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Chapter 37: Thyroid Cancer

Ann Gramza; Sam Wells

INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 62,980 (male: 15,190; female: 47,790. Estimated new cases for 2014 in the United States) (6.1 per 100,000 males 18.2 per 100,000 females)
Deaths: Estimated 1,890 in 2014 (male: 830; female: 1,060)
Median age: 50 years
Male to female ratio: 1:3

  • One of the few cancers that has increased in incidence over the past several years

  • Sixth most common cancer in women

  • The number of new diagnoses is about double the number from 10 years ago

  • Mainly affects young people. Nearly 2 of 3 cases are found in people between the ages of 20 and 55 years

 

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Pathology

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Pathology
Epithelial Carcinomas Incidence Other Cell Types Incidence
Papillary carcinomas 75% Medullary carcinoma <8%
Usual papillary (75) Anaplastic carcinomas✫ 2%
Follicular variant (15) Lymphoma Very rare
Tall cell variant (4) Angiomatoid neoplasms Very rare
Columnar cell variant (<1) Mucoepidermoid carcinomas Very rare
Diffuse sclerosing variant (3) Malignant adult thyroid teratomas Very rare
Oxyphilic (Hürthle cell) variant (2) Carcinomas with thymic features Very rare
Follicular carcinomas 10% Paragangliomas Very rare
Usual follicular (76)    
Oxyphilic (Hürthle cell) variant (20)    
Insular carcinoma (4)    

 

✫Evolved from papillary or follicular

Ain KB. Rev Endocr Metab Disord 2000;1:225–231

LiVolsi VA. Surgical Pathology of the Thyroid. Philadelphia, PA: WB Saunders, 1990

 

Papillary thyroid cancer (PTC)

  1. Develops from the follicular cells in the normal thyroid

  2. Usually found in 1 lobe; only 10–20% appear in both lobes

  3. Considered a differentiated thyroid cancer

  4. Together with follicular thyroid cancer, accounts for 80–90% of all thyroid cancers

  5. Mutations in BRAF have been reported in 60–80% of patients with V600E (T1799A), the most common mutation

 

Follicular thyroid cancer (FTC)

  1. Less common than PTC

  2. Develops from the follicular cells in the normal thyroid

  3. Considered a differentiated thyroid cancer

  4. Together with PTC, accounts for 80–90% of all thyroid cancers

  5. Hürthle cell carcinoma is usually assumed to be a variant of FTC, although its prognosis is worse

  6. Mutations of codon 61 of N-RAS (N2) have been reported in as many as 19% of follicular tumors

 

Medullary thyroid cancer (MTC)

  1. Accounts for 5–10% of thyroid cancers

  2. Develops in the C cells of the thyroid; has very little, if any, similarity to normal thyroid tissue

  3. Occurs with multiple endocrine neoplasia type 2 (MEN 2A and MEN 2B2), in familial medullary thyroid carcinoma (FMTC) and as a sporadic form (≈80% of cases are sporadic)

  4. Germline mutations in the RET (REarranged during Transfection) protooncogene cause hereditary MTC (MEN 2A, MEN 2B, and FMTC). In addition, up to 50% of patients with sporadic MTC have somatic RET mutations

  5. MEN 2B: RET mutations in codons 918, 883, or compound heterozygotes (V804M + E805K, Y806C ...

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