Context : Thyroid cancer is the most common endocrine cancer. Histologically, thyroid cancer can be subdivided into papillary, follicular, anaplastic and medullary (MTC) cancer. Papillary (PTC) and follicular carcinomas (FTC) are well-differentiated thyroid tumours and comprise 85-90% of all thyroid cancers. For PTC and FTC a thyroidectomy with additional radioactive iodine ablation generally results in long-term survival in these patients with a 10-year overall survival rates of 95-98%. MTC covers 5-10% of all thyroid cancers and results from cancerous growth of thyroidal c-cells. Survival decreases with increasing stage; 100%, 90%, 86,5% and 55% survive at stage I, II, III and IV, respectively. Its biological behaviour lies between that of well-differentiated thyroid cancers and anaplastic thyroid cancer but also has fairly good survival when treated in time in the early stages.
Despite the long prognosis, our treatment has a major impact on patients due to hypothyroidism, hypoparathyroidism (iatrogenic damage of the parathyroid glands), chronic voice problems (recurrent laryngeal nerve damage) and RAI induced dysgeusia and xerostomia. This is reflected by both short and long-term reductions in Quality of life (QoL). The incidence of thyroid cancer (TC) is rising due to increased use of and access to imaging modalities such as ultrasonography and PET/CT scan. These TC’s are likely to be diagnosed from a large subclinical reservoir as the prevalence of occult papillary thyroid cancer in autopsy studies is estimated to be 8% - 35%. The threefold increase in incidence rates the last 30 years without impact on survival reflect worldwide over diagnosis and treatment of TC patients.
Therefore, a shift towards less aggressive treatment is urgently needed. The American Thyroid Association recommends de-escalation in the latest guideline for PTC, but many other national guidelines still recommend extensive treatment. The lack of prospective data demonstrating equivalent oncological outcomes is currently withholding worldwide de-escalation for both diagnostic and therapeutic management.
Goal : The primary aim of this project is to evaluate de-escalated diagnostic and treatment strategies for patients with Thyroid cancer
Scope : We will collect literature and perform studies that can underline the importance of using the principle of “less is more”. Minimalizing intensity and aggression of treatment modalities and maintaining the same outcomes. To achieve this, various strategies may be used such as improved selection by means of innovative imaging and new pathology (fluorescent and molecular)methods, development of intraoperative use of minimal invasive treatments and fluorescent techniques and a reduction of unneeded postoperative follow up.
We would like to acknowledge that Madelon Metman (University Medical Center Groningen, Groningen, The Netherlands) has contributed to this research topic.
Context : Thyroid cancer is the most common endocrine cancer. Histologically, thyroid cancer can be subdivided into papillary, follicular, anaplastic and medullary (MTC) cancer. Papillary (PTC) and follicular carcinomas (FTC) are well-differentiated thyroid tumours and comprise 85-90% of all thyroid cancers. For PTC and FTC a thyroidectomy with additional radioactive iodine ablation generally results in long-term survival in these patients with a 10-year overall survival rates of 95-98%. MTC covers 5-10% of all thyroid cancers and results from cancerous growth of thyroidal c-cells. Survival decreases with increasing stage; 100%, 90%, 86,5% and 55% survive at stage I, II, III and IV, respectively. Its biological behaviour lies between that of well-differentiated thyroid cancers and anaplastic thyroid cancer but also has fairly good survival when treated in time in the early stages.
Despite the long prognosis, our treatment has a major impact on patients due to hypothyroidism, hypoparathyroidism (iatrogenic damage of the parathyroid glands), chronic voice problems (recurrent laryngeal nerve damage) and RAI induced dysgeusia and xerostomia. This is reflected by both short and long-term reductions in Quality of life (QoL). The incidence of thyroid cancer (TC) is rising due to increased use of and access to imaging modalities such as ultrasonography and PET/CT scan. These TC’s are likely to be diagnosed from a large subclinical reservoir as the prevalence of occult papillary thyroid cancer in autopsy studies is estimated to be 8% - 35%. The threefold increase in incidence rates the last 30 years without impact on survival reflect worldwide over diagnosis and treatment of TC patients.
Therefore, a shift towards less aggressive treatment is urgently needed. The American Thyroid Association recommends de-escalation in the latest guideline for PTC, but many other national guidelines still recommend extensive treatment. The lack of prospective data demonstrating equivalent oncological outcomes is currently withholding worldwide de-escalation for both diagnostic and therapeutic management.
Goal : The primary aim of this project is to evaluate de-escalated diagnostic and treatment strategies for patients with Thyroid cancer
Scope : We will collect literature and perform studies that can underline the importance of using the principle of “less is more”. Minimalizing intensity and aggression of treatment modalities and maintaining the same outcomes. To achieve this, various strategies may be used such as improved selection by means of innovative imaging and new pathology (fluorescent and molecular)methods, development of intraoperative use of minimal invasive treatments and fluorescent techniques and a reduction of unneeded postoperative follow up.
We would like to acknowledge that Madelon Metman (University Medical Center Groningen, Groningen, The Netherlands) has contributed to this research topic.
