Thyroid cancer: First S3 guideline published

Thyroid cancer is rare. In Germany, approximately 6,000 people are diagnosed with it each year. The prognosis is favorable compared to other tumors. The five-year survival rate for The rate is 94 percent forwomen and 88 percent for men. One reason for this is that the cancers are often diagnosed at an early stage.

About two-thirds of all thyroid carcinomas are papillary. However, there are also several other types of carcinoma, such as follicular, medullary, and anaplastic thyroid carcinoma.

The most important treatment method for thyroid cancer is surgery, which removes the tumor as completely as possible. Often, the entire thyroid is removed. The coordinator of the guideline group, Professor Dr. Andreas Bockisch, recommends: "Especially for a rare tumor type like thyroid cancer, it makes sense to choose treatment in a certified center. They have extensive experience, and in terms of surgery, this means the probability of complete tumor resection is higher and the complication rate is lower."

Since various types of carcinoma accumulate iodine, they can be treated with radioiodine therapy. The guideline explains when this is appropriate and when it is not.

Radioiodine therapy is not possible for medullary thyroid carcinomas. These carcinomas arise from the C cells of the thyroid, which produce the hormone calcitonin, and do not store iodine. They can only be cured through surgery but have a relatively good prognosis. Medullary thyroid carcinomas account for about 5 percent of all thyroid carcinomas.

The topic of follow-up care is addressed in a separate chapter of the guideline. Distant metastases and local recurrences in differentiated thyroid carcinomas can occur even after many years, which is why the guideline authors recommend follow-up care for at least ten years. However, since recurrences usually occur within the first five years after the initial diagnosis, follow-up examinations are particularly important during this period and should be performed every six months. After five years, they should be performed every twelve months.

Neck sonography, a risk-free method, plays a key role in follow-up care. The guideline states: "Neck sonography should be part of every follow-up examination and should include a systematic examination of the thyroid bed as well as the central and lateral lymphatic drainage areas of the thyroid region."

In cases of tumor persistence, recurrence, or metastases, the guideline contains recommendations for further action. One chapter is dedicated to the question of when systemic therapy is indicated and which medications should be used. Depending on the type of cancer and the treatment situation, kinase inhibitors such as sorafenib , lenvatinib , and cabozantinib could be used.

In its press release, the German Cancer Society also addresses the rare, highly aggressive anaplastic thyroid carcinoma. It is characterized by a rapidly progressing, painless swelling, which often causes difficulty swallowing or hoarseness upon initial presentation. Due to the rapid progression of the tumor, prompt action is essential.