Thyroid Cancer No Surgery 101: Low risk primary micro-papillary thyroid cancer alternatives to surgery

Thyroid Cancer No Surgery 101: Low risk primary micro-papillary thyroid cancer alternatives to surgery

Thyroid Cancer No Surgery 101: Low risk primary micro-papillary  thyroid cancer alternatives to surgery
  • Thyroid Cancer No Surgery 101: Low risk primary micro-papillary thyroid cancer alternatives to surgery

    Clinical Review State of the Art Review

    Low risk papillary thyroid cancer

     BMJ 2014;348:g3045

    Juan P Brito, et al
    Comments by Dr.Guttler
  • images

    1.Thyroid cancer is one of the fastest growing diagnoses.

    2. Most of these incident cases are papillary in origin and are both small and localized.

    3. Patients with these small localized papillary thyroid cancers have a 99% survival rate at 20 years.

    4. They have been denoted as low risk.

    5.The incidence of these low risk thyroid cancers is growing, probably because of the use of imaging technologies capable of exposing a large reservoir of subclinical disease.

    6.These subclinical low risk cancers are often treated aggressively.

    7. Surgery is traditionally viewed as the cornerstone treatment for these tumors.,

    thyroid-surgery-complications-8-300x134

    8. Many of these tumors are treated with radioactive iodine ablation

    images and thyrotropin suppressive therapy.

    9. Both have shown no use in low risk thyroid cancer.

    10. The future of promising alternative surgical techniques, non-surgical minimally localized invasive therapies (radiofrequency, RFA ethanol PEI and laser ablation), and active surveillance, all of which form part of a more individualized treatment approach for low risk papillary thyroid tumors.

     

    11. Alternative ablation procedures can be considered a third arm with surgery and active surveillance for those who do not want the surgery or unwilling to have a small cancer in their neck for 40 years.

    2018 update: 

  • 1. Both Ethanol PEI and radiofrequency RFA have shown they can be used in these primary micro-papillary cancers cases.
  • Ethanol by  Ian Hay at Mayo clinic
  • images
  • and
  • RFA by Dr.JH Baek at Asan MC in Seoul Korea.

baek

 Call me at 3103938860 or thyroid.manager@proton mail.com for details on these alternatives to surgery or AS for micro-papillary thyroid cancer. We do ethanol and can get you treated in Korea with RFA after my evaluation.
Richard Guttler MD,FACE,ECNU
Interventional thyroidologist
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