Age As A Prognostic Variable
Table 2 shows the impact that age had on outcome as a binary variable. All cutoff ages from 30 to 70 years showed that the older cohort had poorer DSS . Multivariable analysis for age at different cutoffs, adjusting for the other predictor variables using Cox proportional hazards regression, also showed that age was significant at all cutoff values from 30 to 70 years. The HRs for adjusted age cutoffs were ranging from 7.09 to 19.03.
Ten year disease-specific survival at different age cutoffs from age 30 to age 70 years.
Age As A Continuous Variable
We then calculated the unadjusted and adjusted HRs for age as a continuous variable, again adjusting for the same variables of sex, pathology, and T, N, and M stage. This is shown in Table 4. The adjusted HR was 1.076 indicating that for every additional year the risk of death progressively increased.
Who Gets This Cancer
Prostate cancer occurs only in men, and it is more common in older men than younger men. It is more likely to occur in men with a family history of prostate cancer and men of African American descent. The rate of new cases of prostate cancer was 111.3 per 100,000 men per year based on 20142018 cases, age-adjusted.
Rate of New Cases per 100,000 Persons by Race/Ethnicity: Prostate Cancer
Males
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Papillary Thyroid Cancer Survival Rate
Papillary thyroid cancer is the most common thyroid cancer. Papillary thyroid cancer prognosis is often better than for other types of thyroid cancer. This is especially true for people younger than 55. People in this age group with papillary thyroid cancer are less likely to die than older people with papillary thyroid cancer.
The 5-year survival rates for papillary thyroid cancer are as follows:
- Localized: nearly 100%
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for thyroid cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign the cancer has spread outside of the thyroid.
- Regional: The cancer has spread outside of the thyroid to nearby structures.
- Distant: The cancer has spread to distant parts of the body, such as the bones.
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Thyroid Cancer: What Women Should Know
The symptoms start slowly. Fatigue is the most common. There might bechanges in hair, nails or skin, and other vague complaints that could becaused by aging, diet, stress or dozens of other factors.
Women in the prime of their lives, busy with work and families, may noteven notice. When a doctor finally diagnoses an underactivethyroiddue to cancer, it often comes as a shock.
Jonathon Russell, M.D., assistant professor ofOtolaryngology Head and Neck Surgeryat The Johns Hopkins Hospital, says, Typicalthyroid cancerpatients are women between the ages of 30 and 60younger than many peoplewould think. Theyre likely to put off getting seen by a doctor and mayblame their symptoms on other causes.
What Happens Without Treatment
Physicians will sometimes talk about a particular diseases natural history or typical progression if it is left untreated indefinitely.
With regard to prostate cancer, most cases of the disease are discovered while the cancer is still confined to the prostate itself. This is called local disease or localized disease.
The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present.
If left untreated, however, prostate cancer can proceed on a number of different paths.
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Survival Statistics For Thyroid Cancer
Survival statistics for thyroid cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
There are many different ways to measure and report cancer survival statistics. Your doctor can explain the statistics for thyroid cancer and what they mean to you.
How Common Is Thyroid Cancer
The American Cancer Societys most recent estimates for thyroid cancer in the United States for 2022 are:
- About 43,800 new cases of thyroid cancer
- About 2,230 deaths from thyroid cancer
The death rate for thyroid cancer increased slightly from 2009 to 2018 but appears to have stabilized in recent years. Statistics on survival rates for thyroid cancer are discussed in Survival Rates for Thyroid Cancer.
Thyroid cancer is commonly diagnosed at a younger age than most other adult cancers. And women are 3 times more likely to develop thyroid cancer than men.
Until recently, thyroid cancer was the most rapidly increasing cancer in the US, largely due to increased detection. Much of this rise appears to be the result of the use of more sensitive diagnostic procedures, such as CT or MRI scans , which can detect incidental small thyroid nodules that might not otherwise have been found in the past.
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Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still .
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
- Gleason score: 6 or less
Watchful Waiting Aka Active Surveillance
Dr. Harari notes that there has been increased interest in watchful waiting, also known as active surveillance, for thyroid cancer. In New York at Memorial Sloan Kettering Cancer Center, it is the standard of care for certain populations, she says.
Watchful waiting can be a good choice for people who have small nodules that are not growing quickly or are not invasive in nature. It can also be a good treatment option for people who are very worried about having surgery, Dr. Harari says.
One reason why watchful waiting is garnering interest is that while diagnoses of thyroid cancer have increased over the last decade, mainly as a result of increased imaging done for other purposes, mortality from it hasnt changed.
People are having chest CTs for other reasons and they pick it up, or they have a carotid artery ultrasound and see it, Dr. Lieb says. But if these nodules hadnt been discovered, many of them wouldnt have caused a problem at all they are small, low-risk cancers.
Dr. Chen agrees. The fact that we are finding more and smaller cancers hasnt impacted the death rate, she says. So when we operate on people with small early-stage cancers, we may be doing unnecessary surgery with the potential for complications because all surgeries have risks. So we have someone who probably wouldnt die of thyroid cancer, but we have given them a lifelong problem with nerves, voice loss, and hypoparathyroidism . Its not good.
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Study Design And Population
This retrospective hospital-based cohort study was conducted at the Brazilian National Cancer Institute José Alencar Gomes da Silva , and the outcome variable was the time between the diagnosis of primary DTC and the death due to the disease. The study population consisted of patients who were attended between January 1st, 2000 and December 31, 2010 and registered in the database of the Hospital-based Cancer Registry . Eligibility was considered as histologically confirmed cases of thyroid carcinoma according to the International Classification of Disease for Oncology Third Edition, site codes , and who underwent a therapeutic plan and follow-up at INCA who had a diagnosis at or above 20 years of age , and presented the following histological codes : 8050, 8260, 8340-8344, and 8350 , and 8290, 8330-8332, and 8335 .
Cases with a history of other primary tumor or previous TC diagnosis were excluded from the study. After reviewing all the histopathological reports, the following cases were excluded: PTC recurrence adenocarcinoma no further specification unclear diagnostic about primary or metastatic tumor primary pulmonary tumor uncertainty about tumor malignancy, adenoma or carcinoma . The sample thus consisted of 562 cases of primary DTC.
What Is The Thyroid Gland
Your thyroid gland is one of many glands that make up your endocrine system. Endocrine glands release hormones that control different bodily functions.
The pituitary gland in your brain controls your thyroid gland and other endocrine glands. It releases thyroid-stimulating hormone . As the name suggests, TSH stimulates your thyroid gland to produce thyroid hormone.
Your thyroid needs iodine, a mineral, to make these hormones. Iodine-rich foods include cod, tuna, dairy products, whole-grain bread and iodized salt.
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Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and although no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesnt know your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Standard Treatment Options For Papillary And Follicular Thyroid Cancer
Localized/regional papillary and follicular thyroid cancer
Surgery is the therapy of choice for all primary lesions. Surgical optionsinclude total thyroidectomy or lobectomy. The choice of procedure isinfluenced mainly by the age of the patient and the size of the nodule. Survival results with the two procedures are similar for early-stage disease, with differences in the ratesof surgical complications and local recurrences.
Standard treatment options for localized/regional papillary and follicular thyroid cancer
Standard treatment options for localized/regional papillary and follicular thyroid cancer include the following:
Surgery
The objective of surgery is to completely remove the primary tumor, while minimizing treatment-related morbidity, and to guide postoperative treatment with RAI. The goal of RAI is to ablate the remnant thyroid tissue to improve the specificity of thyroglobulin assays, which allows the detection of persistent disease by follow-up whole-body scanning. For patients undergoing RAI, removal of all normal thyroid tissue is an important surgical objective. Additionally, for accurate long-term surveillance, RAI whole-body scanning and measurement of serum thyroglobulin are affected by residual, normal thyroid tissue, and in these situations, near total or total thyroidectomy is required. This approach facilitates follow-up thyroid scanning.
Total thyroidectomy
Evidence :
Lobectomy
Radioactive iodine therapy
Evidence :
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Who Might Have Thyroid Cancer
Women are three times more likely than men to get thyroid cancer. The disease is commonly diagnosed in women in their 40s and 50s, and men in their 60s and 70s. Even children can develop the disease. Risk factors include:
- Exposure to radioactive fallout from nuclear weapons or a power plant accident.
Additional Treatment After Surgery
Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.
Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:
- Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
- Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
- Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.
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Thyroid Cancer: Common In Women
Thyroid disorders are more common in women, probably due to the roles of hormones, which are different in femalesthan in males.
Thyroid nodules, Russell says, affect up to 80 percent of women, but only 5percent to 15 percent of those lumps and bumps are malignant. Bettertesting means thyroid tumors are on the rise, he notes, saying that itsprojected to become the third most common cancer.
Malignant and cancer are scary words, but Russell says that mostthyroid cancer is highly treatable, even when the cancer cells spread tonearby lymph nodes, which occurs frequently.
With thyroid cancer we talk about prognosis in terms of 20-year survivalinstead of five years, as we do with most other cancers. Its usually aslow-moving disease. Theres a 98 to 99 percent survival rate at 20 years,he says.
We treat it almost like a chronic condition where the patient getstreatment and visits her doctor regularly for follow-up.
Treatment For Thyroid Cancer
Surgery to remove the thyroid and any affected lymph nodes is the preferredtreatment. Afterward, the patient will takethyroid hormonesto cover the loss of the gland and radioactive iodine to treat anyremaining cancer cells.
Traditional surgical removal of the thyroid gland, or thyroidectomy, leavesa prominent scar on the front of the neck. Russell notes that some thyroidcancer survivors are fine with their thyroidectomy scar and regard it as abadge of honor.
But plenty of patients dont want the constant reminder of cancer surgeryeach time they look in the mirror. Or they dont necessarily want a scar tobe the first thing a stranger notices. They say Its my business that Ihad a problem with my thyroid, Russell says.
Russell offers patients the option of ascarless thyroidectomy, in which the surgeon reaches the thyroid gland and removes it through themouth, so theres no cutting or scarring of the neck.
Though initially skeptical about the novel approach, Russell studied thetechnique in Thailand and saw that scarless thyroidectomy could be avaluable alternative to a traditional approach. Now Russells clinic is aleader in performing scarless thyroidectomies and trains surgeons from allover the world.
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What Is Differentiated Thyroid Cancer
Most thyroid cancers are differentiated, according to the American Cancer Society, which means that when the cells are looked at under a microscope they appear similar to normal thyroid cells. Papillary, follicular, and Hurthle cell thyroid cancer are all types of differentiated thyroid cancer. When the cancerous cells are not similar in appearance to normal thyroid tissue, the cancer is called poorly differentiated or undifferentiated. Medullary and anaplastic thyroid cancers fall into this category.
Side Effects Of Radioactive Iodine Therapy
Side effects from radioactive iodine can include:
-
Mild nausea during the first day
-
Swelling and pain in the neck where thyroid cells remain
-
Temporary loss of smell and/or taste
Additionally, high doses of RAI can cause problems with fertility . They can also kill normal thyroid cells along with the cancerous ones, which can lead to the need for thyroid hormone replacement medication.
If you have to have RAI multiple times, the radiation can increase the risk of some cancers, including leukemia, says Dr. Lieb.
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Deaths Related To Differentiated Thyroid Cancer
Of the 23 deaths observed, 91.3% were aged 45 years or 87.0% were aged 55 years and 56.5% had distant metastasis . All patients with FTC who died had distant metastasis. Among PTC deaths, the proportion of patients with distant metastasis was 47.4%. Compared with PTC, FTC deaths had smaller tumors and higher mean age at diagnosis , with no significant difference. In both histological types, 50% of the deaths had regional lymph node metastasis.
Table 2
Age Influences The Prognosis Of Anaplastic Thyroid Cancer Patients
- General Surgery of Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, China
Background: The staging system for patients with anaplastic thyroid cancer was updated in the 8th edition of the American Joint Committee on Cancer Staging Manual. A cut-off age of 55 years was stipulated as a prognostic factor for differentiated thyroid cancer however, age was not considered for ATC patients. To this end, this study investigated the relationship between age at diagnosis and prognosis of ATC patients.
Methods: The clinical information on ATC patients was acquired from the Surveillance, Epidemiology, and End Results Program public database. Youdens index and X-tile analyses were used to calculate the high-point age at diagnosis associated with prognosis. Cox proportional hazards models, Kaplan-Meier curves, and 1000-person-year were then used for verifying the accuracy of the high-point age.
Results: After inclusion/exclusion criteria was applied, 586 patients were included in this study. The high-point age was determined to be 70 years by both the Youdens index and X-tile plot methods. The hazard ratio was 1.662 , indicating that there was an increased risk of poor prognosis for patients > 70 years of age. The cancer-specific mortality rates per 1000-person-years for patients and > 70 years-old were 949.980 and 1546.667 , respectively. P-values were < 0.001 for the results shown above.
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Types Of Thyroid Cancer
There are several types of thyroid cancer. It is possible to have more than one type at once, although this is unusual. Common types of thyroid cancer include:
- papillary develops from the follicular cells and tends to grow slowly
- follicular develops from the follicular cells and includes Hürthle cell carcinoma, a less common subtype.
Rarer types of thyroid cancer include:
- medullary develops from the parafollicular cells . It can run in families and may be associated with tumours in other glands
- anaplastic may develop from papillary or follicular thyroid cancer. It tends to grow quickly and usually occurs in people over 60 years old.