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:
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.