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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017


Treatment guide Differentiated thyroid cancer | Papillary thyroid cancer

Part 5 is a chapter on the treatment

options for people with differentiated

types of thyroid cancer. Differentiated

types include papillary, follicular, and

Hürthle cell. Find out which options

may be right for you. Ask your doctors

questions about your treatment

plan and decide on your next steps.

This information is taken from the

treatment guidelines written by NCCN

experts of thyroid cancer. These treatment

guidelines list options for people with

thyroid cancer in general. Thus, your

doctors may suggest other treatment for

you based on your health and personal

needs. Discuss and decide on your

treatment plan with your doctor.

Differentiated thyroid cancer

Differentiated thyroid cancer includes papillary,

follicular, and Hürthle cell. The follicular type of

thyroid cancer has cells that look almost like normal

cells when examined under a microscope. Patients

usually don’t have symptoms when these cancers

are found. Differentiated thyroid cancers are the most

commonly diagnosed type of thyroid cancer. Within

this group, there are differences for each cell type.

The results from testing can also differ for these


Papillary thyroid cancer

Papillary is the most common type of thyroid

cancer. Family history of thyroid cancer, a history

of an elevated TSH, and contact with radiation

at a young age have all been factors with

papillary thyroid cancer. It is usually a slow-growing

type of thyroid cancer. It usually starts in one lobe of

the thyroid and can spread to nearby tissue or lymph

nodes. Age is important in the staging of this cancer.

Papillary thyroid cancer is broken down even further

into subtypes. The subtypes include:







ariant of









Tall-cell variant



Columnar variant



Diffuse sclerosing variant

FVPTC is the most common subtype. The other

subtypes can grow and spread more quickly.

When an ultrasound shows further testing is needed,

an FNA is usually done. When FNA results show

papillary thyroid cancer, further testing is done for

treatment planning. An ultrasound of the thyroid

and front and sides of the neck is recommended.

Other imaging tests may include a CT or MRI.

The vocal cord may also be assessed since the

cancer can cause harm to it. Any lymph nodes

seen on ultrasound (side view) may be biopsied

to find out the extent of cancer. Once the testing

is complete, surgery will come next. Surgery is

the primary treatment for papillary thyroid cancer.

See Guide 9.

Navigating the guides

in Part 5

The first set of treatment guides (9–10) will list

options for papillary thyroid cancer found on FNA.

Guide 11 lists options for follicular and Hürthle

cell thyroid cancer. These options include primary

treatment and possible next steps of care.