Wang T.S., Evans D.B. (Eds.) Medullary Thyroid Cancer

Springer International Publishing, 2016. — 205 p. — ISBN: 978-3-319-39410-7, 978-3-319-39412-1.Medullary thyroid cancer (MTC) is a unique form of thyroid cancer and distinct from the more common differentiated variants (papillary and follicular). As a neuroendocrine tumor, MTC is derived from the parafollicular cells, or C cells, of the thyroid; the secretion of calcitonin and carcinoembryonic antigen (CEA) enables these serum peptides to be utilized as pre- and postoperative tumor markers, which correlate with the extent of disease and tumor burden. This is in contrast to papillary and follicular thyroid cancer where the use of thyroglobulin as a measure of disease extent is much less sensitive and specific. Serum levels of calcitonin and CEA can be utilized to guide the extent of preoperative imaging, the results of which influence the extent of initial surgery. MTC which is localized to the neck remains largely a surgical disease as there is no effective adjuvant therapy currently available to minimize disease recurrence. In addition, while the majority of patients have sporadic disease, approximately one-fourth of patients with newly diagnosed MTC will have an inherited form, secondary to multiple endocrine neoplasia (MEN) type 2A or 2B, or the related syndrome of familial MTC.These unique biologic features can make the management of patients with MTC quite challenging and require the multidisciplinary expertise of internists, pediatricians, endocrinologists, genetic counselors, medical oncologists, pathologists, and thyroid surgeons. This text is not meant to replace the current American Thyroid Association guidelines, last published in 2015, which serves as the point of reference for the management of patients with MTC; but rather, we hope to provide a more in-depth discussion of some of the clinical challenges which physicians and patients face.History and Epidemiology
Initial Evaluation and Diagnosis of Medullary Thyroid Carcinoma
The Physiology of Serum Calcitonin and Carcinoembryonic Antigen in Medullary Thyroid Cancer
Cytology and Pathology: Pitfalls and Challenges
Molecular Mechanisms of Disease: The RET Proto-oncogene
Genetic Evaluation of the Patient with Medullary Thyroid Cancer
Preoperative Evaluation of the Patient with Medullary Thyroid Cancer
Inherited Medullary Thyroid Carcinoma: Indications and Technique of Early Thyroidectomy
Surgical Management of Inherited MTC: Therapeutic Thyroidectomy
Surgical Management of Parathyroid and Adrenal Glands in Inherited Medullary Thyroid Carcinoma
Surgical Management of Sporadic Medullary Thyroid Cancer (Extent of Thyroid Resection and the Role of Central and Lateral Neck Dissection)
Surgical Management of Invasive Medullary Thyroid Carcinoma
Importance of Thyroid Hormone Replacement Therapy in Patients with Medullary Thyroid Cancer
Medullary Thyroid Cancer: The Role of External Beam Therapy
Management of Patients with Metastatic Medullary Thyroid Carcinoma: The Role for Systemic Therapy
Ablative Therapies of the Liver and Bone in Medullary Thyroid Cancer
Emerging Therapies for Progressive Metastatic Medullary Thyroid Cancer
Follow-Up and Surveillance of Patients with Medullary Thyroid Carcinoma
Surgical Management of Recurrent Medullary Thyroid Cancer