Medullary Thyroid cancer

Question 1

Falsely elevated calcitonin

Answer 1

hypercalcemia, hypergastrinemia, neuroendocrine tumors, renal insufficiency, papillary and follicular thyroid carcinomas, goiter, and chronic autoimmune thyroiditis [18,19]. Furthermore, prolonged treatment with omeprazole (greater than two to four months), beta-blockers, and glucocorticoids have been associated with hypercalcitoninemia

Question 2

EVALUATION

Answer 2

Evaluation should include measurement of

• serum calcitonin
• carcinoembryonic antigen (CEA)
• ultrasonography of the neck (if not already performed)
• genetic testing for germline RET mutations
• biochemical evaluation for coexisting tumors, especially pheochromocytoma.

Serum calcitonin and CEA
Radiologic evaluation
Genetic screening in sporadic MTC
Testing for coexisting tumors

Question 3

Staging

Answer 3

Stage I — MTCs that are less than 2 cm in diameter without evidence of disease outside of the thyroid gland
Stage II — Any tumor between 2 and 4 cm without evidence of extrathyroidal disease
Stage III — Any tumor greater than 4 cm, or level VI nodal metastases or microscopic extrathyroidal invasion regardless of tumor size
Stage IV — Any distant metastases, or lymph node involvement outside of level VI, or gross soft tissue extension

Question 4

doubling times

Answer 4

in one study

survival in a study of 65 patients followed for 3 to 30 years [26]. Ten year survival was 8 percent, 37 percent, and 100 percent for doubling times under six months, between six months and two years, and greater than two years, respectively