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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017


Treatment guide

Medullary thyroid cancer

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.

Medullary thyroid cancer

Medullary thyroid cancer starts in the neuroendocrine

parafollicular C cells of the thyroid. Most people with

medullary thyroid cancer did not inherit this cancer. In

other words, they did not have a family member with

a genetic mutation for thyroid cancer and they cannot

pass this cancer on to their children.

About 20 out of 100 medullary thyroid cancers are

caused by a genetic mutation. This change in the

gene can be passed from parent to child. Some

people who discover that they have this mutation

choose to have prophylactic surgery before the

cancer develops to prevent medullary thyroid cancer

from occurring. The inherited type of medullary

thyroid cancer is called familial medullary thyroid

cancer or MEN2. It can start at a young age unlike

the non-inherited version, which can start at age 50

to 60 years of age.

This type of thyroid cancer tends to spread to the

lymph nodes or distant parts of the body like the

lung, liver, or bones. FNA biopsy can diagnosis this

type of thyroid cancer. Further testing will occur for

treatment planning. This may include measuring the

level of calcitonin produced by this cell type. Other

levels that are tested are CEA and calcium in the

blood. Molecular testing is usually done to check for

RET mutations in families.

Testing for other tumors are done if an inherited

medullary cancer is suspected. An ultrasound of the

thyroid, including the front and sides of the neck,

should be done before surgery. Other imaging

tests may include a CT scan of the chest or MRI of

the liver. Once the results are reviewed, treatment

planning will begin and treatment usually starts with