UPDATES IN THE UNDERSTANDING AND MANAGEMENT OF THYROID CANCER Edited by Thomas J. Fahey
Updates in the Understanding and Management of Thyroid Cancer Edited by Thomas J. Fahey
Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Masa Vidovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from
[email protected] Updates in the Understanding and Management of Thyroid Cancer, Edited by Thomas J. Fahey p. cm. ISBN 978-953-51-0299-1
Contents Chapter 1
An Epidemiological Analysis of Thyroid Cancer in a Spanish Population: Presentation, Incidence and Survival 1 A. Rego-Iraeta, L. Pérez-Mendez and R.V. García-Mayor
Chapter 2
The Functionality of p53 in Thyroid Cancer 33 Debolina Ray, Matthew T. Balmer and Susannah Gal
Chapter 3
Glycosylation and Glycoproteins in Thyroid Cancer: A Potential Role for Diagnostics 53 Anna Krześlak, Paweł Jóźwiak and Anna Lipińska
Chapter 4
Insulin-Like Growth Factor Receptor Signaling in Thyroid Cancers: Clinical Implications and Therapeutic Potential 91 Geetika Chakravarty and Debasis Mondal
Chapter 5
Principles and Application of Microarray Technology in Thyroid Cancer Research 119 Walter Pulverer, Christa Noehammer, Klemens Vierlinger and Andreas Weinhaeusel
Chapter 6
Evaluation and Management of Pediatric Thyroid Nodules 147 Melanie Goldfarb and John I. Lew
Chapter 7
Papillary Thyroid Cancer in Childhood and Adolescence with Specific Consideration of Patients After Radiation Exposure 163 Yuri Demidchik, Mikhail Fridman, Kurt Werner Schmid, Christoph Reiners, Johannes Biko and Svetlana Mankovskaya
Chapter 8
Thyroid Cancer in the Pediatric Population 189 Silva Frieda, Nieves-Rivera Francisco and Laguna Reinaldo
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Chapter 9
Chapter 10
Current Innovations and Opinions in the Surgical Management of Differentiated Thyroid Carcinoma Brian Hung-Hin Lang Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer Tamara Mijovic, Keith Richardson, Richard J. Payne and Jacques How
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Chapter 11
Preparing Patients for Radioiodine Treatment: Increasing Thyroid Cell Uptake and Accelerating the Excretion of Unbound Radioiodine 235 Milovan Matović
Chapter 12
Differentiation Therapy in Thyroid Carcinoma Eleonore Fröhlich and Richard Wahl
Chapter 13
Using γ-Camera to Evaluate the In Vivo Biodistributions and Internal Medical Dosimetries of Iodine-131 in Thyroidectomy Patients 283 Sheng-Pin Changlai, Tom Changlai and Chien-Yi Chen
Chapter 14
Thyroid Cancer: The Evolution of Treatment Options Hitoshi Noguchi
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1 An Epidemiological Analysis of Thyroid Cancer in a Spanish Population: Presentation, Incidence and Survival A. Rego-Iraeta, L. Pérez-Mendez and R.V. García-Mayor
Department of Endocrinology, Diabetes, Nutrition and Metabolism, University Hospital of Vigo Spain 1. Introduction Accurate statistics on cancer occurrence and outcome are essential both for the purposes of research and for planning and evaluation programmes for cancer control (Parkin, 2006). Although tumours of thyroid account for only 1% of the overall human cancer burden, they represent the most common malignancies of the endocrine system and pose a significant challenge to pathologists, surgeons and endocrinologists. Among epithelial tumors, carcinomas of follicular cell origin far outnumber those of C-cell origin. The vast majority of carcinomas of follicular cell origin are indolent malignancies with 10 year survivals in excess of 90 %. 1.1 Classification Thyroid follicular epithelial-derived cancers are divided into three categories: papillary cancer, follicular cancer and anaplastic cancer. Papillary and follicular cancers are considered differentiated cancers, and patients with these tumours are often treated similarly despite numerous biologic differences. Most anaplastic (undifferentiated) cancers appear to arise from differentiated cancers. Other malignant diseases of the thyroid include medullary thyroid cancer (which can be familial, either as part of the multiple endocrine neoplasia type 2 syndrome or isolated familial medullary thyroid cancer), primary thyroid lymphoma, or metastases from breast, colon, or renal cancer or melanoma. In countries with adequate iodine intake, differentiated thyroid cancer accounts for more than 85% of all cases, being the most common type papillary (60-80%). Tumor histology is a critical determinant of patient outcomes; differentiated thyroid cancer is associated with the best survival rate and medullary and anaplastic have significantly poorer outcomes (Hundahl et al., 1998). Certain subtypes, such as the tall and columnar cell variants of papillary cancer and the insular variant of follicular cancer are more common in older patients with higher stage disease and have a worse prognosis than usual forms of thyroid cancer. The traditional separation of thyroid cancer into the major groups of papillary, follicular, medullary and undifferentiated (anaplastic) carcinoma, based on morphology and clinical
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Updates in the Understanding and Management of Thyroid Cancer
features, is strongly supported by advances in molecular studies showing the involvement of distinct genes in these four groups, with little overlap (DeLellis & Williams, 2004). 1.2 Staging and prognostic factors Numerous staging systems have been created in an attempt to accurately prognosticate outcomes for individual patients; two careful studies have compared the efficacy of the various staging systems and found that none is superior (Brierley et al., 1997; Sherman et al., 1998). Consequently, the European Thyroid Association (ETA) (Pacini et al., 2006) and the American Thyroid Association (ATA) (Cooper et al., 2009) have recommended the use of the Tumour, Node, Metastasis (TNM) classification of the American Joint Commission on Cancer (AJCC) and the International Union Against Cancer because it is universally available and widely accepted for other disease sites. An interesting feature of the TNM staging system compared to other classifications is the age factor. While the staging of head and neck cancers relies exclusively in the anatomical extent of disease, it is not possible to follow this pattern for the particular group of malignant tumors that arise in the thyroid gland. The effect of age is such significance in behavior and prognosis, that both the histologic diagnosis and the age of the patient are included in the staging system for these tumors. The AJCC classification is based on the TNM system, which relies on assessing three components: (1) extent of the primary tumour (T), (2) absence or presence of regional lymph node metastases (N), and (3) absence or presence of distant metastases (M). The fifth edition (Fleming et al., 1997), (Table 1) was revised as the sixth edition (Greene et al., 2002), (Table 2). A major alteration was the reclassification of tumour staging (T). For differentiated (papillary and follicular) and medullary tumours confined to the parenchyma of the thyroid gland without extrathyroidal extension, there is no evidence to suggest that using a size cutoff of 1 cm provides better prognostic stratification compared with the 2-cm cut-off used for Stage I II III IV
Papillary or Follicular Age < 45 years Age > 45 years Any T Any N T1 N0 M0 M0 Any T Any N M1
T2 N0 M0 T3 N0 M0 T4 N0 M0 Any T N1 M0 Any T Any N M1
Medullary
Anaplastic Any age
T1 N0 M0 T2 N0 M0 T3 N0 M0 T4 N0 M0 Any T N1 M0 Any T Any N M0
Any T Any N Any M
Table 1. AJCC TNM classification for thyroid cancer (fifth edition). T1 - Tumor 1 cm or less in greatest dimension limited to the thyroid. T2 - Tumour more than 1 cm, but not more than 4 cm, in greatest dimension limited to the thyroid. T3 - Tumour more than 4 cm in greatest dimension limited to the thyroid. T4 - Tumour of any size extending beyond the thyroid capsule. T4a - Excluded. T4b - Excluded. Regional lymph nodes are the cervical and upper mediastinal lymph nodes. N1a - Metastasis in ipsilateral cervical lymph node(s). N1b - Metastasis in bilateral, midline, or contralateral cervical or mediastinal lymph node (s). M0- no distance metastases; M1- distance metastases.
An Epidemiological Analysis of Thyroid Cancer in a Spanish Population: Presentation, Incidence and Survival
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other head and neck sites. Therefore, fifth edition T1 (
