Evidence-based approach to the management of sporadic medullary thyroid carcinoma.
Medullary thyroid carcinoma (MTC) is a rare malignancy of the thyroid C cells. It occurs in hereditary (25% of cases) and sporadic (75%) forms. Sporadic MTCs frequently metastasize to cervical lymph nodes. Thorough surgical extirpation of the primary tumor and nodal metastases by compartment-oriented resection has been the mainstay of treatment (level IV evidence). Surgical resection of residual and recurrent disease is effective in reducing calcitonin levels and controlling complications of central neck disease (level IV evidence). Radioactive iodine, external beam radiation therapy, and conventional chemotherapy have not been effective. Newer systemic treatments, with agents that target abnormal RET proteins hold promise and are being tested in clinical trials for patients with metastatic disease.
Moley
Jeffrey F
JF
Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA. moleyj@wustl.edu
Fialkowski
Elizabeth A
EA
D018276:Carcinoma, Medullary / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D019317:Evidence-Based Medicine; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D051096:Proto-Oncogene Proteins c-ret / Q000187:drug effects; D013964:Thyroid Neoplasms / Q000473:pathology / Q000628:therapy*; D013965:Thyroidectomy
D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human