eMedicine Specialties > Oncology > Carcinomas of Endocrine Organs

Thyroid, Papillary Carcinoma

Author: Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Coauthor(s): Silvia Gagliardi, MD, Consulting Staff, Department of Surgery, Medical Center Vita, Italy; Andrew Scott Kennedy, MD, Co-Medical Director, Wake Radiology Oncology
Contributor Information and Disclosures

Updated: Aug 20, 2008

Introduction

Background

Papillary carcinoma is a relatively common well-differentiated thyroid cancer. Papillary/follicular carcinoma must be considered a variant of papillary thyroid carcinoma (mixed form). Despite its well-differentiated characteristics, papillary carcinoma may be overtly or minimally invasive. In fact, these tumors may spread easily to other organs. Papillary tumors have a propensity to invade lymphatics but are less likely to invade blood vessels. Papillary carcinoma appears as an irregular solid or cystic mass in a normal thyroid parenchyma.

Thyroid cancers are more often found in patients with a history of low- or high-dose external irradiation. Papillary tumors of the thyroid  are the most common form of thyroid cancer to result from exposure to radiation. The life expectancy of patients with this cancer is related to their age. The prognosis is better for younger patients than for patients who are older than 45 years. Of patients with papillary cancers, about 11% present with metastases outside the neck and mediastinum. Some years ago, lymph node metastases in the cervical area were thought to be aberrant (supernumerary) thyroids because they contained well-differentiated papillary thyroid cancer.

Pathophysiology

Papillary thyroid carcinoma seems closely related to the activation of trk and ret proto-oncogenes, both acting by amplifying and rearranging mechanisms. The trk proto-oncogene codes for tyrosine kinase receptors; the ret shows a paracentric inversion of chromosomes 10 and 11 in 30-35% of the cases. However, the met proto-oncogene is overexpressed and/or amplified in 3 of 4 patients.

In addition, evidence suggests that some molecules that physiologically regulate the growth of the thyrocytes, such as interleukin-1 and interleukin-8, or other cytokines (ie, insulinlike growth factor-1, transforming growth factor-beta, epidermal growth factor) could play a role in the pathogenesis of this cancer.

Frequency

United States

Approximately 74-80% of the thyroid cancers diagnosed each year in the United States are of the papillary type.

International

Thyroid cancers are quite rare, accounting for only 1.5% of all cancers in adults and 3% of all cancers in children, but the rate of new cases is increasing in the last decades. The highest incidence of thyroid carcinomas in the world is found among female Chinese residents of Hawaii. During the last few years, the frequency of papillary cancer has increased, but this increase in frequency is related to an improvement in diagnostic techniques and the information campaign about this carcinoma. Of all thyroid cancers, 74-80% of cases are papillary cancer. Follicular carcinoma incidences are higher in regions where incidence of endemic goiter is high.

Mortality/Morbidity

In contrast to other cancers, thyroid cancer is almost always curable. Most thyroid cancers grow slowly and are associated with a very favorable prognosis. The mean survival rate after 10 years is higher than 90% and is 100% in very young patients with minimal nonmetastatic disease.

  • Distant spread (ie, to lungs or bones) is very uncommon. Worldwide, autopsy reviews show a high incidence of microscopic foci of thyroid carcinoma.
  • Differing from medullary thyroid carcinoma, papillary thyroid cancer is not a part of multiple endocrine neoplasia syndromes. Uncommon familial syndromes such as familial adenomatous polyposis, Gardner syndrome (Gardner's syndrome), and Cowden disease (Cowden's disease) may be associated with thyroid papillary tumors in about 5% of cases.
  • The mean mortality rate is 1.5% for females and 1.4% for males.

Race

This cancer occurs more frequently in whites than in blacks.

Sex

The female-to-male ratio is near 3:1 and is related to the patient's age.

  • In patients younger than 19 years, the female-to-male ratio is 3.2:1.
  • In patients aged 20-45 years, the female-to-male ratio is 3.6:1.
  • In patients older than 45 years, the female-to-male ratio is 2.8:1.

A useful and updated source for informations about the epidemiology of papillary carcinoma of the thyroid is American Cancer Society's Cancer Facts and Figures. 

ACS Estimated New Thyroid Carcinoma Cases and Deaths by Sex, US, 2008

Open table in new window

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Table

 Cases and Deaths

Total 

Males

Females

Estimated new cases

37,340

8,930

28,410

Estimated deaths  

1,590

680


 

910

 Cases and Deaths

Total 

Males

Females

Estimated new cases

37,340

8,930

28,410

Estimated deaths  

1,590

680


 

910



Age

Thyroid carcinoma is common in persons of all ages, with a mean age of 49 years and an age range of 15-84 years. In the younger population, papillary thyroid carcinoma tends to occur more frequently than follicular carcinoma, with a peak in patients aged 30-50 years.

Clinical

History

Patients with papillary carcinoma, a relatively common well-differentiated thyroid cancer, may present with the following history:

  • Numerous cases of papillary thyroid cancer are subclinical.
  • The most common presentation of thyroid cancer is an asymptomatic thyroid mass or a nodule that can be felt in the neck.
  • Record a thorough medical history to identify any risk factors or symptoms.
  • For any patient with a thyroid lump that has developed recently, obtain a history regarding every prior exposure to ionizing radiation and the lifetime duration of the radiation exposure.
  • Consider a family history of thyroid cancer.
  • Some patients have persistent cough, difficulty breathing, or difficulty swallowing.
  • Pain is seldom an early warning sign of thyroid cancer.
  • Other symptoms (eg, pain, stridor, vocal cord paralysis, hemoptysis, rapid enlargement) are rare. These symptoms can be caused by less serious problems.
  • At the time of diagnosis, 10-15% of patients have distant metastases to the bones and lungs and, initially, are evaluated for pulmonary or osteoarticular symptoms (eg, pathologic fracture, spontaneous fracture).

Physical

  • Palpate the patient's neck to evaluate the size and firmness of the thyroid and to check for any thyroid nodules. The principal sign of thyroid carcinoma is a palpable, firm, and nontender nodule in the thyroid area. This mass is painless.
  • Some patients have a tight or full feeling in the neck, hoarseness, or signs of tracheal or esophageal compression.
  • With thyroid palpation, a usually solitary nodule that has a hard consistency, an average size of less than 5 cm, and ill-defined borders can be felt. This nodule is fixed in respect to surrounding tissues and moves with the trachea at swallowing.
  • Usually, signs of hyperthyroidism or hypothyroidism are not observed.

See related CME at Examining the Ears, Nose, and Oral Cavity in the Older Patient.

Causes

  • The thyroid is particularly sensitive to the effects of ionizing radiation. Exposure to ionizing radiation results in a 30% risk for thyroid cancer.
  • A history of exposure of the head and neck to x-ray beams, especially during childhood, has been recognized as an important contributing factor for the development of thyroid cancer. For example, 7% of individuals exposed to the atomic bomb in Japan developed thyroid cancers.1
  • From 1920-1960, therapeutic irradiation of body areas  was used to treat tumors and benign conditions (eg, acne; excessive facial hair; tuberculosis in the neck; fungus diseases of the scalp; sore throats; chronic coughs; enlargement of the thymus, tonsils, and adenoids). Approximately 10% of individuals who were treated with irradiation developed thyroid cancer after a latency period of 30 years.
  • Port et al report the "signature" of 7 genes (ie, SFRP1, MMP1, ESM1, KRTAP2-1, COL13A1, BAALC, PAGE1) in papillary thyroid cancers after the Chernobyl accident, demonstrating by PCR techniques their role in distinguishing such cases from sporadic forms.
  • Patients who need radiotherapy for certain types of cancer of the head and neck area also may have an increased risk of developing thyroid cancer.
  • Exposure to diagnostic x-ray beams does not increase the risk of developing thyroid cancers. Several reports have shown a relationship between iodine deficiency and the incidence of thyroid carcinomas.
  • Many other conditions  have been considered as predisposing to papillary thyroid cancer (oral contraceptive use, benign thyroid nodules, late menarche, late age at first birth).2,3
  • Tobacco smoking seems to be associated with a decreased risk of thyroid cancer, but, obviously, it poses more health hazards than benefits.4

More on Thyroid, Papillary Carcinoma

Overview: Thyroid, Papillary Carcinoma
Differential Diagnoses & Workup: Thyroid, Papillary Carcinoma
Treatment & Medication: Thyroid, Papillary Carcinoma
Follow-up: Thyroid, Papillary Carcinoma
References
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References

  1. Ronckers CM, McCarron P, Engels EA, et al. New Malignancies Following Cancer of the Thyroid and Other Endocrine Glands. In: Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. No. 05-5302. Bethesda, MD: NIH Publ.; 2006:375-395. [Full Text].

  2. Negri E, Dal Maso L, Ron E, et al. A pooled analysis of case-control studies of thyroid cancer. II. Menstrual and reproductive factors. Cancer Causes Control. 1999;10(2):143-155. [Medline].

  3. Franceschi S, Preston-Martin S, Dal Maso L, et al. A pooled analysis of case-control studies of thyroid cancer. IV.Benign thyroid diseases. Cancer Causes Control. 1999;10(6):583-595. [Medline].

  4. Mack WJ, Preston-Martin S, Dal Maso L, et al. A pooled analysis of case-control studies of thyroid cancer: cigarettesmoking and consumption of alcohol, coffee, and tea. Cancer. 2003;14(8):773-785. [Medline].

  5. Segev DL, Umbricht C, Zeiger MA. Molecular pathogenesis of thyroid cancer. Surg Oncol. Aug 2003;12(2):69-90. [Medline].

  6. AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. American Association of Clinical Endocrinologists. American College of Endocrinology. Endocr Pract. May-Jun 2001;7(3):202-20. [Medline]. [Full Text].

  7. Al-Brahim N, Asa SL. Papillary thyroid carcinoma: an overview. Arch Pathol Lab Med. Jul 2006;130(7):1057-62. [Medline].

  8. Albores-Saavedra J, Wu J. The many faces and mimics of papillary thyroid carcinoma. Endocr Pathol. 2006;17(1):1-18. [Medline].

  9. Arnaldi LA, Borra RC, Maciel RM, et al. Gene expression profiles reveal that DCN, DIO1, and DIO2 are underexpressed in benign and malignant thyroid tumors. Thyroid. Mar 2005;15(3):210-21. [Medline].

  10. Asa SL. My approach to oncocytic tumours of the thyroid. J Clin Pathol. Mar 2004;57(3):225-32. [Medline]. [Full Text].

  11. Baloch ZW, LiVolsi VA. Microcarcinoma of the thyroid. Adv Anat Pathol. Mar 2006;13(2):69-75. [Medline].

  12. Benvenga S. Update on thyroid cancer. Horm Metab Res. May 2008;40(5):323-8. [Medline].

  13. Burman KD. Micropapillary thyroid cancer: should we aspirate all nodules regardless of size?. J Clin Endocrinol Metab. Jun 2006;91(6):2043-6. [Medline].

  14. Chang SH, Joo M, Kim H. Fine needle aspiration biopsy of thyroid nodules in children and adolescents. J Korean Med Sci. Jun 2006;21(3):469-73. [Medline].

  15. Chao TC, Lin JD, Chen MF. Gasless video-assisted total thyroidectomy in the treatment of low risk intrathyroid papillary carcinoma. World J Surg. Sep 2004;28(9):876-9. [Medline].

  16. Clark JR, Lai P, Hall F, et al. Variables predicting distant metastases in thyroid cancer. Laryngoscope. Apr 2005;115(4):661-7. [Medline].

  17. Das DK. Age of patients with papillary thyroid carcinoma: is it a key factor in the development of variants?. Gerontology. May-Jun 2005;51(3):149-54. [Medline].

  18. Del Rio P, Cataldo S, Sommaruga L, et al. The association between papillary carcinoma and chronic lymphocytic thyroiditis: does it modify the prognosis of cancer?. Minerva Endocrinol. Mar 2008;33(1):1-5. [Medline].

  19. Dimov RS, Deenichin GP, Damianliev RA, et al. Safety and efficacy of modified radical lymph nodes dissection in patients with papillary thyroid cancer and clinically evident lymph nodes metastasis. Folia Med (Plovdiv). 2006;48(1):17-22. [Medline].

  20. Donckier JE, Michel L, Delos M, et al. Interrelated overexpression of endothelial and inducible nitric oxide synthases, endothelin-1 and angiogenic factors in human papillary thyroid carcinoma. Clin Endocrinol (Oxf). Jun 2006;64(6):703-10. [Medline].

  21. Fernandes JK, Day TA, Richardson MS, et al. Overview of the management of differentiated thyroid cancer. Curr Treat Options Oncol. Jan 2005;6(1):47-57. [Medline].

  22. Fraker DL, Skarulis M, Livolsi V. Thyroid tumors. In: DeVita VT Jr, Rosenberg SA, Hellman S, eds. Cancer: Principles and Practice of Oncology. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1997:1629-52.

  23. Furlan JC, Bedard YC, Rosen IB. Role of fine-needle aspiration biopsy and frozen section in the management of papillary thyroid carcinoma subtypes. World J Surg. Sep 2004;28(9):880-5. [Medline].

  24. Grebe SK, Hay ID. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am. Jan 1996;5(1):43-63. [Medline].

  25. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol. Jan 2005;12(1):81-9. [Medline].

  26. Hall P, Adami HO. Thyroid Cancer. In: Adami H, Hunter D, Trichopoulos D, eds. Textbook of Cancer Epidemiology. 2nd ed. New York, NY: Oxford University Press; 2008.

  27. Hay ID, Grant CS, Taylor WF, et al. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. Dec 1987;102(6):1088-95. [Medline].

  28. Hoang JK, Lee WK, Lee M, et al. US Features of thyroid malignancy: pearls and pitfalls. Radiographics. May-Jun 2007;27(3):847-60; discussion 861-5. [Medline].

  29. Hunt JL, Tometsko M, LiVolsi VA, et al. Molecular evidence of anaplastic transformation in coexisting well-differentiated and anaplastic carcinomas of the thyroid. Am J Surg Pathol. Dec 2003;27(12):1559-64. [Medline].

  30. Jukkola A, Bloigu R, Ebeling T, et al. Prognostic factors in differentiated thyroid carcinomas and their implications for current staging classifications. Endocr Relat Cancer. Sep 2004;11(3):571-9. [Medline]. [Full Text].

  31. Kakudo K, Tang W, Ito Y, et al. Papillary carcinoma of the thyroid in Japan: subclassification of common type and identification of low risk group. J Clin Pathol. Oct 2004;57(10):1041-6. [Medline].

  32. Kakudo K, Tang W, Ito Y, et al. Parathyroid invasion, nodal recurrence, and lung metastasis by papillary carcinoma of the thyroid. J Clin Pathol. Mar 2004;57(3):245-9. [Medline].

  33. Khairy GA. Solitary thyroid nodule: the risk of cancer and the extent of surgical therapy. East Afr Med J. Sep 2004;81(9):459-62. [Medline].

  34. Kim S, Wei JP, Braveman JM, et al. Predicting outcome and directing therapy for papillary thyroid carcinoma. Arch Surg. Apr 2004;139(4):390-4; discussion 393-4. [Medline].

  35. Kouvaraki MA, Lee JE, Shapiro SE, et al. Preventable reoperations for persistent and recurrent papillary thyroid carcinoma. Surgery. Dec 2004;136(6):1183-91. [Medline].

  36. Kumagai A, Namba H, Mitsutake N, et al. Childhood thyroid carcinoma with BRAFT1799A mutation shows unique pathological features of poor differentiation. Oncol Rep. Jul 2006;16(1):123-6. [Medline].

  37. Köybasioglu F, Simsek GG, Onal BU. Tall cell variant of papillary carcinoma arising from a thyroglossal cyst: report of a case with diagnosis by fine needle aspiration cytology. Acta Cytol. Mar-Apr 2006;50(2):221-4. [Medline].

  38. La Vecchia C, Ron E, Franceschi S, et al. A pooled analysis of case-control studies of thyroid cancer. III. Oralcontraceptives, menopausal replacement therapy and otherfemale hormones. Cancer Causes Control. 1999;10(2):157-166. [Medline].

  39. Lau WF, Zacharin MR, Waters K, et al. Management of paediatric thyroid carcinoma: recent experience with recombinant human thyroid stimulating hormone in preparation for radioiodine therapy. Intern Med J. Sep 2006;36(9):564-70. [Medline].

  40. Little JW. Thyroid disorders. Part III: neoplastic thyroid disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Sep 2006;102(3):275-80. [Medline].

  41. Liu J, Singh B, Tallini G, et al. Follicular variant of papillary thyroid carcinoma: a clinicopathologic study of a problematic entity. Cancer. Sep 15 2006;107(6):1255-64. [Medline].

  42. Lyshchik A, Drozd V, Demidchik Y, et al. Diagnosis of thyroid cancer in children: value of gray-scale and power doppler US. Radiology. May 2005;235(2):604-13. [Medline].

  43. Mackenzie EJ, Mortimer RH. 6: Thyroid nodules and thyroid cancer. Med J Aust. Mar 1 2004;180(5):242-7. [Medline].

  44. Matsumoto F, Fujii H, Abe M, et al. A novel tumor marker, Niban, is expressed in subsets of thyroid tumors and Hashimoto's thyroiditis. Hum Pathol. Dec 2006;37(12):1592-600. [Medline].

  45. Mazzaferri EL, Robbins RJ, Spencer CA, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. Apr 2003;88(4):1433-41. [Medline].

  46. Endocrine Malignancies. In: Kantarjian HM, Wolff RA, Koller CA, eds. MD Anderson Manual of Medical Oncology. New York, NY: McGraw Hill; 2006:819-54.

  47. Monchik JM, Donatini G, Iannuccilli J, et al. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg. Aug 2006;244(2):296-304. [Medline].

  48. Musholt TJ, Musholt PB, Khaladj N, et al. Prognostic significance of RET and NTRK1 rearrangements in sporadic papillary thyroid carcinoma. Surgery. Dec 2000;128(6):984-93. [Medline].

  49. Musholt TJ, Musholt PB, Petrich T, et al. Familial papillary thyroid carcinoma: genetics, criteria for diagnosis, clinical features, and surgical treatment. World J Surg. Nov 2000;24(11):1409-17. [Medline].

  50. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Thyroid carcinoma. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/PDF/thyroid.pdf. Accessed 05/26/2008.

  51. Ng CM, Choi CH, Tiu SC. False-negatives in thyroid nodule aspiration cytology. Hong Kong Med J. Apr 2007;13(2):168-9. [Medline].

  52. Nikiforova MN, Nikiforov YE. Molecular genetics of thyroid cancer: implications for diagnosis, treatment and prognosis. Expert Rev Mol Diagn. Jan 2008;8(1):83-95. [Medline].

  53. Ohmori N, Miyakawa M, Ohmori K, et al. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis. Intern Med. 2007;46(9):547-50. [Medline].

  54. Pang HN, Chen CM. Incidence of cancer in nodular goitres. Ann Acad Med Singapore. Apr 2007;36(4):241-3. [Medline].

  55. Port M, Boltze C, Wang Y, et al. A radiation-induced gene signature distinguishes post-Chernobyl from sporadic papillary thyroid cancers. Radiat Res. Dec 2007;168(6):639-49. [Medline].

  56. Ramirez R, Hsu D, Patel A, et al. Over-expression of hepatocyte growth factor/scatter factor (HGF/SF) and the HGF/SF receptor (cMET) are associated with a high risk of metastasis and recurrence for children and young adults with papillary thyroid carcinoma. Clin Endocrinol (Oxf). Nov 2000;53(5):635-44. [Medline].

  57. Richter H, Braselmann H, Hieber L, et al. Chromosomal imbalances in post-chernobyl thyroid tumors. Thyroid. Dec 2004;14(12):1061-4. [Medline].

  58. Riesco-Eizaguirre G, Gutierrez-Martinez P, Garca-Cabezas MA, et al. The oncogene BRAF V600E is associated with a high risk of recurrence and less differentiated papillary thyroid carcinoma due to the impairment of Na+/I- targeting to the membrane. Endocr Relat Cancer. Mar 2006;13(1):257-69. [Medline].

  59. Rios A, Rodriguez JM, Canteras M, et al. Risk factors for malignancy in multinodular goitres. Eur J Surg Oncol. Feb 2004;30(1):58-62. [Medline].

  60. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. Apr 2007;245(4):604-10. [Medline].

  61. Ron E, Schneider AB. Thyroid Cancer. In: Schottenfeld D, Fraumeni J, eds. Cancer Epidemiology and Prevention. 3rd ed. New York, NY: Oxford University Press; 2006:975-994.

  62. Rosario PW, Fagundes TA, Padrao EL, et al. Total thyroidectomy and lymph node dissection in patients with papillary thyroid carcinoma. Arch Surg. Dec 2004;139(12):1385. [Medline].

  63. Roth LM, Talerman A. The enigma of struma ovarii. Pathology. Feb 2007;39(1):139-46. [Medline].

  64. Ruggieri M, Straniero A, Pacini FM, et al. Video-assisted surgery of the thyroid diseases. Eur Rev Med Pharmacol Sci. Jul-Aug 2003;7(4):91-6. [Medline].

  65. Santacroce L, Luperto P, Fiorella ML, et al. [Carcinoma of unknown origin++ with latero-cervical metastasis. Diagnostic problems. Retrospective analysis of 110 cases of latero-cervical tumefaction]. Clin Ter. May-Jun 2000;151(3):199-201. [Medline].

  66. Scheumann GF, Seeliger H, Musholt TJ, et al. Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma. Eur J Surg. Sep 1996;162(9):677-84. [Medline].

  67. Schlumberger M, Pacini F, Wiersinga WM, et al. Follow-up and management of differentiated thyroid carcinoma: a European perspective in clinical practice. Eur J Endocrinol. Nov 2004;151(5):539-48. [Medline].

  68. Shaha AR. Prognostic factors in papillary thyroid carcinoma and implications of large nodal metastasis. Surgery. Feb 2004;135(2):237-9. [Medline].

  69. Sherman SI, Wirth LJ, Droz JP, Hofmann M, Bastholt L, Martins RG, et al. Motesanib diphosphate in progressive differentiated thyroid cancer. N Engl J Med. Jul 3 2008;359(1):31-42. [Medline].

  70. Shimura H, Haraguchi K, Hiejima Y, et al. Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: a multicenter study. Thyroid. Mar 2005;15(3):251-8. [Medline].

  71. Stephens LA, Powell NG, Grubb J, et al. Investigation of loss of heterozygosity and SNP frequencies in the RET gene in papillary thyroid carcinoma. Thyroid. Feb 2005;15(2):100-4. [Medline].

  72. Sugitani I, Fujimoto Y, Yamamoto N. Papillary thyroid carcinoma with distant metastases: survival predictors and the importance of local control. Surgery. Jan 2008;143(1):35-42. [Medline].

  73. Sugitani I, Kasai N, Fujimoto Y, et al. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery. Feb 2004;135(2):139-48. [Medline].

  74. Uruno T, Miyauchi A, Shimizu K, et al. Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg. Apr 2005;29(4):483-5. [Medline].

  75. Wartofsky L, Sherman SI, Gopal J, et al. The use of radioactive iodine in patients with papillary and follicular thyroid cancer. J Clin Endocrinol Metab. Dec 1998;83(12):4195-203. [Medline].

  76. Wasenius VM, Hemmer S, Karjalainen-Lindsberg ML, et al. MET receptor tyrosine kinase sequence alterations in differentiated thyroid carcinoma. Am J Surg Pathol. Apr 2005;29(4):544-9. [Medline].

  77. Williams ED, Abrosimov A, Bogdanova T, et al. Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness. Br J Cancer. Jun 1 2004;90(11):2219-24. [Medline].

  78. Woodrum DT, Gauger PG. Role of 131I in the treatment of well differentiated thyroid cancer. J Surg Oncol. Mar 1 2005;89(3):114-21. [Medline].

  79. Wreesmann VB, Ghossein RA, Hezel M, et al. Follicular variant of papillary thyroid carcinoma: genome-wide appraisal of a controversial entity. Genes Chromosomes Cancer. Aug 2004;40(4):355-64. [Medline].

  80. Zhu RS, Yu YL, Lu HK, et al. Clinical study of 312 cases with matastatic differentiated thyroid cancer treated with large doses of 131I. Chin Med J (Engl). Mar 5 2005;118(5):425-8. [Medline].

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Further Reading

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Keywords

papillary thyroid carcinoma, papillary carcinoma, thyroid cancer, thyroid carcinoma, papillary/follicular carcinoma, papillary-follicular carcinoma, papillary cancer of the thyroid, follicular cancer of the thyroid, irradiation, radiation therapy, radiation exposure, ionizing radiation, radiotherapy, thyroid mass, thyroid nodule, thyroid lump, iodine deficiency, familial adenomatous polyposis, Gardner syndrome, Gardner's syndrome, Cowden disease, Cowden's disease, thyroid disease, thyroid disorders

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Contributor Information and Disclosures

Author

Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Silvia Gagliardi, MD, Consulting Staff, Department of Surgery, Medical Center Vita, Italy
Disclosure: Nothing to disclose.

Andrew Scott Kennedy, MD, Co-Medical Director, Wake Radiology Oncology
Andrew Scott Kennedy, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Hepato-Pancreato-Biliary Association, American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting

 
 
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