Thyroid Cancer: A Comprehensive Guide to Clinical Management

Purpose.

To provide “an extensive and inclusive reference source or handbook to clinicians managing patients with thyroid cancer.”

Content.

Fifty-three chapters authored by 23 thyroid experts use a multidisciplinary approach to address every aspect of thyroid cancer. Part I (5 chapters, 51 pages) discusses a multifaceted approach to evaluation of the thyroid nodule and its medical and surgical management. Once the diagnosis of thyroid cancer has been made, Part II (10 chapters) addresses general considerations of thyroid cancer such as pathogenesis, epidemiology, radiation and thyroid cancer, thyroid cancer classification, immunologic aspects, and initial management. Parts III–VII detail the management approach to the different thyroid cancers: papillary, follicular, anaplastic, lymphoma, and medullary carcinoma. Each part is designed to stand alone as a comprehensive analysis of that distinct neoplasm with coverage of its clinical aspects, cytology and pathology, surgical approach, radioiodine therapy, chemotherapy, external radiation therapy, long-term follow-up, and any topics peculiar to that cancer. Part VIII details the pathology and clinical aspects of miscellaneous and unusual types of thyroid cancer such as squamous cell carcinoma, which is rarely encountered even by experienced thyroidologists. Lastly, Part IX looks to future directions in thyroid cancer management, including DNA ploidy, tumor markers, cancer-causing genes, and advances in chemotherapy and radiation therapy.

Highlights.

Thyroid cancer continues to increase in incidence and is newly diagnosed in approximately 19,000 patients each year in the United States. With appropriate therapy, most patients with thyroid cancer have a normal life expectancy, whereas others with more aggressive or neglected disease succumb despite multimodality therapy. During the last decade, much new information has been generated that has provided us with a better understanding of the natural history of thyroid cancer and its therapy. However, with an absence of long-term prospective therapeutic trials to guide management, there continues to be considerable controversy concerning the initial and subsequent therapy and follow-up of patients with thyroid cancer. This medical text addresses areas of controversy and offers evidence-based diverse opinions on the proper management of thyroid cancer. There are many superbly written chapters in this text, but several chapters stand out and provide a wealth of information: Recombinant Human Thyrotropin; Papillary Cancer: Special Aspects in Children; and Thyroid Lymphoma. The chapter entitled Thyroid Cancer: DNA Ploidy, Tumor Markers, and Cancer-Causing Genes is the best presentation available on this topic and is well worth rereading. Lastly, Part VII (Medullary Thyroid Carcinoma) provides an excellent 6-chapter overview with much new information presented in a readily assimilated fashion.

Limitations. As stated in the editor’s preface, when reading this text cover to cover, the comparable chapters (e.g., surgical management) in Parts III–V are redundant because they are written by the same author and are intended to stand alone in each part. Thus, when the reader encounters a patient with anaplastic cancer, he can go directly to Part V (pages 319–350), read this section in its entirety, and know that all available information with appropriate peer-reviewed references is contained in this part. The pathology sections would have benefited from color instead of black-and-white illustrations. As with most multiauthored texts, there appears to be the usual delay in bringing the project to publication. This is readily detected in some chapters, whereas others are remarkably current. Chapter 12 appears to have been written and rewritten at 2 separate times straddling the Nuclear Regulatory Commission’s revision of 10 CFR 35 effective May 29, 1997, and appropriate prerevision statements are not deleted in the rewritten text. Surprisingly, lithium carbonate is not mentioned as useful adjuvant therapy for ¹³¹I-avid metastatic disease. There are also occasional typographic errors (μCi instead of mCi, mCi instead of Ci), conversion errors (rem vs. mSv), and misleading legends of figures that could cause confusion for the uninitiated. These will be corrected easily in the next edition.

Related Reading.

Thyroid cancer management is detailed in portions of several textbooks, including L. Braverman’s Diseases of the Thyroid (Humana Press, 1997) and S. Falk’s Thyroid Disease: Endocrinology, Surgery, Nuclear Medicine, and Radiotherapy (Raven Press, 1997), but their greater scope limits the detail available on thyroid cancer. Two other medical texts devoted to thyroid cancer are also now available: J. Fagin’s Thyroid Cancer (Kluwer Academic, 1999) and O. Clark’s Thyroid Cancer (Quality Medical Publishers, 2000).