ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Changes in the Management of Thyroid Cancer

by Thomas R. Collins • March 10, 2019

  • Tweet
  • Email
Print-Friendly Version

The Option of Active Surveillance

Whether to choose active surveillance or immediate intervention for certain low-risk thyroid cancers can be a difficult decision, but it’s an option that is being taken increasingly seriously in the face of data showing the benefits. “At first glance,” said Marilene Wang, MD, professor of otolaryngology–head and neck surgery at the University of California, Los Angeles, “this concept seems to fly in the face of every oncologic principle that we know.
Early diagnosis and timely treatment have always been the standards for best practice management of cancer.”

You Might Also Like

  • Management Issues in Recurrent and Metastatic Thyroid Cancer
  • Total or Hemithyroidectomy for Papillary Thyroid Microcarcinoma?
  • Active Surveillance of Papillary Thyroid Cancer Safe, Effective Alternative to Surgery in Some Patients
  • Changes in Thyroid Cancer Incidence Post-2009 ATA Guidelines
Explore This Issue
March 2019

But the evidence is hard to ignore. In the last three decades, the incidence of thyroid cancer diagnoses has almost tripled, but the death rate hasn’t changed, according to the latest data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. That, Dr. Wang said, is because many of these cancers that account for the increased incidence are very small papillary microcarcinomas found on routine ultrasound.

The American Thyroid Association 2015 guidelines say that very low-risk tumors “can be” considered for active surveillance—based on two Japanese studies that followed patients for a decade and found low frequency of enlargement and no recurrence or death after surgery when progression was discovered.

More recently, Memorial Sloan Kettering researchers found that, among 291 patients who underwent active surveillance for a median of 25 months, growth of 3 mm or more was seen in just 3.8% of patients, with no regional or distant metastases seen during surveillance. They also found that 3D measurements of tumor volume were better at finding growth than tumor diameter, discovering it a median of 8.2 months earlier. (JAMA Otolaryngol Head Neck Surg. 2017;143:1015–1020).

Nonetheless, SEER data for 1998 to 2010 show that 98% of those with papillary thyroid microcarcinoma undergo surgery, and 75% receive a total thyroidectomy.

Active surveillance is a good option, said Dr. Wang, when only patients considered low-risk are selected, when a multi-disciplinary team with a high level of expertise is available, and when patients are compliant.

A study out of Kuma Hospital in Japan found that the cost of immediate surgery was 4.1 times higher than surveillance even with the costs of salvage surgery for recurrence factored in (Endocr J. 2017;64:59–64).

The level of patient anxiety also is a big factor, Dr. Wang said. “If the patient is highly anxious and they’re going to live a long time, it’s probably better for them to have a hemithyroidectomy,” she said. “If they don’t have much anxiety and their life expectancy is not great, hemithyroidectomy is probably not cost-effective.”

Pages: 1 2 3 4 | Single Page

Filed Under: Features, Home Slider Tagged With: Clinical Guidelines, thyroid cancer, treatment, Triological Society Combined Sections Meeting 2019Issue: March 2019

You Might Also Like:

  • Management Issues in Recurrent and Metastatic Thyroid Cancer
  • Total or Hemithyroidectomy for Papillary Thyroid Microcarcinoma?
  • Active Surveillance of Papillary Thyroid Cancer Safe, Effective Alternative to Surgery in Some Patients
  • Changes in Thyroid Cancer Incidence Post-2009 ATA Guidelines

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.