Medullary Thyroid Cancer

Accounts for 3-5% of all thyroid cancer cases.
20% of MTC patients may have hereditary disease, and all patients with newly diagnosed MTC should be tested for a germline mutation in the RET gene.
80% of MTC is sporadic and no other family members are at risk for disease.
Patients with MEN2 may have other non-cancerous medical conditions, such as over active parathyroid glands (hyperparathyroidism) or other endocrine cancers such as pheochromocytoma, and require evaluation for these conditions.
Medullary thyroid cancer arises from mutations in specific genes, such as RET.

While MTC is occasionally diagnosed by fine needle aspiration of a thyroid nodule, many patients with sporadic MTC learn of the diagnosis after thyroidectomy.
Surgery is the mainstay of treatment for medullary thyroid cancer.
Thyroidectomy should be performed by an experienced thyroid surgeon.
Endocrinologists play a key role in diagnosing and managing patients’ with thyroid cancer. Most patients will require replacement therapy with thyroid hormone (T4) which requires monitoring.
Radioactive iodine is not used for treatment of medullary thyroid cancer.
Thyroid cancer treatment should be individualized by a team of specialists to ensure the best possible outcome.
Medullary thyroid cancers usually produce hormone such as calcitonin and CEA that can be monitored by blood tests.
Patients with persistently elevated calcitonin or CEA after thyroidectomy may have residual or metastatic disease.

The FDA has approved two targeted therapies for treatment of patients with progressive medullary thyroid cancer.
Patients with metastatic disease should be followed by an experienced endocrinologist, oncologist, or surgeon.
Some patients with medullary thyroid cancer may have distant spread of disease (metastasis) to lung, liver, or bones.
Patients with symptoms due to metastatic thyroid cancer or growth of thyroid cancer in other organs may benefit from consultation with a medical oncologist specializing in thyroid cancer and consideration of targeted therapy or participation in clinical trials.

Clinical trials are carefully controlled experiments that are conducted to discover more effective therapies.
Some patients with advanced disease may be candidates for participation in clinical trials.
Patients with advanced disease may be candidates for participation in clinical trials.
Physicians that specialize in care of patients with advanced thyroid cancer can help identify whether you may be an appropriate candidate for participation in a clinical trial.
Consultation with a thyroid cancer specialist to consider new forms of therapy is encouraged for patients with medullary thyroid cancer.

International Thyroid Oncology Group