Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. Staging of thyroid cancer depends on tumor size, cancer spread, the specific type of thyroid cancer, and the patient's age. Staging is an important step in evaluating prognosis and treatment options.
Staging of Papillary and Follicular Thyroid Cancer in Patients Under the Age of 55
Stage I
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Description
- The tumor may be any size, and may have spread to nearby lymph nodes or other parts of the neck.
Treatment
- Surgery (thyroidectomy or lobectomy), followed by thyroid hormone therapy and occasionally radioactive iodine therapy.
Stage II
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Description
- Thyroid cancer may have spread to distant organs.
Treatment
- Surgery (thyroidectomy or lobectomy), followed by thyroid hormone therapy and probably radioactive iodine therapy. Radiation therapy and occasionally, targeted chemotherapy can be used to control spreading of the disease.
Staging of Papillary and Follicular Thyroid Cancer in Patients 55 Years or Older
Stage I
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Description
- The tumor is 2 cm or less in diameter and is in the thyroid only.
Treatment
- Surgery (thyroidectomy or lobectomy), followed by thyroid hormone therapy and rarely radioactive iodine therapy.
Stage II
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Description
- The tumor is between 2 cm and 4 cm in diameter and is in the thyroid only, is limited to the thyroid up to 4 cm with limited involvement of lymph nodes near the thyroid (central neck), or is more than 4 cm limited or minimally invading surrounding tissues without distant metastasis.
Treatment
- Surgery (thyroidectomy), followed by thyroid hormone therapy and possibly radioactive iodine therapy.
Stage III
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Description
- The tumor has gross extrathyrodial extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve from a tumor of any size without distant spread.
Treatment
- Thyroidectomy and lymphadenectomy, followed by radioactive iodine therapy and thyroid hormone therapy.
Stage IVa
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Description
- The cancer has spread beyond the thyroid and invaded structures (pre-vertebral fascia or encasing the carotid artery or mediastinal vessels from a tumor of any size). It may have also spread to lymph nodes in the neck and upper chest.
Treatment
- Thyroidectomy and lymphadenectomy, followed by radioactive iodine therapy and thyroid hormone therapy.
Stage IVb
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- The cancer has invaded distant organs or parts of the body, such as the bones or lungs.
Description
Treatment
- Not usually curable. The doctor may try to remove all tumors with surgery and radioactive iodine therapy. After that, treatment may be focused on relieving symptoms and improving quality of life. The doctor may treat distant tumors with external radiation therapy, chemotherapy, targeted therapy, or may recommend a clinical trial.
Staging of Medullary Thyroid Cancer
In contrast to papillary and follicular thyroid cancer, age does not affect staging in medullary thyroid cancer.
Stage I
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Description
- The tumor is 2 cm or less in diameter and in the thyroid only.
Treatment
- Thyroidectomy and lymphadenectomy followed by thyroid hormone therapy.
Stage II
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Description
- Tumors greater than 2 cm confined to the thyroid, or tumors of any size without lymph node metastasis that demonstrate gross extrathyrodial extension, invading only the strap muscles (sternohyoid, sternothyroid, thyroid, or omohyoid).
Treatment
- Thyroidectomy and lymphadenectomy followed by thyroid hormone therapy.
Stage III
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Description
- Tumor of any size that has spread to nearby lymph nodes in the central neck.
Treatment
- Thyroidectomy and lymphadenectomy followed by thyroid hormone therapy.
Stage IVa
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Description
- The cancer has spread throughout the neck and/or to lateral lymph nodes.
Treatment
- Thyroidectomy and lymphadenectomy followed by thyroid hormone therapy. Radiation therapy is infrequently needed.
Stage IVb
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Description
- The cancer has spread very close to the backbone or very close to blood vessels in the head and neck. It may have also spread to lymph nodes.
Treatment
- Thyroidectomy and lymphadenectomy followed by thyroid hormone therapy. Radiation therapy is occasionally needed.
Stage IVc
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Description
- The cancer has spread to other organs or parts of the body, such as the bones or lungs.
Treatment
- Not usually curable. Treatment may be focused on relieving symptoms and improving quality of life. The doctor may treat distant tumors with external radiation therapy, chemotherapy, targeted therapy, or may recommend a clinical trial.
