Selective surgical management of well-differentiated thyroid cancer

There has been a rapid rise in the incidence of thyroid cancer in the United States, along with more incidentalomas of the thyroid. Treatment of thyroid cancer revolves around appropriate surgical intervention, minimizing complications, and the use of adjuvant therapy in select circumstances. Prognostic features and risk-group analysis are crucial in determining the appropriate treatment. Thyroid cancers are divided into low-, intermediate-, and high-risk groups. Surgical treatment should adhere to the risk-group analysis. The prognostic features in thyroid cancer are age, gender, size and grade of the tumor, extrathyroidal extension, and completeness of resection. The patient presenting with extrathyroidal extension needs extra attention in the operating room to remove all gross tumor during the initial surgical procedure to avoid future recurrences. Nodal metastasis generally has minimal implications; however, in older patients and those with poorly differentiated histology, it has major implications. Grading of the tumor is important, especially for understanding the poorly differentiated varieties of thyroid cancer, such as tall cell and insular. These patients do not respond well to RAI and are best followed with a PET scan. Overall survival in patients with well-differentiated thyroid cancer exceeds 95%.