Practical Management of Thyroid Cancer

Practical Management of Thyroid Cancer

Ernest L. Mazzaferri, Clive Harmer, Ujjal K. Mallick and Pat Kendall-Taylor (Eds)

Practical Management of Thyroid Cancer

A Multidisciplinary Approach

With 121 Figures

Ernest L. Mazzaferri, MD, MACP

Emeritus Professor and Chairman of Internal Medicine, The Ohio State University, Columbus, OH, USA

and

Professor of Medicine, University of Florida, Gainsville, FL, USA

Clive Harmer, FRCR, FRCP

Head of Thyroid Unit, Department of Radiotherapy, Royal Marsden Hospital, London, UK

Ujjal K. Mallick, MS, FRCR

Northern Centre for Cancer Treatment, Newcastle upon Tyne,UK; Vice-Chair, Thyroid Cancer Subgroup, National Cancer Research Institute, UK

and

Chairman, Northern Cancer Network Thyroid Cancer Group, UK

Pat Kendall-Taylor, MD, FRCP

Emeritus Professor, Department of Medicine, University of Newcastle upon Tyne, UK

A catalogue record for this book is available from the British Library.

Library of Congress Control Number: 2005924409

ISBN-10: 1-85233-910-1 e-ISBN: 1-84628-013-3

ISBN-13: 978-1-85233-910-4 Printed on acid-free paper

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Cancer of the thyroid gland may be a less common condition than carcinoma of the breast, lung, or colon, but it occurs with sufficient frequency to constitute a major problem that is of concern to general practitioners, physicians, and particularly sur- geons. Some idea of the frequency of thyroid carcinoma is given by its incidence in the United States. Every year some 26,000 patients are diagnosed there as suffering from thyroid cancer. Comparable figures apply to most countries in Europe although the inci- dence does vary somewhat from country to country, perhaps depending on the endoge- nous iodine intake. Of the 21,000 patients diagnosed annually in the United States, two thirds will be women, and some 800 will die of the disease during the year.

This book should do much to improve the outcome in the treatment of thyroid cancer.

First because it is written by a small team of experts of international repute. Secondly their wide experience of the condition allows them to write with authority and thirdly they express their views in clear and commendable English.

There is no evasion of the difficulties that confront those who have to treat thyroid cancer. The condition usually declares itself by the appearance of a lump, often very small, in the patient’s neck. The general practitioner who is usually the first port of call for the patient seldom has the facilities to investigate the matter further, but it is essen- tial that he or she is familiar with the further diagnostic steps that must be taken. This knowledge brings increased interest to the general practitioner’s professional life and allows him or her to support the patient on the long path the patient will have to follow in the weeks or months to come.

At last we have in this book a really authoritative, comprehensive and very readable book on a condition that all members of the medical profession are likely to encounter at some time in their professional lives. Recent advances in the availability of different radioisotopes of iodine, new techniques for the imagining of these isotopes and for the rapid measurement of thyroid hormones and thyroid autoantibodies have revolutionized the diagnosis and management of cancer of the thyroid gland.With our enhanced under- standing and knowledge, the prognosis for patients with thyroid cancer has much improved and will improve even further when the knowledge contained in this book has been widely absorbed by members of the medical and nursing professions at large. To these professionals this book will be a delight because there is nowadays very little dis- agreement as to what is the best and most effective way to treat thyroid cancers and these ways are clearly set out in this highly commendable book.

Sir Richard Bayliss

Foreword

v

Preface

vii

This book is intended for practitioners who manage patients with thyroid cancer and students who are learning about the disease. It aims to provide practical information about this diverse group of tumors to physicians, surgeons, and other healthcare providers involved in the day-to-day management of patients, while supplying a suffi- cient depth of intellectual material to spark the interest of serious students of the disease.

An admittedly audacious goal, we believe this series of concise reviews by experts in the field, laced with more than two thousand figures, tables, and references, forms a robust basis for our overall approach to thyroid cancer. A broad variety of practitioners was necessary to write this book, reflecting the multidisciplinary team required to manage our patients. The careful reader will see some diverse views among authors, reflecting the usual differences of opinion in medicine, disagreements that we should embrace because they spark the fire of debate that generates new ideas.

We thank Sir Richard Bayliss for his kind words in the foreword of this book and my fellow editors for their thoughtful ideas and contributions. We all owe a great debt of gratitude to our multinational authors who focused their cumulative expertise and vast experience to bear on the ideas expressed in this book, while showing their passion for medicine on virtually every page – and they did this by generously contributing hun- dreds of hours of their time.

Chapter 5 is written by Jenny Pitman, a thyroid cancer patient who shares her emo- tional journey with our readers, one that grips virtually every patient with this disease.

This is the story of a brave lady who reached deep into her soul to find the personal strength that was necessary to deal with the news that she had cancer . . . and then she shared this strength with other patients at the Royal Marsden and with our readers. We thank her for her contributions not only to the book, but to her fellow patients. She inspires all of us.

Ernest L. Mazzaferri, MD, MACP

Contents

ix

Foreword . . . . v

Preface . . . . vii List of Contributors . . . . xiii 1. An Overview of the Management of Thyroid Cancer

Ernest L. Mazzaferri . . . . 1 Section I. The UK Multidisciplinary Approach to Management of

Thyroid Cancer

2. The UK Evidence-Based Guidelines for the Management of Thyroid Cancer: Key Recommendations

Pat Kendall-Taylor . . . . 31 3. Thyroid Cancer Multidisciplinary Team and the Organisational

Paradigm

Ujjal K. Mallick . . . . 39 4. Thyroid Cancer from the Perspective of a Patient

Jennifer S. Pitman . . . . 55 5. The Role of the Specialist Nurse

Caroline Owen-Hafiz . . . . 59 6. The Role of the Clinical Psychologist

Katherine Kendell . . . . 65

x Contents

Section II. The Diagnosis of Thyroid Cancer 7. Thyroid Nodules

Petros Perros . . . . 75 8. Thyroid Cancer and the General Practitioner

Geoffrey Mitchell and Duncan Leith . . . . 83 9. The Role of the Pathologist

Anne Marie McNicol . . . . 95 10. Thyroid Cancer and the Endocrinologist

Wilmar M. Wiersinga . . . . 109

Section III. Initial Thyroid Surgery 11. The Specialist Endocrine Surgeon

Nadine R. Caron, Cord Sturgeon, and Orlo H. Clark . . . . 121 12. Initial Thyroid Surgery for Patient with Differentiated

Thyroid Carcinoma

Douglas B. Villaret and Ernest L. Mazzaferri . . . . 135 13. Management of Cervical Lymph Nodes in Differentiated

Thyroid Cancer

John C. Watkinson . . . . 149 14. Complications of Thyroid Surgery

Thomas W. J. Lennard . . . . 165

Section IV. Non-surgical Management of Differentiated Thyroid Cancer 15. Non-surgical Management of Thyroid Cancer

Masud S. Haq and Clive Harmer . . . . 171 16. Fertility Following Treatment with Iodine-131 for Thyroid Cancer

Louiza Vini . . . . 193

Section V. Follow-up Management of Differentiated Thyroid Cancer 17. Recombinant Human TSH (rhTSH): Use in Papillary and Follicular

Thyroid Cancer

Furio Pacini and Martin J. Schlumberger . . . . 201 18. Thyroglobulin

Carole A. Spencer and Shireen Fatemi . . . . 211

19. Follow-up of Patients with Differentiated Thyroid Carcinoma

Martin J. Schlumberger, Sophie M. Leboulleux and Furio Pacini . . . . . 229 20. Management of Differentiated Thyroid Carcinoma Patients with

Negative Whole-Body Radioiodine Scans and Elevated Serum Thyroglobulin Levels

Ernest L. Mazzaferri . . . . 237

Section VI. Medullary Thyroid Carcinoma

21. Medullary Thyroid Cancer: Diagnosis and Management

Aldo Pinchera and Rossella Elisei . . . . 255 22. Nonmedullary Thyroid Cancer and the Role of the Geneticist

Sanjay Popat and Richard S. Houlston . . . . 281

Section VII. Thyroid Cancer in Children 23. Thyroid Cancer in Childhood

Nicholas J. Sarlis and Wellington Hung . . . . 303 24. Radiation-Induced Thyroid Cancer: Lessons from Chernobyl

James A. Fagin and Yuri E. Nikiforov . . . . 321 25. The Use of Stable Potassium Iodide (KI) in the Event of a Nuclear

Emergency

Christoph Reiners . . . . 327

Section VIII. Diagnostic Imaging Studies for Thyroid Cancer 26. Ultrasound of the Thyroid

David L. Richardson . . . . 335 27. Diagnostic Nuclear Medicine Investigations in the Management of

Thyroid Cancer

Susan E. M. Clarke . . . . 341 28. CT and MRI in Thyroid Cancer

Julian E. Kabala . . . . 359

Section IX. Papillary Microcarcinoma 29. Papillary Microcarcinoma of the Thyroid

William D. Drucker and Richard J. Robbins . . . . 371

Contents xi

xii Contents

Section X. Aggressive Thyroid Cancers 30. Rare Thyroid Cancers

Masud S. Haq and Clive Harmer . . . . 393 31. Management of Anaplastic Thyroid Cancer

Jan Tennvall, Göran Lundell, and Göran Wallin . . . . 403 32. Specialist Palliative Care for Anaplastic Thyroid Carcinoma

Mary Comiskey . . . . 411

Section XI. Future Developments and Directions for Research in Thyroid Cancer

33. Emerging Therapies for Thyroid Cancer

Matthew D. Ringel . . . . 423 34. Clinical Trials for Thyroid Carcinoma: Past, Present, and Future

Steven I. Sherman . . . . 429

Index . . . . 435

List of Contributors

xiii Sir Richard Bayliss, KCVO, MD, FRCP,

FRCPath, FMed Sci Lister Hospital, London, UK Nadine R. Caron, MD, MPH, FRCS

Department of Surgery, University of British Columbia, Prince George, BC, Canada Orlo H. Clark, MD, FACS

Department of Surgery, University of California, San Francisco, UCSF

Comprehensive Cancer Center at Mt Zion Hospital, San Francisco, CA, USA Susan E. M. Clarke, MSc, FRCP, FRCR

Department of Nuclear Medicine, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK

Mary Comiskey, MB BCh, FRCP

Northern Centre for Cancer Treatment and Marie Curie Hospice Newcastle, Newcastle upon Tyne Hospitals NHS Trust and Marie Curie Cancer Care, Newcastle upon Tyne, UK William D. Drucker, MD

Endocrine Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Rossella Elisei, MD

Department of Endocrinology and Metabolism, University of Pisa, University Hospital, Pisa, Italy

James A. Fagin, MD

Division of Endocrinology and Metabolism, University of Cincinnati, Cincinnati, OH, USA

Shireen Fatemi, MD

Department of Endocrinology, Southern California Permanente Medical Group, Panorama City, CA, USA

Masud S. Haq, BSc, MBBS, MRCP Thyroid Unit, Royal Marsden Hospital, London, UK

Clive Harmer, FRCR FRCP

Thyroid Unit, Royal Marsden Hospital, London, UK

Richard S. Houlston, MD, PhD, FRCP, FRCPath

Section of Cancer Genetics, Institute of Cancer Research, Sutton, UK

Wellington Hung, MD, PhD, FACE, FAAP, FACP

Developmental Endocrinology Branch, National Institute of Child Health and Human, Development, National Institutes of Health, Bethesda, MD, USA

Julian E. Kabala, MB ChB, MRCP, FRCR Department of Clinical Radiology, Bristol Royal Infirmary, Bristol, UK

Pat Kendall-Taylor, MD, FRCP Department of Medicine, University of Newcastle upon Tyne, UK

Katherine Kendell, BA, MSc

Northern Centre for Cancer Treatment, Newcastle General Hospital, Newcastle upon Tyne, UK

xiv List of Contributors

Sophie M. Leboulleux, MD

Department of Nuclear Medicine and Endocrine Tumours, Institut Gustave Roussy, Villejuif, France

Duncan Leith, MBBS

Cramlington Medical Group, Cramlington, UK Thomas W. J. Lennard, MD, FRCS

School of Surgical and Reproductive Sciences, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK Göran Lundell, MD, PhD

Department of Oncology, Karolinska University Hospital, Stockholm, Sweden Ujjal K. Mallick, MS, FRCR

Northern Centre for Cancer Treatment, Newcastle General Hospital, Newcastle upon Tyne and Northern Cancer Network Thyroid Cancer Group, UK

Ernest L. Mazzaferri, MD, MACP

Department of Internal Medicine, The Ohio State University, Columbus, OH and Department of Medicine, University of Florida, Gainesville, FL, USA

Anne Marie McNicol, BSc, MB ChB, MD, MRCP, FRCP, FRCPath

Divison of Cancer Sciences and Molecular Pathology, University of Glasgow, and Department of Pathology, Royal Infirmary, Glasgow

Geoffrey Mitchell, MBBS, FRACGP, FAChPM School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Yuri E. Nikiforov, MD, PhD

Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA

Caroline Owen-Hafiz, RGN, MSc

Department of ENT/Head and Neck Surgery, The Regional Cancer Unit, Queen Elizabeth Hospital, University of Birmingham NHS Trust, Birmingham, UK

Furio Pacini, MD

Department of Internal Medicine, Endocrinology and Metabolism, and Biochemistry, University of Siena, Siena, Italy Petros Perros, BSc, MBBS, MD, FRCP Department of Endocrinology, Freeman Hospital, Newcastle upon Tyne, UK

Aldo Pinchera, MD, FRCP

Department of Endocrinology and Metabolism, University of Pisa, University Hospital, Pisa, Italy

Jennifer S. Pitman

Novelist and Former Racehorse Trainer Hungerford, UK

Sanjay Popat, BSc, MB BS, MRCP, PhD Section of Cancer Genetics, Institute of Cancer Research, Sutton, UK

Christoph Reiners, MD

Clinic and Policlinic for Nuclear Medicine, University of Würzburg, Würzburg, Germany David L. Richardson, MB BS, FRCR

Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK Matthew D. Ringel, MD

Divisions of Endocrinology, Oncology, and Human Cancer Genetics, The Ohio State University, College of Medicine, Columbus, OH, USA

Richard J. Robbins, MD

Endocrine Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Nicholas J. Sarlis, MD, PhD, FACE, FACP Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

Martin J. Schlumberger, MD

Department of Nuclear Medicine and Endocrine Tumours, Institut Gustave Roussy, Villejuif, France

Steven I. Sherman, MD

Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

Carole A. Spencer, PhD, MT, FACB Department of Medicine, University of Southern California, Los Angeles, CA, USA Cord Sturgeon, MD

Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

List of Contributors xv

Jan Tennvall, MD, PhD

Department of Oncology, Lund University Hospital, Lund, Sweden

Douglas B. Villaret, MD, FACS

Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, FL, USA

Louiza Vini, MD, FRCR

Department of Radiotherapy, Athens Medical Center, Athens, Greece

Göran Wallin, MD, PhD

Department of Surgery, Karolinska University Hospital, Stockholm, Sweden

John C. Watkinson, MSc, MS, FRCS, DLO Department of ENT/Head and Neck and Thyroid Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham, UK

Wilmar M. Wiersinga, MD, PhD Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands