title: Extent of disease and practice patterns for medullary thyroid cancer.
abstract: BACKGROUND
  There have been significant improvements in the management of medullary thyroid cancer (MTC), and consensus treatment guidelines have been established by numerous international and national societies. It is unclear if the advances in diagnosis and treatment of MTC have led to earlier diagnosis and more complete initial treatment of patients with MTC.
  
  
  METHODS
  Patients with MTC (n=1,070) were identified in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database from 12 population-based cancer registries between 1973 and 2000. Four equal-time quartiles (group I=1973 to 1979, group II=1980 to 1986, group III=1987 to 1993, and group IV=1994 to 2000) were compared for changes in demographics, extent of disease, and treatment.
  
  
  RESULTS
  Mean tumor size was significantly larger in 1988 than in 1989 through 2000 (p=0.044), but there was no significant trend toward smaller tumor size. The number of patients having total or near total thyroidectomy increased significantly in the latter two quartiles (p < 0.001) but not the number of patients having cervical lymph node dissection. Unfortunately, 15% of patients in group IV still had less than total or near total thyroidectomy, and 41% had no cervical lymph node dissection. There were no significant differences in age, gender, rate of lymph node or distant metastasis, SEER stage, TNM stage, and cause-specific mortality among the four time groups and annually.
  
  
  CONCLUSIONS
  There was no significant trend toward earlier stage of disease at diagnosis and treatment and no significant increase in the survival of patients with MTC during a 28-year period. A high proportion of patients continue to receive less than optimal initial surgical treatment.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-1674, USA.
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Francis S
authors.initials: FS
authors.lastname: Greenspan
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Woeber
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Grunwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000639:trends; D012189:Retrospective Studies; D018426:SEER Program; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D013965:Thyroidectomy; D014481:United States