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Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Since the actual cause of papillary thyroid carcinoma is unknown, it cannot be fully prevented. Reducing radiation exposure during childhood is suggested. Other preventive measures may include genetic testing, limiting alcohol consumption, treating diabetes mellitus, reducing dietary nitrites, having adequate dietary iodine, treating obesity, and avoiding smoking. For high-risk patients, surgical removal of the thyroid may prevent papillary thyroid carcinoma from developing. Better diagnostic methods are resulting in earlier detection of papillary thyroid carcinoma. There is no actual prevention for follicular thyroid carcinoma and the same risk reduction strategies exist as for papillary thyroid carcinoma. There are also no specific methods for its early detection. However genetic testing may be considered. There is no known method of prevention for medullary thyroid cancer. Newly identified rearranged-during-transfection point mutations have helped to detect MTC earlier than in previous decades, and new treatment guidelines have resulted. Screening methods are based on serum calcitonin levels, and for metastatic or recurrent MTCs, neck ultrasonography, chest CT, liver MRI, bone scintigraphy, and axial skeleton MRI are options. There is no known method of preventing anaplastic thyroid carcinoma. There is also no way to diagnose the disease early. By the time symptoms are present, there is often evidence that the carcinoma has spread to distant body sites
Small-Molecule Targeted Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Vandetanib (CaprelsaTM) is a small-molecule orally administered tyrosine kinase inhibitor approved by the FDA in 2011 for the treatment of late-stage thyroid cancer (Figure 6.25). It was initially evaluated in clinical trials for non-small-cell lung cancer although no benefit was observed when administered alongside chemotherapy. It is recommended by NICE in the UK for the treatment of aggressive and symptomatic medullary thyroid cancer in patients with unresectable locally advanced or metastatic disease. Structure of vandetanib (Caprelsa™).
Thyroidectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Patients with MEN 2 syndromes require a prophylactic thyroidectomy since they all develop medullary thyroid cancer. MEN 2A and 2B are both a result of a mutation of the RET gene. MEN 2A patients develop hyperparathyroidism and pheochromocytomas in addition to medullary thyroid cancer, while MEN 2B patients develop pheochromocytomas, medullary thyroid cancer, and ganglioneuromatosis. The RET mutation determines the degree of aggressiveness of the medullary thyroid cancer and thus the optimal age for thyroidectomy. The patients are divided into three groups depending on their mutation: Highest risk (codon 918), high risk (codons 634 and 883), and moderate risk (all other codons). Patients in the highest risk category are the MEN 2B patients who require a prophylactic total thyroidectomy before the age of 1 year. High- and moderate-risk patients are MEN 2A patients. The high-risk patients require their prophylactic thyroidectomy at or before age 5 depending on calcitonin levels. Moderate-risk patients have their calcitonin levels followed, and undergo a total thyroidectomy when the calcitonin begins to rise.
Occurrence of sporadic medullary thyroid carcinoma in Graves’ disease in association with a RET proto-oncogene mutation
Published in Acta Clinica Belgica, 2022
Julian E. Donckier, Caroline Fervaille, Claude Bertrand
Thyroid carcinoma, the most common endocrine cancer, may occur in Graves’ disease with a mean event rate of 7% according to a recent meta-analysis [1]. Some studies have suggested an increased risk of differentiated thyroid cancer in patients with Graves’ disease, especially in the presence of thyroid nodules [2–5]. Medullary thyroid cancer (MTC) is less common, with 15 cases having been reported since 1980 [6–10]. The RET proto-oncogene encoding the transmembrane receptor of the tyrosine kinase family has been shown to exhibit mutations in MTC either in inherited syndromes or in sporadic cases [11–13]. To our knowledge, in none of the previous cases, such a mutation has been studied or found to be in association with Graves’ disease. Moreover, how Graves’ disease could drive the occurrence of this cancer has never been addressed. We here describe a case of MTC occurring in Graves’ disease in association with a RET mutation and discuss its characteristics as well as the possible links between both diseases.
Tyrosine kinase inhibitors for advanced or metastatic thyroid cancer: a meta-analysis of randomized controlled trials
Published in Current Medical Research and Opinion, 2018
Jen-Wei Liu, Chiehfeng Chen, El-Wui Loh, Chun-Cheng Chu, Mu-Yi Wang, Hsin-Ju Ouyang, Ya-Ting Chang, Wei-Zhan Zhuang, Ching-Wen Chou, Der-Jr Huang, Chia-Hwa Lee, Yun Yen, Ka-Wai Tam
Thyroid cancer is the most common endocrine cancer1. Over the past few decades, the global incidence of thyroid cancer has continuously increased. In 2016, approximately 64,300 new cases were estimated in the United States2. Thyroid cancer can be classified into the following three main types: differentiated thyroid cancer (DTC), medullary thyroid cancer (MTC), and anaplastic thyroid cancer (ATC). DTC includes papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and Hurthle cell thyroid cancer. Constituting 80% of all thyroid cancers, PTC represents the most common subtype with more favorable prognosis than that of other subtypes. Approximately 10% of all cases of thyroid cancer are of the FTC subtype, whereas MTC constitutes only approximately 1%–2%. Accounting for less than 1% of thyroid cancer cases, ATC is rare3. Generally, thyroid cancer has a favorable prognosis following classical treatments including surgery and radioactive iodine treatment.
Costs of biomarker testing among patients with metastatic lung or thyroid cancer in the USA: a real-world commercial claims database study
Published in Journal of Medical Economics, 2023
Lisa M. Hess, Diane Michael, Peter M. Krein, Tyler Marquart, Anthony N. Sireci
Clinical biomarker testing practices vary widely in patients with lung and thyroid cancers despite guideline-recommended approaches5–8. Data from the early 2020s across multiple databases show that only half to three-quarters of patients with NSCLC in the US receive guideline-recommended broad/next-generation sequencing (NGS)-based biomarker testing5,7,8. Evidence for testing for RET was observed among 60% of patients with medullary thyroid cancer6, while data for testing patterns are limited for other histologies. The cost of biomarker testing has been suggested as a barrier and issue to address for coverage and reimbursement of diagnostic testing9,10.