Stages of Thyroid Cancer
Stages of Thyroid Cancer
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Once thyroid cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment.

Papillary and follicular thyroid cancer

The following stages are used for papillary and follicular thyroid cancer:

Stage I
In patients younger than 45 years, cancer may have spread within the neck or upper chest and/or to nearby lymph nodes but not to other parts of the body.

In patients aged 45 years and older, the tumor is 2 centimeters (about ¾ inch) or smaller and in the thyroid only.

Stage II
In patients younger than 45 years, the cancer has spread to distant parts of the body, such as the lung or bone, and may have spread to nearby lymph nodes.

In patients aged 45 years and older, the tumor is larger than 2 centimeters but not larger than 4 centimeters (between ¾ and 1½ inches) in the thyroid only.

Stage III
The cancer is found in patients aged 45 years or older. The tumor either:
Is larger than 4 centimeters; or
may be any size and has spread just outside the thyroid and/or to lymph nodes in the neck.

Stage IVA
The cancer is found in patients aged 45 years or older. The tumor may be any size and has spread within the neck and/or to lymph nodes in the neck or upper chest.

Stage IVB
The cancer is found in patients aged 45 years or older. The tumor may be any size and has spread to neck tissues near the backbone or around blood vessels in the neck or upper chest. Cancer may have spread to lymph nodes.

Stage IVC
The cancer has spread to other parts of the body, such as the lung or bone, and may have spread to nearby lymph nodes.

Medullary thyroid cancer
The following stages are used for medullary thyroid cancer:

Stage 0
No tumor is found in the thyroid but the cancer is detected by screening tests. Stage 0 is also called carcinoma in situ.

Stage I
The tumor is 2 centimeters or smaller and in the thyroid only.

Stage II
The tumor is larger than 2 centimeters but not larger than 4 centimeters and is in the thyroid only.

Stage III
The tumor either:
is larger than 4 centimeters; or
may be any size and has spread just outside the thyroid and/or to lymph nodes in the neck.

Stage IVA
The tumor may be any size and has spread within the neck and/or to lymph nodes in the neck or upper chest.

Stage IVB
The tumor may be any size and has spread to neck tissues near the backbone or around blood vessels in the neck or upper chest. Cancer may have spread to lymph nodes.

Stage IVC
Cancer has spread to other parts of the body, such as the lung or bone, and may have spread to nearby lymph nodes.

Anaplastic thyroid cancer
Anaplastic thyroid cancer is considered to be stage IV thyroid cancer. It grows quickly and has usually spread within the neck when it is found. Anaplastic thyroid cancer develops most often in older people.

Recurrent thyroid cancer
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the thyroid or in other parts of the body.

How thyroid cancer is treated
There are treatments for all patients with thyroid cancer. Four types of treatment are used:
Surgery (taking out the cancer).

Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
Hormone therapy (using hormones to stop cancer cells from growing) .
Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of thyroid cancer. A doctor may remove the cancer using one of the following operations:
1. Lobectomy removes only the side of the thyroid where the cancer is found. Lymph nodes in the area may be taken out (biopsied) to see if they contain cancer.
2. Near-total thyroidectomy removes all of the thyroid except for a small part.
3. Total thyroidectomy removes the entire thyroid.
4. Lymph node dissection removes lymph nodes in the neck that contain cancer.
5. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors.

Radiation for thyroid cancer may come from a machine outside the body (external radiation therapy) or from drinking a liquid that contains radioactive iodine. Because the thyroid takes up iodine, the radioactive iodine collects in any thyroid tissue remaining in the body and kills the cancer cells.

Hormone therapy uses hormones to stop cancer cells from growing. In treating thyroid cancer, hormones can be used to stop the body from making other hormones that might make cancer cells grow. Hormones are usually given as pills.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream; travels through the body, and can kill cancer cells outside the thyroid.

Treatment by stage
Treatment of thyroid cancer depends on the type and stage of the disease, and the patient’s age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

Clinical trials are ongoing in many parts of the country for some patients with thyroid cancer. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I and II Papillary and Follicular Thyroid Cancer
Treatment may be one of the following:
1 Surgery to remove the thyroid (total thyroidectomy). This may be followed by hormone therapy and radioactive iodine.
2. Surgery to remove one lobe of the thyroid (lobectomy), followed by hormone therapy. 3. Radioactive iodine also may be given following surgery.

Stage III Papillary and Follicular Thyroid Cancer
Treatment may be one of the following:
1. Surgery to remove the entire thyroid (total thyroidectomy) and lymph nodes where cancer has spread.
2. Total thyroidectomy followed by radiation therapy with radioactive iodine or external-beam radiation therapy.

Stage IV Papillary and Follicular Thyroid Cancer
Treatment may be one of the following:
1. Radioactive iodine.
2. External-beam radiation therapy.
3. Surgery to remove the cancer from places where it has spread.
4. Hormone therapy.
5. A clinical trial of new treatments, including chemotherapy.

Medullary Thyroid Cancer
Treatment may be one of the following:
1. Total thyroidectomy for tumors in the thyroid only. Lymph nodes in the neck may also be removed.
2. Radiation therapy for tumors that come back in the thyroid as palliative treatment to relieve symptoms and improve the patient\\'s quality of life.
3. Chemotherapy for cancer that has spread to other parts of the body, as palliative treatment to relieve symptoms and improve the patient\\'s quality of life.

Anaplastic Thyroid Cancer
Treatment may be one of the following:
1. Surgery to create an opening in the windpipe, for tumors that block the airway. This is called a tracheostomy.
2. Total thyroidectomy to reduce symptoms if the tumor is in the area of the thyroid only.
3. External-beam radiation therapy.
4. Chemotherapy.
5. Clinical trials of chemotherapy and radiation therapy following thyroidectomy.
6. Clinical trials studying new methods of treatment of thyroid cancer.

Recurrent Thyroid Cancer
The choice of treatment depends on the type of thyroid cancer the patient has, the kind of treatment the patient had before, and where the cancer comes back. Treatment may be one of the following:
1. Surgery with or without radioactive iodine. A second surgery may be done to remove tumor that remains.
2. Radioactive iodine.
3. External-beam radiation therapy or radiation therapy given during surgery to relieve symptoms caused by the cancer.
4. Chemotherapy.
5. Clinical trials of new treatments.

For more information from the NCI, please write to this address:
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
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Submitted: 06/19/06

Description: Once thyroid cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment.

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