New research in thyroid cancer could save lives

A new study raises the question of whether the current staging system for thyroid cancer should be revised for younger patients to better reflect their prognosis.

Researchers from the Duke Cancer Institute and Duke Clinical Research Institute found that younger thyroid cancer patients with lymph node involvement are at an increase risk of dying, according to the study. This goes against current beliefs and staging forecast tools that classify them as low risk.

This system classifies cancers in four stages for patients over the age of 45, with Stage 1 having the best prognosis and Stage 4 having the worst. However, there are only two stages for patients under 45, both typically associated with an overall positive prognoses.

“Thyroid cancer incidence has been on the rise for many years now, and this article may change our thinking about prognosis and management for many of these patients,” says Dr. Wendell Malalis, an endocrinologist at Advocate Sherman Hospital in Elgin, Ill. “This study may be clinically significant for a new staging system in thyroid cancer.”

The study analyzed nearly 70,000 patient outcomes to determine if the staging system correctly reflects the impact of lymph node involvement for younger patients’ survival rates.

Researchers found when cancer spreads to the lymph nodes in the neck of younger patients, they had a lower survival rate compared to patients without cancer in the lymph nodes. They also determined that the number of lymph nodes played a role in survival risks, which was lower for those with one cancerous node, but higher for those with six or more, according to the study.

“The interesting point in this study is that they put a significance not only on lymph node detection, but also the number of nodes found,” Dr. Malalis says. “It highlights the importance of pre-operative imaging like a full neck ultrasound and possibly lymph node dissection for patients at a high suspicion for thyroid cancer.”

Currently, the American Joint Committee on Cancer is working to revise the staging criteria for all cancers, including thyroid, the fastest growing malignancy in the U.S.

“More studies would help before overhauling the current staging system for thyroid cancer,” Dr. Malalis says.