Advances and controversies in the management of medullary thyroid carcinoma

Abstract

Tyrosine kinase inhibitors are effective therapeutic agents for the treatment of progressive MTC. Nevertheless, it is not clear who will benefit the most from therapy, and the decision regarding when and how to initiate the treatment should be made based on the patient's medical history and tumor behavior. Hopefully, in the near future, molecular profiling of MTC can be used to determine the most effective molecular therapeutic target.

Cohexisting Medullary and Papillary Thyroid Cancer

“…Since MTC was first recognized as a distinct tumor in 1959, it became clear that MTC is more difficult to cure than PTC and has higher rates of recurrence and mortality (1,2). In addition, unlike PTC, there is no known effective systemic therapy for MTC (2).…”

“…In fact, PTC is associated with cervical LN metastases in 30%-90% of patients (1). FMTC is often multifocal and bilateral (2). The incidence of positive LNs correlates with the size of the primary lesion at the time of diagnosis; 60% of patients have positive LNs if the MTC is larger than 2 cm (2).…”

“…Medullary thyroid carcinoma (MTC) represents only 5%-8% of thyroid cancers (2). MTC has a different embryological origin; it derives from parafollicular cells of the ultimobranchial body of the neural crest.…”

“…MTC has a different embryological origin; it derives from parafollicular cells of the ultimobranchial body of the neural crest. MTC secretes calcitonin and other hormonal peptides, and is considered a part of the amine precursor uptake and decarboxylation system of the thyroid (2). MTC may occur either as a hereditary or as a nonhereditary entity.…”

“…The prognosis of MTC is generally worse than PTC (70%-80%) (1,2). PTC happens to be a multicentric tumor and tends to spread to the regional lymph nodes (LNs) in the early stage of the disease (1).…”