Thyroid carcinoma

During the past years advances have been made in the understanding of the molecular mechanisms involved in the initiation and progression of thyroid carcinoma. Mutations in tumor suppressor genes such as p53 and oncogenes such as N-ras may be important for progression of well-differentiated thyroid carcinomas. Activation of the ret protooncogene located on chromosomal region 10q11.2 has been identified as a key factor in the initiation of papillary and medullary carcinoma. Integration of these discoveries into a prognostic classification scheme may allow us to better predict the biologic behavior of tumors in individual patients. Despite the recent advances in our understanding of the molecular events occurring during thyroid carcinogenesis, major questions persist regarding aspects of patient management. New diagnostic modalities may enable us to noninvasively discriminate between benign and malignant thyroid nodules, and to detect recurrent disease earlier. Although the optimal surgical procedure for well-encapsulated tumors is still debated, recent clinical studies have shown that for those patients with tumors > 1.5 cm, the routine use of RAI and hormone suppression can improve local control and survival rates. Findings in two recent reviews suggest that patients with widely invasive thyroid masses benefit from the surgical removal of all gross tumor. Further investigation is required to define the role of adjuvant radiotherapy and the most appropriate management of unresectable disease. Incorporation of prognostic markers into clinical staging systems should allow surgeons to better tailor their treatment plans for each patient. Translation of recent basic science advances into the clinical arena may also aid in the development of novel treatment strategies for patients with aggressive tumors.