Before starting treatment, a doctor will complete a full pre-treatment evaluation, which is outlined in previous sections. In general, there are multiple options for the treatment of thyroid cancers that can be used alone or in combination:
Surgery
A total thyroidectomy (meaning the complete removal of the thyroid gland), as well as a central compartment neck dissection (meaning removal of the lymph nodes in the middle of the neck near the thyroid gland) are the standard treatment for medullary thyroid cancer, because MTC often spreads to the lymph nodes in the neck.
Before surgery, imaging of the lymph nodes in the lateral compartments of the neck will be very important in order to determine whether a lateral compartment neck dissection should also be performed during surgery.
High levels of calcitonin in a patient’s blood are directly correlated with an increased likelihood of having lymph node metastases. Therefore, a patient’s preoperative calcitonin levels, measured with blood tests, often dictate the extent of lymph node dissection performed during surgery. It is important to remember that calcitonin is a protein that is produced in thyroid C-cells, which are specific to MTC. Therefore, the use of calcitonin as an aid to determine the extent of surgery is only valid in cases of MTC.
Radiation
It is important to note that medullary thyroid cancer does not respond to treatment with radioactive iodine (RAI), which is commonly used in patients with well-differentiated thyroid cancer.
External beam radiation can be used as an additional treatment after surgery for MTC, though this is typically only used in cases that are at a high risk for recurrence, such as cases with:
- Residual cancer remaining after surgery.
- Gross extrathyroidal extension.
- Extensive lymph node metastases.
Chemotherapy & Biologic Medications
Chemotherapy is not typically used for medullary thyroid cancer, except for very advanced cancers that have not responded to any other treatment options. Multiple types of chemotherapies are currently being investigated, and may be offered as part of a clinical trial, if the patient is comfortable and willing to try an experimental treatment. A medical care team consisting of several types of healthcare professionals will collaborate to determine the best treatment for each patient.
