Papillary, Follicular, and Anaplastic Thyroid Carcinoma and Thyroid Lymphoma

Abstract

Thyroid cancer is the most common endocrine malignancy. Differentiated thyroid carcinoma (DTC) is the most frequent type of thyroid cancer and generally has a good prognosis. Diagnosis is based on neck ultrasound and fine needle aspiration biopsy (FNAB) which selects patients for thyroid surgery. Total thyroidectomy is required for large, invasive tumours with lymph node invasion; lobectomy is sufficient for small nodules without any suspicious features. Clinical and pathology data are used to stratify patients according to their risk of mortality and disease recurrence. Adjuvant therapy with radioiodine is indicated in high-risk groups. Follow-up is based on serial thyroglobulin measurements and ultrasound in a dynamic risk evaluation system. In case of disease persistence or recurrence radioiodine scans, high resolution cross-sectional imaging studies with computed tomography (CT) or MRI and 18FDG-PET are performed. Particular management is required for children and during pregnancy. Anaplastic thyroid carcinoma is a rare, aggressive malignancy, affecting older patients, rapidly evolving, and almost uniformly fatal. Prompt management is essential, involving early surgery followed by external radiotherapy, chemotherapy, and palliative care when needed. Thyroid lymphoma is a rare thyroid cancer that frequently occurs on the background of autoimmune thyroiditis. Management depends on histological subtype and stage. In localized forms radiotherapy alone may be sufficient; diffuse forms require a combination of radiotherapy and chemotherapy to improve survival and decrease the risk of recurrences.