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Stages of thyroid cancer

Scanning of patient to detect extent of cancer
Scanning of patient to detect extent of cancer

The most important fact to establish is whether the thyroid carcinoma is confined to the gland. An ultrasound of the thyroid and neck has already probably been done and is an accurate first procedure to delineate the thyroid tumour and identify abnormal lymph nodes. An MRI scan of the neck is also useful, particularly for demonstrating any local extensions of the primary growth.

 

 A CT scan may be useful. Especially if the thyroid tumour extends down into the chest but there is an iodine load involved in the contrast that is used in neck CT scanning, and this may make difficult subsequent iodine therapy if this is necessary within a few weeks of the CT scan.

 

The commonest sites of distant spread for thyroid carcinoma are the lungs and the bones (usually in that order). Therefore, a chest x-ray or Ct (with the above caveat over iodine loading) of the thorax and a bone isotope scan are used in staging.

 

For differentiated carcinoma, the radical surgical operation (see below) will often be recommended whatever the staging shows and the operative specimen yields further staging information as to whether the tumour had spread outside the gland or not. By these means, the patient is classified as having intracapsular or extracapsular disease.

 

The measurement of the serum tumour marker (thyroglobulin) is not useful at this time.

 

In medullary carcinoma cases, the staging is much the same but there is a hormone marker of disease presence in the form the hormone calcitonin (which as has been said above is the normal physiological product of the thyroid C cells). This hormone marker is almost invariably raised in this disease and the level should fall back to normal levels after curative surgery.

 

By contrast, lymphoma staging is that for any high grade lymphoma (see lymphoma section), but PET scanning and bone marrow exam amongst other tests will be ordered.


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