Carcinomas of the thyroid
George Crile, M.D.
Department of General Surgery
William A. Hawk, M.D.
Division of Laboratory Medicine
IT is difficult to reconcile the various points of view about the treatment of cancer of the thyroid unless surgeons stop talking about cancer of the thyroid as an entity and start to break it down into its component parts. The problem is that cancer of the thyroid is not like cancer of the stomach or cancer of the colon, in which most of the tumors follow the same patterns of metastases and are of approximately the same degree of malignancy. Cancer of the thyroid is more like cancer of the skin, in which there is a spectrum of tumors that includes such different entities as the highly malignant melanoma, the moderately malignant squamous-cell carcinoma, and the relatively benign basal-cell carcinoma.
No one would make a general statement as to how all types of cancer of the skin should be treated, or advise prophylactic dissection of lymph nodes in the treatment of a basal-cell cancer of the skin. Yet in the treatment of certain cancers of the thyroid, such as the encapsulated angioinvasive carcinoma, although metastasis to regional nodes is nearly as rare as it is in basal-cell cancer, some surgeons advocate prophylactic dissection of lymph nodes. The trouble is that they are thinking of thyroid cancer as an entity.
One of the chief difficulties lies in the nomenclature of thyroid carcinomas and in the lack of understanding between surgeons and pathologists. It is unfortunate that thyroid cancers are classified as papillary, follicular, or undifferentiated, in accordance with their morphologic . . .