Clinical Review State of the Art Review

Low risk papillary thyroid cancer

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3045 (Published 16 June 2014) Cite this as: BMJ 2014;348:g3045
  1. Juan P Brito, assistant professor, endocrine fellow, and healthcare delivery scholar12,
  2. Ian D Hay, professor of medicine and thyroidologist1,
  3. John C Morris, professor of medicine, thyroidologist1
  1. 1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
  2. 2Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA
  1. Correspondence to: J C Morris Morris.John{at}mayo.edu

Abstract

Thyroid cancer is one of the fastest growing diagnoses; more cases of thyroid cancer are found every year than all leukemias and cancers of the liver, pancreas, and stomach. Most of these incident cases are papillary in origin and are both small and localized. Patients with these small localized papillary thyroid cancers have a 99% survival rate at 20 years. In view of the excellent prognosis of these tumors, they have been denoted as low risk. The incidence of these low risk thyroid cancers is growing, probably because of the use of imaging technologies capable of exposing a large reservoir of subclinical disease. Despite their excellent prognosis, these subclinical low risk cancers are often treated aggressively. Although surgery is traditionally viewed as the cornerstone treatment for these tumors, there is less agreement about the extent of surgery (lobectomy v near total thyroidectomy) and whether prophylactic central neck dissection for removal of lymph nodes is needed. Many of these tumors are treated with radioactive iodine ablation and thyrotropin suppressive therapy, which—although effective for more aggressive forms of thyroid cancer—have not been shown to be of benefit in the management of these lesions. This review offers an evidence based approach to managing low risk papillary thyroid cancer. It also looks at the future of promising alternative surgical techniques, non-surgical minimally localized invasive therapies (ethanol ablation and laser ablation), and active surveillance, all of which form part of a more individualized treatment approach for low risk papillary thyroid tumors.

Footnotes

  • Contributors: All authors contributed to the concepts and structure of this manuscript. JCM is guarantor.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: None.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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