Medullary Thyroid Carcinoma (MTC)

I am treating a patient with a rare form of thyroid cancer. Medullary thyroid carcinoma makes up about 1-2% of all thyroid cancers in the USA. As you can imagine, it is exceedingly rare in Singapore. This cancer can be inherited or sporadic. The inherited forms are part of a syndrome called the Multiple Endocrine Neoplasia 2 syndromes or a non-syndromic Familial MTC.

With this cancer there is a simple cancer marker – Calcitonin – which is raised in patients with MTC. A high or low Calcitonin level has no effect on the patient. In patients with residual disease, the level of Calcitonin is directly correlated with disease burden. So levels in excess of 1000 suggest disease that has spread beyond the head and neck and is possible in the bones.

10 year survival for MTC varies from over 90% for stage I disease to 21% for stage IV disease.

There are no new targeted therapies for MTC. Vandetinib is one promising drug.

Often MTC is identified after a thyroid gland or lobe is removed for a presumed classical papillary thyroid cancer. It is important that your surgeon or endocrinologist recognizes that there are guidelines that help clinicians treat MTC in an evidence based fashion.

My patient had a rising level of Calcitonin for over a year. Enlarged and abnormal lymph nodes in the left neck were largely ignored.

I undertook a left neck dissection and cleared the nodes from the lower neck. The picture demonstrates the neck anatomy after surgery with the carotid artery, jugular vein and accessory nerve exposed.

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