of
Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Babak Larian, MD, FACS Department of Surgery, Cedars-Sinai Medical
Center, Los Angeles, CA, USA
Stephen W. Lim, MD Department of Medicine and Samuel Oschin
Comprehensive Cancer Center, Cedars-Sinai Medical Center,
Los Angeles, CA, USA
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