Papillary thyroid cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Natural History
Complications
Prognosis
- Prognosis of patients with papillary thyroid cancer is found to be dependent on the patient's age, size of the tumor, presence of metastatic disease, and presence of tumor invasion into adjacent tissues near the thyroid gland.
Depending on source, the overall 5-year survival rate for papillary thyroid cancer is 96 percent[1] or 97 percent,[2] with a 10-year survival rate of 93 percent.[1]
For a more specific prognosis for individual cases, there are at minimum 13 known scoring systems for prognosis; among the more often used are:
- AGES - Age, Grade, Extent of disease, Size
- AMES - Age, Metastasis, Extent of disease, Size
- MACIS - Metastasis, Age at presentation, Completeness of surgical resection, Invasion (extrathyroidal), Size[3] (this is a modification of the AGES system). It is probably the most reliable staging method available. Also known as the MAICS system.
- TNM staging - Tumor, node, metastasis. Remarkable about the TNM staging for (differentiated) thyroid carcinoma is that the scoring is different according to age.
MACIS
The MACIS system of estimating the prognosis of papillary thyroid cancer was developed by Clive S. Grant at the Mayo Clinic, and was based on careful evaluation of a large group of patients. It is probably the most reliable staging method available.[4]
It assigns scores to the main factors involved, and uses the sum of this score to calculate the prognosis:
| Factors | Score | |
|---|---|---|
| Distant Metastasis: spread of the cancer to areas outside the neck | Yes | 3 |
| No | 0 | |
| Age at the time the tumor was discovered | Less than 39 years | 3.1 |
| Over 40 years | 0.08 x age | |
| Invasion into surrounding areas of the neck as seen by the naked eye | Yes | 1 |
| No | 0 | |
| Completeness of surgical resection (or removal) of the tumor | Incomplete | 1 |
| Complete | 0 | |
| Size of the tumor | 0.3 x size in cm | |
| Sum of MACIS score | 20 yr Survival |
|---|---|
| < 6.0 | 99% |
| 6.0 - 6.99 | 89% |
| 7.0 - 7.99 | 56% |
| > 8.0 | 24% |
Most patients fall into the low risk category (MACIS score less than 6.0) and are cured of the cancer at the time of surgery.
Children with multiple lung metastases and/or a miliary aspect still have an excellent long-term prognosis if given adequate treatment.
5 year Relative Survival Rate
- 5 year relative survival rate of follicular thyroid cancer depends on the stage of the disease at the time of diagnosis.
- Stage 1 has 100% 5 year relative survival rate
- Stage 2 has 100% 5 year relative survival rate
- Stage 3 has 93% 5 year relative survival rate
- Stage 4 has 51% 5 year relative survival rate
References
- ↑ 1.0 1.1 Numbers from National Cancer Database in the US, from Page 10 in: Biersack, H-J; Grünwald, F (Eds) (2005). Thyroid Cancer. Berlin: Springer. ISBN 3-540-22309-6. (Note: Book also states that the 14 percent 10-year survival for anaplastic thyroid cancer was overestimated)
- ↑ Rounded up to nearest natural number from 96.7 percent as given by eMedicine > Thyroid, Papillary Carcinoma Author: Luigi Santacroce. Coauthors: Silvia Gagliardi and Andrew Scott Kennedy. Updated: Sep 28, 2010
- ↑ "New York Thyroid Center: Prognosis Staging for Thyroid Cancer". Retrieved 2007-12-22.
- ↑ New York Thyroid Center > Thyroid cancer > Prognosis staging Retrieved on April 30, 2010