title: Surgery for lymph node metastases of medullary thyroid carcinoma: A review.
abstract: Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells that occurs in hereditary and sporadic clinical settings. Metastatic spread commonly occurs to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the most effective option for curative therapy, reduction in tumor burden, or effective palliation. In patients undergoing preventative surgery for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is elevated. Preservation of parathyroid function in these young patients is of paramount importance. In patients with established primary tumors, systematic surgical removal of lymph node basins (compartmental dissection) should be guided by ultrasound mapping of lymph node metastases and level of serum calcitonin. A "berry-picking" approach is discouraged. Newly approved targeted molecular therapies offer wider treatment options for patients with progressive or metastatic disease.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.affiliation: Section of Endocrine and Oncologic Surgery, Department of Surgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.|Department of Surgery, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Moley
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D018276:Carcinoma, Medullary / Q000151:congenital / Q000473:pathology / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D058990:Molecular Targeted Therapy; D018813:Multiple Endocrine Neoplasia Type 2a / Q000473:pathology / Q000601:surgery; D018814:Multiple Endocrine Neoplasia Type 2b / Q000473:pathology / Q000601:surgery; D009154:Mutation; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000628:therapy; D010166:Palliative Care; D011379:Prognosis; D051096:Proto-Oncogene Proteins c-ret / Q000235:genetics; D012086:Reoperation / Q000009:adverse effects; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor; D002116:Calcitonin; D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human
keywords: endocrine disease; lymph node metastases; medullary thyroid carcinoma; pediatric oncology; surgery