Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Area of Science:

• Oncology
• Endocrinology
• Nuclear Medicine

Background:

• Thyroid cancer encompasses differentiated (papillary, follicular, Hürthle cell), medullary, and anaplastic subtypes, each with distinct prognoses and management strategies.
• Differentiated thyroid carcinomas generally have an excellent prognosis, while anaplastic thyroid carcinoma is nearly uniformly lethal.

Purpose of the Study:

• To outline the National Comprehensive Cancer Network (NCCN) recommendations for managing medullary and anaplastic thyroid carcinomas.
• To describe the surgical management of differentiated thyroid carcinomas.

Main Methods:

• Review of NCCN guidelines for medullary and anaplastic thyroid carcinoma treatment.
• Description of standard surgical approaches for differentiated thyroid carcinoma.
• Discussion of adjunctive therapies like radioactive iodine (iodine-131) and thyroxine therapy.
• Consideration of systemic therapies, including kinase inhibitors and targeted therapy options for advanced or unresectable cases.

Main Results:

• Surgery is the primary treatment for differentiated and medullary thyroid carcinomas.
• Radioactive iodine ablation (iodine-131) and thyroxine therapy are crucial components in managing differentiated thyroid carcinoma.
• For unresectable or persistent medullary thyroid carcinoma, kinase inhibitors are considered.
• Anaplastic thyroid carcinoma management focuses on systemic therapy, preferably targeted options, as radioactive iodine is not applicable.

Conclusions:

• Treatment strategies for thyroid cancer vary significantly based on histological subtype and disease stage.
• NCCN guidelines provide a framework for optimal management, integrating surgery, radioactive iodine, thyroxine, kinase inhibitors, and targeted therapies.
• Early diagnosis and appropriate treatment selection are critical for improving outcomes in differentiated thyroid cancer, while advanced subtypes like anaplastic thyroid carcinoma present significant therapeutic challenges.