Cancer of the thyroid represents less than 0.5% of all malignant neoplasms in adults in England and Wales. In 1999 age-standardised (Europe) incidence rates were 2.3 per 100,000 per year in women and 0.9 per 100,000 in men. The incidence in England and Wales increased by about 10% every 5 years in both sexes and mortality declined by 8% for men and 17% for women during the period 1971-1995. In 1990 there were almost 900 new cases of thyroid cancer in the UK. Annually there are about 250 deaths from thyroid cancer in England and Wales. Its incidence is increasing world-wide. It is the commonest endocrine neoplasm and is responsible for about 64% of deaths from endocrine cancers, excluding ovarian carcinoma. It can affect all ages but the highest incidence occurs at between 20 and 54 years.
Differentiated thyroid cancer is the most common form of thyroid cancer. It is highly curable. The overall survival rate for middle-aged adults with differentiated thyroid carcinomas ranges from 80% to 95%.
The management of differentiated thyroid cancer remains controversial. Large randomised controlled studies have not been possible because of the high cure rate, long natural history and rarity of this tumour. Improvements in treatment have mostly been dependent on information from large retrospective studies. The evidence is therefore at (Agency for Health Care Policy and Research) levels 2 and 3. Areas of controversy include: the extent of initial thyroidectomy; the need for routine radioiodine ablation; the radioiodine doses for scans, ablation and treatment; staging and risk categorisation; the use of recombinant human thyroid-stimulating hormone (TSH); the management of rising thyroglobulin and a negative radioiodine scan; and the role of external beam radiotherapy and chemotherapy. Some of these issues have been addressed in several consensus development conferences, guidelines and large retrospective series, as highlighted in the Northern Cancer Network (NCN) guidelines. The emerging role of fluorodeoxyglucose-positron emission tomography scans in the diagnosis and management of recurrent thyroid cancer], the role of quantitative reverse transcriptase-polymerase chain reaction assay of circulating thyroglobulin messenger RNA in monitoring, and redifferentiation therapy are also being currently investigated.
Mallick UK, Lucraft H, Proud G, Perros P, Fenwick J, Kendall-Taylor P, Johnson S, Lennard T, Ball S, James RA, Douglas F, Weightman DR. Optimising the Management of Differentiated Thyroid Cancer. Clinical Oncology (2000)12:363-364.
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