Current Management of Medullary Thyroid Cancer

• Published in: The oncologist (Dayton, Ohio) Ohio), 2008-05, Vol.13 (5), p.539-547
• Main Authors: Sippel, Rebecca S., Kunnimalaiyaan, Muthusamy, Chen, Herbert
• Format: Article
• Language: English
• Subjects: Biopsy, Fine-Needle; Carcinoma, Medullary - diagnosis; Carcinoma, Medullary - genetics; Carcinoma, Medullary - pathology; Carcinoma, Medullary - surgery; Genetic Testing; Germ-Line Mutation; Humans; Lymph Node Excision; Medullary thyroid cancer; Multiple endocrine neoplasia; Multiple Endocrine Neoplasia - diagnosis; Multiple Endocrine Neoplasia - genetics; Multiple Endocrine Neoplasia - pathology; Multiple Endocrine Neoplasia - surgery; Prognosis; Proto-Oncogene Proteins c-ret - genetics; Proto-Oncogenes - genetics; Receptor Protein-Tyrosine Kinases - genetics; RET protein; Thyroid neoplasm; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - genetics; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2007-0239

Learning Objectives After completing this course, the reader will be able to: Evaluate a patient with a new diagnosis of medullary thyroid cancer. Use genetic testing for the ret proto‐oncogene and assess how the location of the mutation affects the risks for the patient. Select among the surgical treatment options for patients with medullary thyroid cancer, including the optimal surgical treatment for patients with palpable disease as well as those patients who are found to be genetic carriers. This article is available for continuing medical education credit at CME.TheOncologist.com Medullary thyroid cancer accounts for 5%–10% of all thyroid cancers. The majority of medullary thyroid cancers are sporadic, but 20% of cases are a result of a germline mutation in the ret proto‐oncogene. Hereditary medullary thyroid cancer can be seen as part of the multiple endocrine neoplasia syndrome type 2A or 2B or as part of familial medullary thyroid cancer. This article discusses the current methods available for the diagnosis and evaluation of a patient with suspected medullary thyroid cancer. The management of medullary thyroid cancer is predominantly surgical excision, consisting of a total thyroidectomy and lymph node dissection. The extent and timing of surgical excision are discussed. Systemic therapeutic options are limited for medullary thyroid cancer, but several therapeutic targets show promise for the development of new therapies in the future. This article discusses the current methods available for the diagnosis and evaluation of a patient with suspected medullary thyroid cancer. The extent and timing of surgical excision are discussed as well as systemic therapeutic options, including several therapeutic targets with promise for the development of new therapies.