Unusual Cancers of Childhood Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Head and Neck Cancers
Table 1. Characteristics of Thyroid Carcinoma in Children and Adolescents Versus Adultsa
|Characteristic||Children and Adolescents (%)||Adults (%)|
|a Adapted from Yamashita et al.|
|Lymph node involvement||30-90||5-55|
Patients with thyroid cancer usually present with a thyroid mass with or without cervical adenopathy.[60,61,62,63] Younger age is associated with a more aggressive clinical presentation in differentiated thyroid carcinoma. Compared with adults, children have a higher proportion of nodal involvement (40%-90% vs. 20%-50%) and lung metastases (20%-30% vs. 2%). Likewise, when compared with pubertal adolescents, prepubertal children have a more aggressive presentation with a greater degree of extrathyroid extension, lymph node involvement, and lung metastases. However, outcome is similar in the prepubertal and adolescent groups. In well-differentiated thyroid cancer, male gender, large tumor size, and distant metastases have been found to have prognostic significance for early mortality; however, even patients in the highest risk group who had distant metastases had excellent survival at 90%.
Initial evaluation of a child or adolescent with a thyroid nodule should include the following:
- Ultrasound of the thyroid.
- Serum thyroid-stimulating hormone (TSH) level.
- Serum thyroglobulin level.
Tests of thyroid function are usually normal, but thyroglobulin can be elevated.
Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[66,67,68,69,70] Open biopsy or resection may be preferable for young children as well.
Table 2. Thyroid Carcinomas in Children
|Histology||Associated Chromosomal Abnormality||Presentation||Diagnosis||Treatment|
|EGF = epidermal growth factor; MEN2 = multiple endocrine neoplasia type 2; TSH = thyroid-stimulating hormone.|
|Papillary thyroid carcinoma (differentiated with generally a benign course)||RET/PTCmore common in children.BRAFV600E mutations seen in adults are rare in children.||Thyroid mass. Prepubertal children more often with nodal and lung metastases.||Ultrasound, TSH, thyroglobulin. Fine needle or open biopsy.||Total or near-total thyroidectomy; I-131; thyroid hormone. In metastatic or recurrent disease, tyrosine kinase or EGF receptor inhibitors may be of benefit.|
|Follicular thyroid carcinoma (differentiated with generally benign course)||Sporadic or familial||Thyroid mass. Prepubertal children more often with nodal and lung metastases.||Ultrasound, TSH, thyroglobulin. Fine needle or open biopsy.||Total or near-total thyroidectomy; I-131; thyroid hormone. In metastatic or recurrent disease, tyrosine kinase or EGF receptor inhibitors may be of benefit.|
|Medullary thyroid carcinoma||MEN2||Aggressive. 50% with metastases at presentation.||In familial MEN2,RETtesting.||Aggressive surgical intervention. Prophylactic thyroidectomy is indicated in familial cases.|