Papillary thyroid cancer

Papillary thyroid carcinoma is usually discovered on routine examination as an asymptomatic thyroid nodule that appears as a neck mass. In some instances, the mass may have produced local symptoms. This mass is normally referred to a fine needle aspiration biopsy (FNA) for investigation. FNA accuracy is very high and it is a process widely used in these cases. Other investigation methods include ultrasound imaging and nuclear scan. The ultrasound is a useful test to distinguish solid from cystic lesions and to identify calcifications.{{cite journal | vauthors = Al-Brahim N, Asa SL | title = Papillary thyroid carcinoma: an overview | journal = Archives of Pathology & Laboratory Medicine | volume = 130 | issue = 7 | pages = 1057–1062 | date = July 2006 | pmid = 16831036 | doi = 10.5858/2006-130-1057-PTCAO }} The thyroid ultrasound is also very effective to discover microcarcinomas, which refer to very small carcinomas (<1 cm).

Papillary thyroid carcinomas are also discovered when a hard nodule is found in multinodular goiter, when enlarged cervical lymph nodes are detected, or when there are unidentified metastatic lesions elsewhere in the body. Expanding lesions found in the thyroid gland, especially if they are painful, should be examined as they may indicate the presence of papillary thyroid carcinoma. Other clinical signs that could indicate papillary thyroid are fixation to the trachea, a firm neck mass, damage to recurrent laryngeal or cervical sympathetic nerves. Five percent of the population can have thyroid nodules, and the majority will be benign.Surgical Recall 7th Edition {{ISBN|978-1451192919}}{{page needed|date=November 2021}}

Appropriate workup includes an ultrasound of the neck, followed by lab studies. Patients will usually meet with both an endocrinologist and a surgeon (head and neck surgeon or endocrine surgeon).

Thyroglobulin can be used as a tumor marker for well-differentiated papillary thyroid cancer.{{cite journal | vauthors = Lin JD | title = Thyroglobulin and human thyroid cancer | journal = Clinica Chimica Acta; International Journal of Clinical Chemistry | volume = 388 | issue = 1–2 | pages = 15–21 | date = February 2008 | pmid = 18060877 | doi = 10.1016/j.cca.2007.11.002 }}{{cite journal | vauthors = Tuttle RM, Leboeuf R, Martorella AJ | title = Papillary thyroid cancer: monitoring and therapy | journal = Endocrinology and Metabolism Clinics of North America | volume = 36 | issue = 3 | pages = 753–78, vii | date = September 2007 | pmid = 17673127 | doi = 10.1016/j.ecl.2007.04.004 }} HBME-1 staining may be useful for differentiating papillary carcinomas from follicular carcinomas; in papillary lesions it tends to be positive.{{cite journal | vauthors = Papotti M, Rodriguez J, De Pompa R, Bartolazzi A, Rosai J | title = Galectin-3 and HBME-1 expression in well-differentiated thyroid tumors with follicular architecture of uncertain malignant potential | journal = Modern Pathology | volume = 18 | issue = 4 | pages = 541–546 | date = April 2005 | pmid = 15529186 | doi = 10.1038/modpathol.3800321 | doi-access = free }}

Reduced expression of ATP5E is significantly associated with the diagnosis of papillary thyroid cancer and may serve as an early tumor marker of the disease.{{cite journal | vauthors = Hurtado-López LM, Fernández-Ramírez F, Martínez-Peñafiel E, Carrillo Ruiz JD, Herrera González NE | title = Molecular Analysis by Gene Expression of Mitochondrial ATPase Subunits in Papillary Thyroid Cancer: Is ATP5E Transcript a Possible Early Tumor Marker? | journal = Medical Science Monitor | volume = 21 | pages = 1745–1751 | date = June 2015 | pmid = 26079849 | pmc = 4482184 | doi = 10.12659/MSM.893597 }} Serum microRNAs have shown good diagnostic performance for distinguishing patients with papillary thyroid cancer from patients with benign thyroid nodules and healthy controls, and are suggested as novel and minimally invasive diagnostic approach in clinical practice.{{Cite journal |last1=Chen |first1=Yuping |last2=Dong |first2=Bingtian |last3=Huang |first3=Lichun |last4=Huang |first4=Huibin |date=2022-06-10 |title=Serum microRNAs as biomarkers for the diagnosis of papillary thyroid carcinoma: a meta-analysis |journal=Bosnian Journal of Basic Medical Sciences |volume=22 |issue=6 |pages=862–871 |language=en |doi=10.17305/bjbms.2022.7343 |pmid=35678022 |pmc=9589316 |issn=1840-4812|doi-access=free }}

{{Anchor|Lateral aberrant thyroid}}

File:Papillary Carcinoma of the Thyroid Gland, Gross Appearance (22780603300).jpg

File:Papillary_Carcinoma_of_the_Thyroid.jpg

Papillary thyroid cancer gets its name from the papillae among its cells, visible on microscopy. Features include:

• Characteristic Orphan Annie eye nuclear clearings (nuclei with uniform staining, which appear empty due to powdery chromatin and marginal micronucleoli){{cite web|url=http://esynopsis.uchc.edu/eAtlas/Endo/1802.htm|title=Papillary Carcinoma of Thyroid (Hi Pow)|publisher=University of Connecticut Health Center|access-date=2008-09-14|url-status=dead|archive-url=https://archive.today/20120709024633/http://esynopsis.uchc.edu/eAtlas/Endo/1802.htm|archive-date=2012-07-09}} and psammoma bodies on light microscopy. The former is useful in identifying the follicular variant of papillary thyroid carcinomas.{{cite journal | vauthors = Yang GC, Liebeskind D, Messina AV | title = Ultrasound-guided fine-needle aspiration of the thyroid assessed by Ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to six-year follow-up | journal = Thyroid | volume = 11 | issue = 6 | pages = 581–589 | date = June 2001 | pmid = 11442006 | doi = 10.1089/105072501750302895 }}
• Lymphatic spread is more common than hematogenous spread
• Multifocality is common
• The so-called lateral aberrant thyroid is usually a lymph node metastasis from a papillary thyroid carcinoma.{{cite journal | vauthors = Escofet X, Khan AZ, Mazarani W, Woods WG | title = Lessons to be learned: a case study approach. Lateral aberrant thyroid tissue: is it always malignant? | journal = The Journal of the Royal Society for the Promotion of Health | volume = 127 | issue = 1 | pages = 45–46 | date = January 2007 | pmid = 17319317 | doi = 10.1177/1466424007073207 | s2cid = 33217834 }}
• Papillary microcarcinoma is a subset of papillary thyroid cancer defined as measuring less than or equal to 1 cm.{{cite journal | vauthors = Shaha AR | title = TNM classification of thyroid carcinoma | journal = World Journal of Surgery | volume = 31 | issue = 5 | pages = 879–887 | date = May 2007 | pmid = 17308849 | doi = 10.1007/s00268-006-0864-0 | s2cid = 23121159 }} The highest incidence of papillary thyroid microcarcinoma in an autopsy series was reported by Harach et al. in 1985, who found 36 of 101 consecutive autopsies to have an incidental microcarcinoma.{{cite journal | vauthors = Harach HR, Franssila KO, Wasenius VM | title = Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study | journal = Cancer | volume = 56 | issue = 3 | pages = 531–538 | date = August 1985 | pmid = 2408737 | doi = 10.1002/1097-0142(19850801)56:3<531::AID-CNCR2820560321>3.0.CO;2-3 | s2cid = 23922855 | doi-access = free }} Michael Pakdaman et al. report the highest incidence in a retrospective surgical series at 49.9 percent of 860 cases.{{cite journal | vauthors = Pakdaman MN, Rochon L, Gologan O, Tamilia M, Garfield N, Hier MP, Black MJ, Payne RJ | display-authors = 6 | title = Incidence and histopathological behavior of papillary microcarcinomas: study of 429 cases | journal = Otolaryngology–Head and Neck Surgery | volume = 139 | issue = 5 | pages = 718–722 | date = November 2008 | pmid = 18984270 | doi = 10.1016/j.otohns.2008.08.014 | s2cid = 5937993 }} Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having cancer. It was Woolner et al. who first arbitrarily coined the term "occult papillary carcinoma" in 1960, to describe papillary carcinomas ≤ 1.5 cm in diameter.{{cite journal | vauthors = Woolner LB, Lemmon ML, Beahrs OH, Black BM, Keating FR | title = Occult papillary carcinoma of the thyroid gland: a study of 140 cases observed in a 30-year period | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 20 | issue = 1 | pages = 89–105 | date = January 1960 | pmid = 13845950 | doi = 10.1210/jcem-20-1-89 }}

Several variants are recognized, although classic papillary thyroid carcinoma is the most frequent: microscopic-follicular variant, diffuse-sclerosing variant, tall-cell variant, columnar-cell variant, hobnail variant, and others. The encapsulated-follicular variant, specifically when noninvasive, has been newly reclassified as the noninvasive follicular thyroid neoplasm with papillary-like nuclear features.{{cite journal | vauthors = Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LD, Barletta JA, Wenig BM, Al Ghuzlan A, Kakudo K, Giordano TJ, Alves VA, Khanafshar E, Asa SL, El-Naggar AK, Gooding WE, Hodak SP, Lloyd RV, Maytal G, Mete O, Nikiforova MN, Nosé V, Papotti M, Poller DN, Sadow PM, Tischler AS, Tuttle RM, Wall KB, LiVolsi VA, Randolph GW, Ghossein RA | display-authors = 6 | title = Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors | journal = JAMA Oncology | volume = 2 | issue = 8 | pages = 1023–1029 | date = August 2016 | pmid = 27078145 | pmc = 5539411 | doi = 10.1001/jamaoncol.2016.0386 }}

Although papillary carcinoma has a propensity to invade lymphatics, it is less likely to invade blood vessels.{{EMedicine|article|282276|Papillary Thyroid Carcinoma}}

These kinds of tumors are most commonly unencapsulated, and they have a high tendency to metastasize locally to lymph nodes, which may produce cystic structures near the thyroid that are difficult to diagnose because of the paucity of malignant tissue.{{cite web|url=http://www.thyroidmanager.org/Chapter18/18-cause.htm|title=The Thyroid and its Diseases|access-date=2010-07-15|url-status=dead|archive-url=https://web.archive.org/web/20100701070003/http://www.thyroidmanager.org/Chapter18/18-cause.htm|archive-date=2010-07-01}}{{cite journal | vauthors = Grani G, Fumarola A | title = Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 99 | issue = 6 | pages = 1970–1982 | date = June 2014 | pmid = 24617715 | doi = 10.1210/jc.2014-1098 | doi-access = free }} Furthermore, papillary tumors may metastasize to the lungs and produce a few nodules or the lung fields may exhibit a snowflake appearance throughout.

Other characteristics of the papillary carcinoma is that E.M. shows increased mitochondria, increased RER, as well as increased apical microvilli. Moreover, papillary carcinomas have an indolent growth, and 40 percent of cases spread out of the capsule.{{cite web|url=http://www.pathology.vcu.edu/education/endocrine/endocrine/newthyroid/ |title=Papillary Carcinomas |access-date=2010-07-15 |url-status=dead |archive-url=https://web.archive.org/web/20100419064201/http://www.pathology.vcu.edu/education/endocrine/endocrine/newthyroid/ |archive-date=April 19, 2010 }}

Image:Thyroid papillary carcinoma histopatholgy (1).jpg|Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores. H&E stain.

Image:Thyroid papillary carcinoma histopathology (2).jpg|Micrograph showing that the papillae in papillary thyroid carcinoma are composed of cuboidal cells. H&E stain.

File:Nuclear grooves.jpg|Nuclear grooves (arrows indicate one of them)

File:Histopathology of papillary thyroid cancer in a thyroglossal cyst, high magnification, annotated.jpg|Nuclear pseudoinclusions, which are invaginations of cytoplasm into the nucleus.{{cite journal | vauthors = Ip YT, Dias Filho MA, Chan JK | title = Nuclear inclusions and pseudoinclusions: friends or foes of the surgical pathologist? | journal = International Journal of Surgical Pathology | volume = 18 | issue = 6 | pages = 465–481 | date = December 2010 | pmid = 21081532 | doi = 10.1177/1066896910385342 | s2cid = 22429137 }}

Image:Thyroid papillary carcinoma histopathology (3).jpg|Micrograph (high power view) showing nuclear changes in papillary thyroid carcinoma (PTC), which include groove formation, optical clearing, eosinophilic inclusions and overlapping of nuclei. H&E stain.

Image:Thyroid papillary carcinoma histopathology (4).jpg|Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei. H&E stain.

Image:Lymph_node_with_papillary_thyroid_carcinoma.jpg|Micrograph of metastatic papillary thyroid carcinoma to a lymph node. H&E stain.

Image:Papillary_thyroid_carcinoma_tall_cell_var_high_mag.jpg|Micrograph of papillary thyroid carcinoma, tall cell variant - high magnification. H&E stain.

Image:Papillary_thyroid_carcinoma_tall_cell_var_intermed_mag.jpg|Micrograph of papillary thyroid carcinoma, tall cell variant - intermediate magnification. H&E stain.

Mutations associated with papillary thyroid cancer are mainly two forms of chromosomal translocation and one form of point mutation. These alterations lead to activation of a common carcinogenic pathway—the MAPK/ERK pathway.

Chromosomal translocations involving the RET proto-oncogene (encoding a tyrosine kinase receptor that plays essential roles in the development of neuroendocrine cells) located on chromosome 10q11 occur in approximately a fifth of papillary thyroid cancers. The fusion oncoproteins generated are termed RET/PTC proteins (ret/papillary thyroid carcinoma), and constitutively activate RET and the downstream MAPK/ERK pathway. The frequency of ret/PTC translocations is significantly higher in papillary cancers arising in children and after radiation exposure. The gene NTRK1 (encoding the TrkA receptor), located on chromosome 1q, is similarly translocated in approximately 5 percent to 10 percent of papillary thyroid cancers.

Approximately a third to a half of papillary thyroid carcinomas harbor point mutations in the BRAF oncogene, also activating the MAPK/ERK pathway. In those cases the BRAF mutations found were V600E mutation. After performing a multivariate analysis, it was found that the absence of tumor capsule was the only parameter associated (P=0.0005) with BRAF V600E mutation. According to recent studies, papillary cancers carrying the common V600E mutation tend to have a more aggressive long-term course. BRAF mutations are frequent in papillary carcinoma and in undifferentiated cancers that have developed from papillary tumors.

Many more changes in gene expression are currently being investigated. Previous studies demonstrated the dysregulation of different microRNAs in thyroid cancer. For example, downregulation of miR-369-3p and consequent upregulation of its target TSPAN13 appear to be involved in the pathophysiology of PTC.{{cite journal | vauthors = Li P, Dong M, Wang Z | title = Downregulation of TSPAN13 by miR-369-3p inhibits cell proliferation in papillary thyroid cancer (PTC) | journal = Bosnian Journal of Basic Medical Sciences | volume = 19 | issue = 2 | pages = 146–154 | date = May 2019 | pmid = 30114378 | pmc = 6535391 | doi = 10.17305/bjbms.2018.2865 }}

Mitochondrial mutations: MtDNA(mitochondrial) haplogroups, characterized by unique sets of non pathological mtDNA polymorphisms can modulate the pathogenesis of different diseases in specific populations because of its influence on the expression of genes related to ROS production and OXPHOS coupling efficiency and the regulation of apoptosis.{{cite journal | vauthors = Bai RK, Leal SM, Covarrubias D, Liu A, Wong LJ | title = Mitochondrial genetic background modifies breast cancer risk | journal = Cancer Research | volume = 67 | issue = 10 | pages = 4687–4694 | date = May 2007 | pmid = 17510395 | doi = 10.1158/0008-5472.CAN-06-3554 | doi-access = free }} In Asian populations, haplogroup D4a is associated with an increased risk of thyroid cancer{{cite journal | vauthors = Fang H, Shen L, Chen T, He J, Ding Z, Wei J, Qu J, Chen G, Lu J, Bai Y | display-authors = 6 | title = Cancer type-specific modulation of mitochondrial haplogroups in breast, colorectal and thyroid cancer | journal = BMC Cancer | volume = 10 | issue = 1 | pages = 421 | date = August 2010 | pmid = 20704735 | pmc = 2933623 | doi = 10.1186/1471-2407-10-421 | doi-access = free }} while in European populations, Haplogroup K is considered to be protective of Thyroid cancer.{{cite journal | vauthors = Cocoş R, Schipor S, Badiu C, Raicu F | title = Mitochondrial DNA haplogroup K as a contributor to protection against thyroid cancer in a population from southeast Europe | journal = Mitochondrion | volume = 39 | pages = 43–50 | date = March 2018 | pmid = 28851673 | doi = 10.1016/j.mito.2017.08.012 }}

Surgery remains the mainstay of treatment for papillary thyroid cancer. The Revised 2009 American Thyroid Association guidelines for papillary thyroid cancer state that the initial procedure should be near-total or total thyroidectomy. Thyroid lobectomy alone may be sufficient treatment for small (<1 cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of prior head and neck irradiation or radiologically or clinically involved cervical nodal metastasis.{{cite journal | vauthors = Cooper DS, Doherty GM, Haugen BR, Hauger BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM | display-authors = 6 | title = Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer | journal = Thyroid | volume = 19 | issue = 11 | pages = 1167–1214 | date = November 2009 | pmid = 19860577 | doi = 10.1089/thy.2009.0110 | hdl-access = free | hdl = 2027.42/78131 }}

• Minimal disease (diameter up to 1.0 centimeters) - hemithyroidectomy (or unilateral lobectomy) and isthmectomy may be sufficient. There is some discussion whether this is still preferable over total thyroidectomy for this group of patients.
• Gross disease (diameter over 1.0 centimeters) - total thyroidectomy, and central compartment lymph node removal is the therapy of choice. Additional lateral neck nodes can be removed at the same time if an ultrasound guided FNA and thyroglobulin TG cancer washing was positive on the pre-operative neck node ultrasound evaluation.

Arguments for total thyroidectomy are:{{cite journal | vauthors = Udelsman R, Shaha AR | title = Is total thyroidectomy the best possible surgical management for well-differentiated thyroid cancer? | journal = The Lancet. Oncology | volume = 6 | issue = 7 | pages = 529–531 | date = July 2005 | pmid = 15992702 | doi = 10.1016/S1470-2045(05)70247-3 }}

• Reduced risk of recurrence, if central compartment nodes are removed at the original surgery.
• 30-85% of papillary carcinoma is multifocal disease. Hemithyroidectomy may leave disease in the other lobe. However, multifocal disease in the remnant lobe may not necessarily become clinically significant or serve as a detriment to patient survival.
• Ease of monitoring with thyroglobulin (sensitivity for picking up recurrence is increased in presence of total thyroidectomy, and ablation of the remnant normal thyroid by low dose radioiodine 131 after following a low iodine diet (LID).
• Ease of detection of metastatic disease by thyroid and neck node ultrasound.
• Post-operative complications at high-volume thyroid surgery centers with experienced surgeons are comparable to that of hemithyroidectomy.

Arguments for hemithyroidectomy:

• Most patients have low-risk cancer with an excellent prognosis, with similar survival outcomes in low-risk patients who undergo total thyroidectomy versus hemithyroidectomy.
• Less likelihood of patient requiring lifelong thyroid hormone replacement after surgery.

Thyroid total body scans are less reliable at finding recurrence than TG and ultrasound.

Papillary tumors tend to be more aggressive in patients over age 45. In such cases, it might be required to perform a more extensive resection including portions of the trachea. Also, the sternocleidomastoid muscle, jugular vein, and accessory nerve are to be removed if such procedure allows apparently complete tumor resection. If a significant amount of residual tumor is left in the neck, external radiotherapy has been indicated and has proven useful especially in those cases when the residual tumor does not take up radioiodine.

After surgical thyroid removal, the patient waits around 4–6 weeks to then have radioiodine therapy. This therapy is intended to both detect and destroy any metastasis and residual tissue in the thyroid. The treatment may be repeated 6–12 months after initial treatment of metastatic disease where disease recurs or has not fully responded.{{EMedicine|article|282276|Papillary Thyroid Carcinoma|treatment}}

Patients are administered hormone replacement levothyroxine for life after surgery, especially after total thyroidectomy. Chemotherapy with cisplatin or doxorubicin has proven limited efficacy, however, it could be helpful for patients with bone metastases to improve their quality of life. Patients are also prescribed levothyroxine and radioiodine after surgery. Levothyroxine influences growth and maturation of tissues and it is involved in normal growth, metabolism, and development. In case of metastases, patients are prescribed antineoplastic agents which inhibit cell growth and proliferation and help in palliating symptoms in progressive disease.

After successful treatment, 35 percent of the patients may experience a recurrence within a 40-year span. Also, patients may experience a high incidence of nodule metastasis, with 35 percent cases of cervical node metastases. Approximately 20 percent of patients will develop multiple tumors within the thyroid gland.{{cite web|url=http://www.bcm.edu/oto/grand/12_04_03.htm |title=Papillary Thyroid Carcinoma |access-date=2010-07-15 |url-status=dead |archive-url=https://web.archive.org/web/20080719085620/http://www.bcm.edu/oto/grand/12_04_03.htm |archive-date=July 19, 2008 }}

There is ongoing discussion regarding the best management regarding the optimal surgical procedure for papillary thyroid cancer. Prognosis of patients with papillary thyroid cancer is found to be dependent on the patient's age, the size of the tumor, presence of metastatic disease, and the presence of tumor invasion into adjacent tissues near the thyroid gland. Recent studies have examined a more conservative approach to surgery and have demonstrated that hemithyroidectomy may be acceptable for patients with low-risk papillary thyroid cancer with tumor size 1 cm to 4 cm with no presence of invasion to tissues surrounding the thyroid or metastasis. Studies examining large databases of patients with papillary thyroid cancer have concluded that there is no survival advantage for patients with stage I papillary thyroid cancer size 1–4 cm receiving total thyroidectomy versus hemithyroidectomy.{{cite journal | vauthors = Adam MA, Pura J, Goffredo P, Dinan MA, Hyslop T, Reed SD, Scheri RP, Roman SA, Sosa JA | display-authors = 6 | title = Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 100 | issue = 1 | pages = 115–121 | date = January 2015 | pmid = 25337927 | pmc = 5399499 | doi = 10.1210/jc.2014-3039 }} In light of this data, choosing the optimal course of surgical and medical management of papillary thyroid cancer should involve shared decision making from patient, endocrinologists, and surgeons.

Depending on source, the overall 5-year survival rate for papillary thyroid cancer is 96 percentNumbers from National Cancer Database in the US, from [https://books.google.com/books?id=u1aFpF-EcgwC&pg=PA10 Page 10] in: {{cite book |editor=Biersack, H-J |editor2= Grünwald, F|title=Thyroid Cancer |publisher=Springer |location=Berlin |year=2005 |isbn=978-3-540-22309-2 }} (Note: Book also states that the 14 percent 10-year survival for anaplastic thyroid cancer was overestimated) or 97 percent, with a 10-year survival rate of 93 percent.

For a more specific prognosis for individual cases, there are at minimum 13 known scoring systems for prognosis; among the more often used are:

• AGES - Age, Grade, Extent of disease, Size
• AMES - Age, Metastasis, Extent of disease, Size
• MACIS - Metastasis, Age at presentation, Completeness of surgical resection, Invasion (extrathyroidal), Size{{cite web |url=http://cpmcnet.columbia.edu/dept/thyroid/staging.html |title=New York Thyroid Center: Prognosis Staging for Thyroid Cancer |access-date=2007-12-22 |url-status=dead |archive-url=https://web.archive.org/web/20071214064614/http://cpmcnet.columbia.edu/dept/thyroid/staging.html |archive-date=2007-12-14 }} (this is a modification of the AGES system). It is probably the most reliable staging method available. Also known as the MAICS system.
• TNM staging - Tumor, node, metastasis. Remarkable about the TNM staging for (differentiated) thyroid carcinoma is that the scoring is different according to age.

The MACIS system of estimating the prognosis of papillary thyroid cancer was developed by Clive S. Grant at the Mayo Clinic and was based on careful evaluation of a large group of patients. It is probably the most reliable staging method available.[https://web.archive.org/web/20050301145044/http://www.cumc.columbia.edu/dept/thyroid/staging.html New York Thyroid Center > Thyroid cancer > Prognosis staging] Retrieved on April 30, 2010

It assigns scores to the main factors involved and uses the sum of this score to calculate the prognosis:

Most patients fall into the low-risk category (MACIS score less than 6.0) and are cured of the cancer at the time of surgery.

Children with multiple lung metastases and/or a miliary aspect still have an excellent long-term prognosis if given adequate treatment.{{cite journal | vauthors = Vermeer-Mens JC, Goemaere NN, Kuenen-Boumeester V, de Muinck Keizer-Schrama SM, Zwaan CM, Devos AS, de Krijger RR | title = Childhood papillary thyroid carcinoma with miliary pulmonary metastases | journal = Journal of Clinical Oncology | volume = 24 | issue = 36 | pages = 5788–5789 | date = December 2006 | pmid = 17179115 | doi = 10.1200/JCO.2006.08.8732 }}

Based on overall cancer staging into stages I to IV, papillary thyroid cancer has a 5-year survival rate of 100 percent for stages I and II, 93 percent for stage III and 51 percent for stage IV.[http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-survival-rates cancer.org > Thyroid Cancer] By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).

File:Thyroglossal cyst with papillary thyroid cancer (annotated).jpg is a rare occurrence (less than 1% of such cysts).{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidthyroglossal.html|title=Thyroid & parathyroid - Congenital / metabolic anomalies - Thyroglossal duct cyst|author=Andrey Bychkov, M.D., Ph.D.|website=PathologyOutlines}} Topic Completed: 14 March 2016. Minor changes: 27 January 2021.]]

According to Surveillance, Epidemiology, and End Results (SEER), the incidence of papillary cancer has increased from 4.8 to 14.9 per 100,000 from 1975 to 2012. Females are more likely to get papillary cancer when compared to males with incidence ratio of 2.5 to 1 where most of the cancers are diagnosed between 40 and 50 years old in females. However, death rates from papillary cancer remains static from 2003 to 2012 at 0.5 per 100,000 men and women. There was an increased incidence of papillary cancer from 1910 to 1960 due to the use of ionising radiation in treating childhood head and neck cancers.{{cite web| vauthors = Tuttle RM, Ross DS, Mulder JE |title=Papillary thyroid cancer|url=https://www.uptodate.com/contents/papillary-thyroid-cancer?source=history_widget|publisher=UpToDate|access-date=13 October 2017}} The incidence decreased after radiation therapy was abandoned. Environmental exposures to radiation such as atomic bombings of Hiroshima and Nagasaki and Chernobyl disaster also causes an increase in childhood papillary thyroid cancer at 5 to 20 years after the exposure to radiation.{{cite journal | vauthors = Vaisman F, Corbo R, Vaisman M | title = Thyroid carcinoma in children and adolescents-systematic review of the literature | journal = Journal of Thyroid Research | volume = 2011 | pages = 845362 | date = 2011 | pmid = 21904689 | pmc = 3166725 | doi = 10.4061/2011/845362 | doi-access = free }} Family history of thyroid cancer syndrome such as familial adenomatous polyposis, Carney complex, Multiple endocrine neoplasia type 2 (MEN-2), Werner syndrome, and Cowden syndrome increases the risk of getting papillary cancer.

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{{Reflist}}

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|C|73||c|73}}

| ICD9 = {{ICD9|193}}

| ICDO = {{ICDO|8260|3}}

| OMIM = 603744

| MedlinePlus = 000331

| eMedicineSubj = med

| eMedicineTopic = 2464

| MeshID = D013964

}}

• [https://www.dmoz.org//Health/Conditions_and_Diseases/Cancer/Endocrine/Thyroid/ Thyroid cancer at DMOZ]
• [http://www.cancernetwork.com/cancer-management/thyroid-and-parathyroid-cancers Cancer Management Handbook: Thyroid and Parathyroid Cancers]
• {{cite journal | vauthors = Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L | display-authors = 6 | title = 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer | journal = Thyroid | volume = 26 | issue = 1 | pages = 1–133 | date = January 2016 | pmid = 26462967 | pmc = 4739132 | doi = 10.1089/thy.2015.0020 }}

{{Endocrine gland neoplasia}}

Category:Thyroid cancer