Thyroid Cancer

  • Clinical and pathologic staging of patients with cancer is valuable for many reasons, including the following:
    • To estimate risk of recurrence and disease-specific mortality for an individual patient
    • To tailor decisions regarding postoperative adjunctive therapy (such as the need for radioiodine [RAI] ablation and degree of thyroid-stimulating hormone [TSH] suppression):
      • To the patient’s risk for disease recurrence and mortality
    • To make decisions regarding the frequency, modality, and intensity of follow-up based upon an individual patient’s risk of recurrence and mortality
    • To enable accurate communication regarding a patient among health care professionals
    • To allow evaluation of differing therapeutic strategies applied to comparable groups of patients in clinical studies
    • To provide “a method of conveying clinical experience to others without ambiguity
  • Initial postoperative staging:
    • You can use the several staging systems to estimate disease-specific mortality:
      • Tumor, node, metastasis (TNM) staging systems
      • MSKCC:
        • Grade, Age, Metastases, Extent, Size (GAMES) 
      • Mayo Clinic:
        • Metastases, Age, Complete Resection, Invasion, Size  (MACIS)
      • Karolinska Hospital and Institute:
        • DNA ploidy, Age, Metastases, Extent, Size (DAMES)
      • Age, Grade, tumor Extent, Size (AGES)
      • Lahey Clinic:
        • Age, distant Metastasis, Extent, Size (AMES)
    • Clinical and pathologic staging system:
      • Such as the American Thyroid Association (ATA) system:
        • To estimate the risk of recurrence  
  • Re-staging during follow-up:
    • These initial risk assessments are then:
      • Actively modified based upon data obtained during follow-up:
        • That reflect the individualized patient’s response to therapy
    • This dynamic risk assessment approach:
      • Allows for more accurate risk assessments:
        • Than either a static estimate of risk based on the:
          • TNM staging system or the ATA risk of recurrence classification system 
  • The ATA recommends the TNM staging system:
    • For all patients with differentiated thyroid cancer and any of the:
      • Postoperative clinicopathologic staging systems:
        • To achieve more accurate risk factor stratification 
  • It should be recognized, however:
    • No staging system reliably predicts outcome in individual patients:
      • Clinicians should use individual clinicopathologic characteristics:
        • To determine the specific treatment for a given patient
No Difference in Outcome in High Dose vs Low Dose Radioactive iodine

#Arrangoiz #ThyroidSurgeon #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #EndocrineSurgery #ThyroidCancer #Miami #Mexico #MountSinaiMedicalCenter #Surgeon #Teacher #ThyroidNodules #RadioactiveIodine #RAI #PTC #MSMC

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