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What Is Stage 4 Thyroid Cancer

How Common Is Thyroid Cancer

What is papillary thyroid cancer?

Thyroid cancer is a rare form of cancer, accounting for less than 1% of all cancer cases in the UK. Each year, around 2,700 people are diagnosed with thyroid cancer in the UK.

It’s most common in people aged 35 to 39 years and in those aged 70 years or over.

Women are 2 to 3 times more likely to develop thyroid cancer than men. It’s unclear why this is, but it may be a result of the hormonal changes associated with the female reproductive system.

Treatment Of Stage Iv Thyroid Cancer

Medically reviewed by Dr. C.H. Weaver M.D. Medical Editor 9/2021

Stage IV thyroid canceralso called metastatic disease is cancer that has spread beyond the thyroid to the soft tissues of the neck, lymph nodes in the neck, or distant locations in the body. The lungs and bone are the most frequent sites for distant spread. Papillary carcinoma more frequently spreads to regional lymph nodes than to distant sites. Follicular carcinoma is more likely to invade blood vessels and spread to distant locations. Anaplastic thyroid cancer is considered metastatic at diagnosis.

The prognosis for patients with distant metastases has historically been poor but the recent development of newer precision cancer medicines appears promising. Cancer treatment may consist of surgery, radioactive iodine treatment, radiation, chemotherapy, precision cancer medicines or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patients chance of cure and prolonging survival.

Staging And Grading For Stage 4 Cancer

Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:

  • T , or the size of the original tumor
  • N , or whether the cancer is present in the lymph nodes
  • M , or whether the cancer has spread to other parts of the body

Not all cancers are staged using the TNM system, though. Some cancers, especially liquid cancers, are staged through different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Female reproductive system cancers, such as cervical cancer, are staged with a separate staging system created by the International Federation of Gynecology and Obstetrics .

As your care team gathers information about your cancer for the purposes of staging, they may need to order several tests, including:

Your care team may likely also need to perform a biopsy, a procedure that involves removing a sample of cells and analyzing it for signs of cancer. Imaging scans may be able to tell your care team where your cancer is, but looking at the cancer cells specifically tell them how fast they are likely to growor what grade they are.

Grading is different from staging and is done for most, but not all, cancers.

The grade of your cancer is part of how your cancer care team stages your cancer and determines your prognosis, or outlook.

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Demographic And Clinical Characteristics

The clinical characteristics of all TC patients in stage IVB were shown in Table 1, including 1,345 cases with a median age of 70 years . The majority of cases were classified into the tumors > 4 cm group , followed by tumors > 1 cm but 4 cm group and tumors 1 cm group . The rates for PTC, FTC, and anaplastic thyroid cancer were 56.73% , 19.26% , and 8.55% , respectively. In all N categories, the majority of cases of PTC, FTC, ATC, and other variants involved tumors > 4 cm . The overall mortality in all TC cases was 53.73% . The patients with tumors > 4 cm had the highest mortality rate of 67.90% , followed by tumors > 1 cm but 4 cm and 1 cm group. Similar results were obtained in PTC and FTC . A total of 39.63% patients received radioactive iodine therapy or radiation beam plus isotopes or implants, which refer to patients with records in SEER dataset named Combination of beam with implants or isotopes and Radioisotopes . A total of 24.91% patients received therapy of radiation beam or radioactive implants. The rates of patients with tumors > 4 cm were 33.68% , 52.90% , and 81.74% for PTC, FTC, and ATC, respectively. Similar results were obtained in each N category .

Table 1. The clinical characteristics of thyroid cancer with increased tumor size .

When Does Metastatic Thyroid Cancer Show Symptoms

Definition of stage IVA anaplastic thyroid cancer

    Metastatic thyroid cancer, also known as stage 4 thyroid cancer, refers to cancer that has spread from the thyroid gland to distant areas of the body. This is the most advanced stage of thyroid cancer. At this late stage, many symptoms are likely to be present. In fact, symptoms typically appear at an earlier stage and can often be detected before the thyroid cancer has metastasized.

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    What Is The Treatment For Stage Iv Thyroid Cancer

    The cancer can be treated if it has spread to the nearby lymph nodes but not if it has spread to different parts of the body such as the lungs or bones. Then the treatment aims to relieve the patient of the symptoms and improve the quality of life.

    Treatment for stage IV papillary and follicular thyroid cancers:

    The treatment options for stage 4 of papillary or follicular cancers are:

    • Radioiodine therapy
    • Hormone therapy
    • Targeted therapy with tyrosine kinase inhibitor
    • Surgery
    • Clinical trials of chemotherapy and targeted therapy

    Treatment for stage IV medullary thyroid cancer:

    The treatment for stage 4 medullary thyroid cancer is:

    • Total thyroidectomy followed by thyroid hormone therapy because the thyroid gland is removed. This can only keep the patient healthy but does not reduce the risk of cancer coming back. MTC cells do not take up radioactive iodine so radioiodine therapy cannot be used.
    • External beam radiation therapy may be given after surgery to reduce the chance of recurrence.
    • For cancers that have spread to different parts of the body, radiotherapy, chemotherapy and targeted therapy can be used in addition to removing the primary tumour surgically.

    Treatment for stage IV anaplastic thyroid cancer:

    The treatment options for stage IV anaplastic thyroid cancer include:

    • Total thyroidectomy

    Stage 4 Thyroid Cancer Life Expectancy

    • Stage 1: If the tumor is less than 2 cm, the prognosis is good at this stage and has not yet developed beyond the thyroid gland. According to a study, at this stage the person diagnosed 100% is still alive after 10 years.
    • Stage 2: In Stage 2, the tumor is larger than 2 cm, but is still located in the thyroid gland, or has spread to other tissues outside the thyroid gland, but not to the lymph nodes. At this stage, about 93% of the people are still alive after 10 years.
    • Stage 3rd: The tumor has spread to the lymph node or ballot box near the thyroid gland at Stage 3 people diagnosed with medullary thyroid carcinoma in phase 3rd, and still survive for 10 years after about 71%.
    • Phase IV: At this stage, the tumor has spread to the tissues of the neck, trachea, esophagus, throat, or body parts of the skin, such as the lungs or bones. The outlook for the decade has declined significantly: only 21% of the people at this stage are still alive after 10 years.

    Stage 4 thyroid cancer life expectancy

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    How Is Stage 4 Thyroid Cancer Treated

    Im about to sound like a broken record, but this again depends on the type of cancer. For almost all types the first step in treatment is a total thyroidectomy. For patients diagnosed at earlier stages, whose disease has progressed, any remaining thyroid tissue and involved lymph nodes will likely be removed. This is known as a radical neck dissection. Further treatment for papillary and follicular carcinomas involves radioactive iodine treatment. Sadly, these two types of thyroid cancer can become resistant to radioactive iodine, and thus may require radiation and/or chemotherapy.

    Medullary and ananplastic diseases, however, are not sensitive to radioactive iodine at all, and must begin with surgery, followed by radiation/chemotherapy. Further targeted treatments are possible utilizing biomarkers and genetic traits of the tumor.

    Surgical removal of metastases has been utilized in some patients, but it should be understood that the primary outcome with these surgeries is to improve quality of life.

    What Causes Thyroid Cancer

    Staging of Thyroid Cancer

    In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition.

    Risk factors for thyroid cancer include:

    • having a benign thyroid condition
    • having a family history of thyroid cancer
    • having a bowel condition known as familial adenomatous polyposis
    • acromegaly a rare condition where the body produces too much growth hormone
    • having a previous benign breast condition
    • weight and height

    Read more about the causes of thyroid cancer

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    How Is Anaplastic Thyroid Cancer Diagnosed

    Anaplastic thyroid cancer can present in several ways. Most often it presents as a lump or nodule in the neck. These tumors grow very quickly and often growth can be visible to the patient or the family and friends of the patient. In some cases, anaplastic thyroid cancer presents as a neck mass with difficulty swallowing, difficulty breathing, or hoarseness if one of the vocal chords is paralyzed by the tumor.

    Typically, a fine needle aspiration or core biopsy is performed. Once the diagnosis is confirmed, a full assessment of the patients overall health should be completed. This includes blood tests, as well as imaging scans to determine if and where the cancer has spread.

    All patients with Anaplastic Thyroid Cancer are diagnosed as Stage IV due to the aggressive nature of this tumor. There are three sub-stages:

    • Stage IVA: Anaplastic thyroid cancer is present only in the thyroid
    • Stage IVB: Anaplastic thyroid cancer is present in the thyroid and in the neck, but not in other parts of the body
    • Stage IVC: Anaplastic thyroid cancer is present in the thyroid as well as other parts of the body, such as the bones, lungs or brain

    About 10% of patients have anaplastic thyroid cancer that is present only in the thyroid, and approximately 40% of those diagnosed have cancer that is localized in the neck and/or lymph nodes. The remaining patients have anaplastic thyroid cancer that has metastasized to other parts of the body at the time of diagnosis.

    What Kind Of Treatment Will I Need

    There are many ways to treat thyroid cancer but surgery is the main treatment. The treatment plan thats best for you will depend on:

    • The stage of the cancer
    • The chance that a type of treatment will cure the cancer or help in some way
    • Your age
    • Other health problems you have
    • Your feelings about the treatment and the side effects that come with it

    Depending on the type and stage of your thyroid cancer, you may need more than 1 type of treatment.

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    How Might Obesity Increase The Risk Of Cancer

    Several possible mechanisms have been suggested to explain how obesity might increase the risks of some cancers.

    Other possible mechanisms by which obesity could affect cancer risk include changes in the mechanical properties of the scaffolding that surrounds breast cells and altered immune responses, effects on the nuclear factor kappa beta system, and oxidative stress .

    Does Avoiding Weight Gain Or Losing Weight Decrease The Risk Of Cancer


    Most of the data about whether avoiding weight gain or losing weight reduces cancer risk comes from cohort and case-control studies. As with observational studies of obesity and cancer risk, these studies can be difficult to interpret because people who lose weight or avoid weight gain may differ in other ways from people who do not.

    Nevertheless, when the evidence from multiple observational studies is consistent, the association is more likely to be real. Many observational studies have provided consistent evidence that people who have lower weight gain during adulthood have lower risks of colon cancer, kidney cancer, andfor postmenopausal womenbreast, endometrial, and ovarian cancers .

    Fewer studies have examined possible associations between weight loss and cancer risk. Some of these have found decreased risks of breast, endometrial, colon, and prostate cancers among people who have lost weight. However, most of these studies were not able to evaluate whether the weight loss was intentional or unintentional .

    Stronger evidence for a relationship between weight loss and cancer risk comes from studies of people who have undergone bariatric surgery . Obese people who have bariatric surgery appear to have lower risks of obesity-related cancers than obese people who do not have bariatric surgery .

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    Age 55 And Older People 55 Years Of Age And Older When Diagnosed Will Be Given A Stage From 1 To 4 For Differentiated Thyroid Cancer

    Stage 1

    The tumour is only in the thyroid and is no larger than 4 cm.

    Stage 2

    The tumour is larger than 4 cm and may have grown into nearby muscles in the neck.

    The cancer has spread to nearby lymph nodes. The tumour is any size and may have grown into nearby muscles in the neck.

    Stage 3

    • a nerve to the larynx

    The cancer may also have spread to nearby lymph nodes.

    Stage 4A

    The tumour has grown into the connective tissue in front of the spine , into blood vessels in the space between the lungs , or around a carotid artery. The cancer may also have spread to nearby lymph nodes.

    Stage 4B

    The cancer has spread to other parts of the body , such as to the lungs, liver or bone. This is also called metastatic thyroid cancer.

    Can The Cancer Stage Change

    Once diagnosed, a cancers stage never changes. Even if the patient improves or gets worse, their cancer is the same as when diagnosed.

    Once diagnosed with stage 4 cancer, you will always have stage 4 cancer. That doesnt mean that you cannot sustain a long period of disease-free survival.

    Part of the reason for this is statisticalstages help scientists track and reevaluate survival statistics and treatment protocols. But they also let doctors track the efficacy of treatments for your stage.

    Doctors use cancer stages to compare patients with similar diagnoses, to more easily study the effectiveness of treatments, to track a persons cancer progression, and as a way to estimate survival rates for specific cancers.

    Part of the confusion regarding staging status arises from the fact the disease is sometimes re-staged. Re-staging determines if there has been a progression or remission of the disease.

    If cancer is re-staged or recurs , doctors keep the initial staging diagnosis and add a new stage to the patients diagnosis. New staging diagnoses get differentiated with letterslike c for clinical, p for pathological , or y for after treatment.

    For instance, stage 2 breast cancer that suddenly spreads to the lungs is stage 2 breast cancer with lung metastases rather than stage 4 breast cancer. Similarly, if stage 4 breast cancer meets the definition of remission after treatment, they describe it as stage 4 breast cancer with no evidence of disease.

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    What Is The Thyroid Gland

    Your thyroid gland is one of many glands that make up your endocrine system. Endocrine glands release hormones that control different bodily functions.

    The pituitary gland in your brain controls your thyroid gland and other endocrine glands. It releases thyroid-stimulating hormone . As the name suggests, TSH stimulates your thyroid gland to produce thyroid hormone.

    Your thyroid needs iodine, a mineral, to make these hormones. Iodine-rich foods include cod, tuna, dairy products, whole-grain bread and iodized salt.

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    Stage Iv Of Thyroid Cancer:

    Thyroid Cancer: what is my prognosis?

    The characteristics of stage IV thyroid cancer on the basis of age and type of thyroid cancer is as follows:

    Stage IV papillary and follicular thyroid cancer:

    Stage IVA: The tumour can be of any size and has grown extensively beyond the thyroid gland towards the back of the spine and into large blood vessels nearby, it might or might not have spread to nearby lymph nodes but has not spread to distant organs and the staging is .

    Stage IVB: The tumour can be of any size, it might or might not have spread into nearby lymph nodes but has spread to other parts of the body and the staging is .

    Stage IV medullary thyroid cancer:

    Stage IVA: The tumour can be of any size but has grown beyond the thyroid gland and has spread to nearby tissues in the neck. The tumour may or may not have spread to nearby lymph nodes but has not spread to distant organs and the staging is or the tumour is of any size but has not affected external structures but has spread to nearby lymph nodes and not to distant organs and the staging is where X can be 1, 2 or 3.

    Stage IVB: The tumour can be of any size and has grown extensively beyond the thyroid gland towards the back of the spine and into large blood vessels nearby, it might or might not have spread to nearby lymph nodes but has not spread to distant organs and the staging is .

    Stage IVC: The tumour can be of any size, it might or might not have spread into nearby lymph nodes but has spread to other parts of the body and the staging is .

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    Overview Of Typical Thyroid Cancer Treatment

    • Thyroid cancer is usually diagnosed by sticking a needle into a thyroid nodule or removal of a worrisome thyroid nodule by a surgeon.
    • The thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign or malignant .
    • The pathologist decides the type of thyroid cancer: papillary, follicular, mixed papillary-follicular, medullary, or anaplastic.
    • The patient must be comprehensively evaluated with a thorough high-resolution ultrasound. Not only must the thyroid be completely examined. But the entire lymph nodes of the neck need to be examined to determine whether there is any spread to lymph nodes. Any suspicious lymph nodes must be biopsied prior to surgery so that the correct surgical procedure can be done the first time! You can find out more about the importance of high-resolution ultrasound in the evaluation of your thyroid nodule or cancer your in this video on thyroid nodules.

    The entire thyroid cancer must be surgically removed sometimes with just partial removal of the thyroid gland or total removal of the thyroid gland. With the use of high-resolution ultrasound before your operation and by expert inspection by your surgeon during your operation, the lymph nodes in the neck are examined to see if lymph nodes also need to be removed.


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