Treatment Options For Stage 4 Thyroid Cancer

Thyroid cancer is the cancer in the thyroid gland, an endocrine organ which produces hormones that control the speed of metabolism. Read more about thyroid cancer here.

Visual representation of cancer affecting the body in a microscopic level

How is thyroid cancer staged?

Staging of thyroid cancer helps the doctors figure out the on how much the cancer has spread in the body and determine its best treatment. Staging also helps calculate survival statistics too. The lower the number of the stage, the less is the cancer has spread, with early stages being 1 and the most advanced stage being 4. The staging system and the other factors taken into consideration to determine the stage of thyroid cancer are as follows:

TNM method:

Cancer types that form tumours are staged using TNM system and the same method is used for thyroid cancer too. The size of the primary tumour (T), the presence of cancerous lymph nodes (N) and how far the thyroid cancer has spread to a different part of the body (M) can be described using the TNM system.

Type of thyroid cancer:

Differentiated thyroid cancer refers to those types in which the cancerous cells look and act like normal thyroid cells, and this accounts for more than 90% of all thyroid cancers. Papillary and follicular thyroid cancers are differentiated with the former accounting to 80% of the total cases and the latter, 10%. Read more about the types of thyroid cancer here.
All anaplastic thyroid cancers are staged to be stage IV due to the poor diagnosis of this cancer type and the exact stages will be discussed in the treatment of stage IV of thyroid cancers.

Age:

Age is also taken as a factor for staging differentiated thyroid cancers while it is not a factor for medullary thyroid cancer. Differentiated thyroid cancers are staged the same but the age factor is also taken into consideration to determine the stage as younger people are less likely to die due to these cancers than older patients.

Stage IV of thyroid cancer:

The characteristics of stage IV thyroid cancer on the basis of age and type of thyroid cancer is as follows:

Stage IV papillary and follicular thyroid cancer:

Stage IVA: The tumour can be of any size and has grown extensively beyond the thyroid gland towards the back of the spine and into large blood vessels nearby, it might or might not have spread to nearby lymph nodes but has not spread to distant organs and the staging is (T4, any N, M0).

Stage IVB: The tumour can be of any size, it might or might not have spread into nearby lymph nodes but has spread to other parts of the body and the staging is (any T, any N, M1).

Stage IV medullary thyroid cancer:

Stage IVA: The tumour can be of any size but has grown beyond the thyroid gland and has spread to nearby tissues in the neck. The tumour may or may not have spread to nearby lymph nodes but has not spread to distant organs and the staging is (T4, any N, M0) or the tumour is of any size but has not affected external structures but has spread to nearby lymph nodes and not to distant organs and the staging is (TX, N1, M0) where X can be 1, 2 or 3.

Stage IVB: The tumour can be of any size and has grown extensively beyond the thyroid gland towards the back of the spine and into large blood vessels nearby, it might or might not have spread to nearby lymph nodes but has not spread to distant organs and the staging is (T4, any N, M0).

Stage IVC: The tumour can be of any size, it might or might not have spread into nearby lymph nodes but has spread to other parts of the body and the staging is (any T, any N, M1).

Stage IV anaplastic thyroid cancer:

Anaplastic thyroid cancer has only stage IV in its staging as it has a very poor prognosis and the signs of stage IV anaplastic thyroid cancer are similar to that of medullary thyroid cancer.

Stage IA: The tumour can be of any size but is confined to the thyroid gland and it has not spread to nearby lymph nodes or distant organs and the staging is (TX, N0, M0) where X can be 1, 2 or 3.

Stage IVB: The tumour is of any size but confined to the thyroid but has spread to nearby lymph nodes but not distant organs and the staging is (TX, N1, M0) where X can be 1, 2 or 3 or the tumour has grown extensively beyond the thyroid gland, may or may not spread to nearby lymph nodes but has not spread to distant organs and the staging is (T4, any N, M0).

Stage IVC: The tumour can be of any size, it might or might not have spread into nearby lymph nodes but has spread to other parts of the body and the staging is (any T, any N, M1).

What is the treatment for stage IV thyroid cancer?

The cancer can be treated if it has spread to the nearby lymph nodes but not if it has spread to different parts of the body such as the lungs or bones. Then the treatment aims to relieve the patient of the symptoms and improve the quality of life.

Treatment for stage IV papillary and follicular thyroid cancers:

The treatment options for stage 4 of papillary or follicular cancers are:

  • Radioiodine therapy (for tumours that take up iodine)
  • Hormone therapy
  • Targeted therapy with tyrosine kinase inhibitor
  • Surgery {insert link:3.14}
  • Radiotherapy
  • Clinical trials of chemotherapy and targeted therapy

Treatment for stage IV medullary thyroid cancer:

The treatment for stage 4 medullary thyroid cancer is:

  • Total thyroidectomy followed by thyroid hormone therapy because the thyroid gland is removed. This can only keep the patient healthy but does not reduce the risk of cancer coming back. MTC cells do not take up radioactive iodine so radioiodine therapy cannot be used.
  • External beam radiation therapy may be given after surgery to reduce the chance of recurrence.
  • For cancers that have spread to different parts of the body, radiotherapy, chemotherapy and targeted therapy can be used in addition to removing the primary tumour surgically.

Treatment for stage IV anaplastic thyroid cancer:

The treatment options for stage IV anaplastic thyroid cancer include:

  • Total thyroidectomy
  • Tracheostomy
  • External radiation therapy
  • Chemotherapy

Anaplastic cancer has a very low five year survival rate of about 5% and is too advanced to be cured completely and most of the treatment aims to relieve the symptoms of the patient and improve the quality of life.

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