Papillary thyroid cancer staging: Difference between revisions

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__NOTOC__
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{{Papillary thyroid cancer}}
{{Papillary thyroid cancer}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{Ammu}} {{Sahar}}
==Overview==
==Overview==
According to the American Joint Committee on Cancer (AJCC)<ref> Stage Information for Thyroid Cancer  Cancer.gov
According to the American Joint Committee on Cancer (AJCC) there are 4 stages of papillary thyroid cancer based on the [[clinical features]] and findings on [[imaging]]. Each stage is assigned a letter and a number that designate the [[tumor]] size, number of involved [[lymph node]] regions, and [[metastasis]].
(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015</ref> there are 4 stages of papillary thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of involved lymph node regions, and metastasis.
==Staging==
==Staging==
===Stage===
* According to the American Joint Committee on Cancer (AJCC) there are 4 stages of papillary thyroid cancer based on the [[clinical features]] and findings on [[imaging]].<ref name="urlThyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#_441_toc |title=Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
Based on overall [[cancer staging]] into stages I to IV, papillary thyroid cancer has a [[5-year survival rate]] of 100 percent for stages I and II, 93 percent for stage III and 51 percent for stage IV.<ref name=acc>[http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-survival-rates cancer.org > Thyroid Cancer] By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).</ref>
* Each stage is assigned a letter and a number that designate the [[tumor]] size, number of involved [[lymph node]] regions, and [[metastasis]].
====Papillary thyroid cancer in patients younger than 45 years====
{| class="wikitable"
* Stage I: In stage I papillary thyroid cancer, the tumor is any size, may be in the thyroid, or may have spread to nearby tissues and lymph nodes. Cancer has not spread to other parts of the body.
|+
* Stage II: In stage II papillary thyroid cancer, the tumor is any size and cancer has spread from the thyroid to other parts of the body, such as the lungs or bone, and may have spread to lymph nodes.
====Papillary and follicular thyroid cancer in patients 45 years and older====
* Stage I: In stage I papillary thyroid cancer, cancer is found only in the thyroid and the tumor is 2 centimeters or smaller.
* Stage II: In stage II papillary thyroid cancer, cancer is only in the thyroid and the tumor is larger than 2 centimeters but not larger than 4 centimeters.
* Stage III: In stage III papillary thyroid cancer, either of the following is found:
:* The tumor is larger than 4 centimeters and only in the thyroid or the tumor is any size and cancer has spread to tissues just outside the thyroid, but not to lymph nodes; or
:* The tumor is any size and cancer may have spread to tissues just outside the thyroid and has spread to lymph nodes near the trachea or the larynx (voice box)
* Stage IV: Stage IV papillary thyroid cancer is divided into stages IVA, IVB, and IVC.
:* In stage IVA, either of the following is found:
::* The tumor is any size and cancer has spread outside the thyroid to tissues under the skin, the trachea, the esophagus, the larynx (voice box), and/or the recurrent laryngeal nerve (a nerve with 2 branches that go to the larynx); cancer may have spread to lymph nodes near the trachea or the larynx.
::* The tumor is any size and cancer may have spread to tissues just outside the thyroid. Cancer has spread to lymph nodes on one or both sides of the neck or between the lungs.
:* In stage IVB, cancer has spread to tissue in front of the spinal column or has surrounded the carotid artery or the blood vessels in the area between the lungs. Cancer may have spread to lymph nodes.
:* In stage IVC, the tumor is any size and cancer has spread to other parts of the body, such as the lungs and bones, and may have spread to lymph nodes.


==Staging==
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Primary tumor
<br>
|-
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| align="center" style="background:#f0f0f0;" |'''Tumor size'''
|+'''''Thyroid TNM staging'''''
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
| align="center" style="background:#f0f0f0;" |'''Finding'''
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|'''Image'''
|-
| T0
|  ||
* No evidence of primary [[tumor]]
|
|-
| T1
|  ||
* [[Tumor]] ≤2 cm in greatest dimension limited to the [[thyroid]]
|
|-
| T1
| a||
* [[Tumor]] ≤1 cm, limited to the [[thyroid]]
| [[Image:Diagram showing stage T1a thyroid cancer CRUK 250.png|200px|thumb|none]]
|-
| T1
| b||
* [[Tumor]] >1 cm but ≤2 cm in greatest dimension, limited to the [[thyroid]]
| [[Image:Diagram showing stage T1b thyroid cancer CRUK 251.svg.png|200px|thumb|none]]
|-
| T2
|  ||
* [[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
|
|-
| T3
|  ||
* [[Tumor]] >4 cm limited to the [[thyroid]], or gross extrathyroidal extension invading only strap [[muscles]]
| [[Image:Diagram showing stage T3 thyroid cancer CRUK 265.png|200px|thumb|none]]
|-
|T3
|a
|
* [[Tumor]] >4 cm limited to the [[thyroid]]
|
|-
|T3
|b
|
* Gross extrathyroidal extension invading only strap [[muscles]] ([[sternohyoid]], [[sternothyroid]], [[thyrohyoid]], or [[Omohyoid muscle|omohyoid muscles]]) from a [[tumor]] of any size
|
|-
| T4
|  ||
* [[Tumor]] includes gross extrathyroidal extension beyond the strap [[muscles]]
|
|-
| T4
| a||
* [[Tumor]] with gross extrathyroidal extension invading subcutaneous [[Soft tissue|soft tissues]], [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]] from a [[tumor]] of any size
|[[Image:Diagram showing stage T4a thyroid cancer CRUK 272.png|200px|thumb|none]]
|-
| T4
| b||
* [[Tumor]] with gross extrathyroidal extension invading [[prevertebral fascia]] or encasing the [[carotid artery]] or [[mediastinal]] vessels from a [[tumor]] of any size.
|[[Image:Diagram showing stage T4b thyroid cancer CRUK 273.png|200px|thumb|none]]
|-
| TX
|  ||
* Primary [[tumor]] cannot be assessed
|
|-
|+
 
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Regional lymph node involvement
|-
| align="center" style="background:#f0f0f0;" |'''Node involvement'''
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
| N0
| ||
* No [[lymph node]] involvement
|
|-
|-
! style="background: #DCDCDC;" |TX
|N0
! style="background: #F5F5F5;" |Primary [[tumor]] cannot be assessed
|a
|
* One or more cytologically or [[histologically]] confirmed benign [[lymph nodes]]
|
|-
|-
! style="background: #DCDCDC;" |T0
|N0
! style="background: #F5F5F5;" |No evidence of primary [[tumor]]
|b
|
* No [[Radiological|radiologic]] or clinical evidence of locoregional [[lymph node]] [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" |T1
| N1
! style="background: #F5F5F5;" |[[Tumor]] ≤2 cm in greatest dimension limited to the [[thyroid]]
| ||
* [[Metastasis]] to regional nodes
|
|-
|-
! style="background: #DCDCDC;" |T1a
| N1
! style="background: #F5F5F5;" |[[Tumor]] ≤1 cm, limited to the [[thyroid]]
| a||
* [[Metastasis]] to level VI or VII ([[Pretracheal lymph nodes|pretracheal]], [[Paratracheal lymph nodes|paratracheal]], or [[Prelaryngeal lymph nodes|prelaryngeal]]/Delphian, or upper mediastinal) [[lymph nodes]]. This can be unilateral or bilateral [[disease]]
|[[Image:Diagram showing stage N1a thyroid cancer CRUK 242.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T1b
| N1
! style="background: #F5F5F5;" |[[Tumor]] >1 cm but ≤2 cm in greatest dimension, limited to the [[thyroid]]
| b||
* [[Metastasis]] to unilateral, bilateral, or contralateral [[Cervical lymph nodes|cervical]] neck [[lymph nodes]] (levels I, II, III, IV, or V) or [[retropharyngeal lymph nodes]]
|[[Image:Diagram showing stage N1b thyroid cancer CRUK 243.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T2
| NX
! style="background: #F5F5F5;" |[[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
| ||
* Regional [[lymph node]] cannot be assessed
|
|-
|-
! style="background: #DCDCDC;" |T3
|+
! style="background: #F5F5F5;" |[[Tumor]] >4 cm in greatest dimension limited to the [[thyroid]] or any [[tumor]] with minimal extrathyroid extension (e.g., extension to [[sternothyroid muscle]] or perithyroid soft tissues)
 
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Distant metastasis
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4a
| align="center" style="background:#f0f0f0;" |'''Presence of metastasis'''
! style="background: #F5F5F5;" |Moderately advanced [[disease]]
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #F5F5F5;" |[[Tumor]] of any size extending beyond the thyroid capsule to invade subcutaneous [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
| M0
| ||
* No distant [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4b
| M1
! style="background: #F5F5F5;" |Very advanced [[disease]]
| IV||
* Distant [[metastasis]]
|[[Image:Stage M1 Thyroid cancer.png|200px|thumb|none]]
|-
|-
! style="background: #F5F5F5;" |[[Tumor]] invades prevertebral fascia or encases [[carotid artery]] or mediastinal vessel
|}
|}
<br>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Regional Lymph Nodes (N)'''''
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
 
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|-
 
|-
 
|-
 
|-
|-
! style="background: #DCDCDC;" |NX
 
! style="background: #F5F5F5;" |Regional [[lymph node]] cannot be assessed
|-
|-
! style="background: #DCDCDC;" |N0
 
! style="background: #F5F5F5;" |No regional lymph node metastasis]]
|-
|-
! style="background: #DCDCDC;" |N1
 
! style="background: #F5F5F5;" |Regional [[lymph node]] metastasis
|-
|-
! style="background: #DCDCDC;" |N1a
 
! style="background: #F5F5F5;" |[[Metastases]] to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
|-
|-
! style="background: #DCDCDC;" |N1b
! style="background: #F5F5F5;" |[[Metastases]] to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)
|}


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Distant Metastasis (M)'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|-
|-
! style="background: #DCDCDC;" |M0
 
! style="background: #F5F5F5;" |No distant [[metastasis]]
|-
|-
! style="background: #DCDCDC;" |M1
! style="background: #F5F5F5;" |Distant [[metastasis]]
|}


|-


|}
<br />
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Anatomic Stage/Prognostic Groups'''''
|+'''''Anatomic Stage/Prognostic Groups'''''
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Papillary thyroid carcinoma'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Papillary thyroid carcinoma'''
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''YOUNGER THAN 45 YEARS'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''Younger than 55 years'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
Line 123: Line 199:


|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''45 YEARS AND OLDER'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''55 years and older'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M1
! style="background: #F5F5F5;" |M0
|-
|-
! style="background: #DCDCDC;" |II
! rowspan="4" style="background: #DCDCDC;" |II
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
|-
|-
 
! style="background: #F5F5F5;" |T2
! style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3a
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3b
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


Line 165: Line 235:


! style="background: #DCDCDC;" |IVA
! style="background: #DCDCDC;" |IVA
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |N0
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-


! style="background: #DCDCDC;" |
! rowspan="6" style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |Any T
! style="background: #F5F5F5;" |N1a
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M1


|-
|-
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |T1
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |T2
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3a
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |N1
! style="background: #F5F5F5;" |T3
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T3b
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
! style="background: #F5F5F5;" |T4a
! style="background: #F5F5F5;" |N1b
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0


|-
|-
 
! style="background: #F5F5F5;" |T4
! style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |T4b
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |M0
! style="background: #F5F5F5;" |M0
Line 213: Line 273:
|-
|-


! style="background: #DCDCDC;" |Stage IVC
! style="background: #DCDCDC;" |IVC
! style="background: #F5F5F5;" |Any T
! style="background: #F5F5F5;" |Any T
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |Any N  
! style="background: #F5F5F5;" |M1
! style="background: #F5F5F5;" |M1
|}
|}
<gallery>
 
File:Stage M1 Thyroid cancer.png|Stage M1 thyroid cancer
File:Diagram showing stage N1a thyroid cancer CRUK 242.png|Stage N1a thyroid cancer
File:Diagram showing stage N1b thyroid cancer CRUK 243.png|Stage N1b thyroid cancer
File:Diagram showing stage T1a thyroid cancer CRUK 250.png|Stage T1a thyroid cancer
File:Diagram showing stage T1b thyroid cancer CRUK 251.svg.png|Stage T1b thyroid cancer
File:Diagram showing stage T3 thyroid cancer CRUK 265.png|Stage T3 thyroid cancer
File:Diagram showing stage T4a thyroid cancer CRUK 272.png|Stage T4a thyroid cancer
File:Diagram showing stage T4b thyroid cancer CRUK 273.png|Stage T4b thyroid cancer
</gallery>
==Reference==
==Reference==
{{Reflist|2}}
{{Reflist|2}}
Line 239: Line 290:
[[Category:Hereditary cancers]]
[[Category:Hereditary cancers]]
[[Category:Thyroid disease]]
[[Category:Thyroid disease]]
[[Category:Primary care]]

Latest revision as of 23:34, 29 July 2020

Papillary thyroid cancer Microchapters

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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] Sahar Memar Montazerin, M.D.[3]

Overview

According to the American Joint Committee on Cancer (AJCC) there are 4 stages of papillary thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of involved lymph node regions, and metastasis.

Staging

  • According to the American Joint Committee on Cancer (AJCC) there are 4 stages of papillary thyroid cancer based on the clinical features and findings on imaging.[1]
  • Each stage is assigned a letter and a number that designate the tumor size, number of involved lymph node regions, and metastasis.
Primary tumor
Tumor size Sub-stage Finding Image
T0
  • No evidence of primary tumor
T1
T1 a
T1 b
  • Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid
T2
  • Tumor >2 cm but ≤4 cm in greatest dimension, limited to the thyroid
T3
  • Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles
T3 a
T3 b
T4
  • Tumor includes gross extrathyroidal extension beyond the strap muscles
T4 a
T4 b
TX
  • Primary tumor cannot be assessed
Regional lymph node involvement
Node involvement Sub-stage Finding Image
N0
N0 a
N0 b
N1
N1 a
N1 b
NX
Distant metastasis
Presence of metastasis Sub-stage Finding Image
M0
M1 IV


Anatomic Stage/Prognostic Groups
Stage T N M
Papillary thyroid carcinoma
Younger than 55 years
I Any T Any N M0
II Any T Any N M1
55 years and older
I T1 Any N M0
II T1 N1 M0
T2 N1 M0
T3a Any N M0
T3b Any N M0
III T4a Any N M0
IVA T4b Any N M0
IVB Any T Any N M1
T1 N1 M0
T2 N1 M0
T3a N1 M0
T3b Any N M0
T4 Any N M0
IVC Any T Any N M1

Reference

  1. ↑ "Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute".
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