Current Approaches to Primary Therapy for Papillary and Follicular Thyroid Cancer

Patient variables Age 15 yr or 45 yr Age 15-45 yr Male sex Female sex Family history of thyroid cancer No family history of thyroid cancer Tumor variables Tumor 4 cm in diameter Tumor 4 cm in diameter Bilateral disease Unilateral disease Extrathyroidal extension No extrathyroidal extension Vascular Invasion (both papillary and follicular thyroid cancer) Absence of vascular invasion Cervical, or mediastinal lymph node metastases No lymph node metastases Certain tumor subtypes: Hu rthle cell, tall cell, columnar cell, diffuse sclerosis, insular variants Encapsulated papillary thyroid carcinoma, papillary microcarcinoma, cystic papillary thyroid carcinoma Marked nuclear atypia, tumor necrosis, and vascular invasion (i.e. histologic grade) Absence of nuclear atypia, tumor necrosis, and vascular invasion Tumors or metastases that concentrate radioiodine poorly or not at all Tumors or metastases that concentrate radioiodine well Distant metastases No distant metastases Modified from the NCCN guidelines for the diagnosis and treatment of thyroid cancer (3, 6).