RE: Stages? (RESEARCH)

[Guest guest]

Probably referring to AJCC stages which are used to assess risk category.

For papillary and follicular cancer (yours), first assess the UICC stage to

get the extent of the tumor as follows (applied to the primary tumor, which

I believe is usually the largest of the tumors in a multifocal case):

T1 Tumor 1 cm or less in greatest dimension

limited to the thyroid

T2 Tumor > 1 cm but not more than 4 cm in

greatest dimension limited to the thyroid

T3 Tumor more than 4 cm in greatest

dimension limited to the thyroid

T4 Tumor of any size extending beyond the

thyroid capsule

Second, you determine the presense or absense of metastatic lymph node

involvement (M0 or M1). From your description, it looks like M1.

Third, the presense or absense of distant metastatic lesions (N0 or N1).

Finally your age (<45).

The AJCC staging then is (for pap ca or foll ca ONLY)

If <45, you are automatically Stage I if M0, and Stage II if M1.

If >=45, you are Stage I if T1, Stage II if T2 or T3, Stage III if T4 or N1,

and Stage IV if M1.

For a table, see http://www.cap.org/html/cancer_html/thyr.html

So, you are <45, and M1 therefore Stage II.

This unfortunately does not really give a good prediction of survival rate.

Better to use one of the scoring systems such as those described in the

following articles:

Byar DP, Green SB, Dor P, et al (Thyroid Cancer

ative Group). A prognostic index for thyroid carcinoma:

a study of the E.O.R.T.C. Eur J Cancer. 1979;

15:1033-1041. ( " EORTC " score)

Cady B, Rossi R. An expanded view of risk-group definition

in differentiated thyroid carcinoma. Surgery. 1988;

104:947-953. ( " AMES " Score)

DeGroot LJ, Kaplan EL, McCormick M, Straus FH.

Natural history, treatment, and course of papillary thyroid

carcinoma. J Clin Endocrinol Metab. 1990;71:414-424.

Mazzaferri EL, Jhiang SM. Long-term impact of initial

surgical and medical therapy on papillary and follicular

thyroid cancer. Am J Med. 1994;97:418-428.

Hay ID, Grant CS, WF, McConahey WM.

Ipsilateral lobectomy versus bilateral lobar resection in

papillary thyroid carcinoma: a retrospective analysis of

surgical outcome using a novel prognostic scoring system.

Surgery. 1987;102:1088-1095 ( " AGES " Score)

LE, Cady B. Differentiated thyroid cancer:

reexamination of risk groups and outcome of treatment.

Arch Surg. 1998;133:419-425.

These systems take into account more factors than simply T/M/N and you can

find what risk group you are in by reading the articles and addiing your

numbers together in the various formulas. You can then follow the tables to

see what risk group you are in, and long term survival of those risk groups

(which is generally very good with pap ca).

A more recent article that compares three of these different systems

(AMES/AGES/EORTC) and suggests EORTC and AGES to have better predictive

value is

Steinmuller T, Klupp J,Rayes N,Ulrich F,Jonas S,Graf KJ and Neuhaus P.

Prognostic Factors in Patients with Differentiated Thyroid

Carcinoma

Eur J Surg 2000; 166: 29-33.

Looking at EORTC, for example:

Age in years (+12 if male) (+10 if poorly differentiated follicular) (+45 if

anaplastic) (+10 if

extrathyroidal growth) (+15 if distant metastases).

For you that would seem to be: 24+0+0+0+10+0= 34 (I assume no distant

metastases).

An EORTC Score under 50 (which, based on the info you provide includes you)

is the lowest risk group. In the Steinmuller study, for example, out of 42

pap ca in Stage I not a single person died. Also interesting, the type of

surgery (PT vs. TT) did not influence survival at all. This was a

relatively short term study (median time 72 months) however; 40yrs studies

would likely show more, but in any event you would be in the lowest EORTC

group based on the info you provided.

There are probably other studies that I am not aware of as well ... anyone

else?

> Stages?

>

>

> I was originally told that if there was mets to the nodes

> this changed little, only the initial surgery. What is the mortality

> rate difference between stage 1 stage 2 and stage 3? What makes

> it stage 2? Being in both lobes or 8 pos nodes?

> I realize your TG

> is suppressed when your meds are where they should be but am I wrong

> in saying the fact that they are getting a reading at all (TG) definitely

> means unwanted thyroid tissue somewhere?

>

> Bergeron(age 24)

> elizabetholson0@...

> that last 0 is a zero

>

> pap. thyca 11/00 (both lobes and extensive lymph nodes)

> tt 12/00, RAI 175mCi 1/01

> total body scan one week later with residual activity in the neck

> TG 1.4 5 months after RAI. TG 2.4 3 months later that is current

> as of 2 weeks ago

> TSH 2.32, T3T4 1.4, TG antibodies <2, TG 2.4

>

>

>

>

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