Stage 4 thyroid cancer with metastasis forming in lungs prognosis

ON THIS PAGE: You will find information about the number of people who are diagnosed with thyroid cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 43,800 adults (11,860 men and 31,940 women) in the United States will be diagnosed with thyroid cancer. Thyroid cancer is the seventh most common cancer in women. Worldwide, an estimated 586,202 people were diagnosed with thyroid cancer in 2020.

Until recently, thyroid cancer was the most quickly increasing cancer diagnosis in the United States. Researchers believe that part of the reason for the increase was that new, highly sensitive diagnostic tests led to increased detection of smaller cancers. But from 2014 to 2018, the incidence rate dropped by 2.5% annually as more conservative criteria for diagnosing thyroid cancer was used. Thyroid cancer is often diagnosed at a younger age, compared to other adult cancers.

It is estimated that 2,230 deaths (1,070 men and 1,160 women) from this disease will occur in the United States this year. The death rate stayed steady from 2010 to 2019. Women are 3 times more likely to have thyroid cancer than men. However, women and men die at similar rates. This suggests that men have a worse prognosis than women when there is a diagnosis of thyroid cancer. Prognosis is the chance of recovery. In 2020, an estimated 43,646 people died from thyroid cancer worldwide.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. In the United States, the 5-year survival rate for people with thyroid cancer is 98%. However, survival rates are based on many factors, including the specific type of thyroid cancer and stage of disease.If the cancer is located only in the thyroid, it is called localized thyroid cancer. About two-thirds of cases are diagnosed at this stage. The 5-year survival rate is almost 100% for localized papillary, follicular, and medullary thyroid cancers. For localized anaplastic thyroid cancer, the 5-year survival rate is 34%.

If thyroid cancer has spread to nearby tissues or organs and/or the regional lymph nodes, it is called regional thyroid cancer. The 5-year survival rate for regional papillary thyroid cancer is 99%. For regional follicular cancer, the rate is 98%, and for regional medullary cancer, the rate is 90%. For regional anaplastic thyroid cancer, the rate is 9%.

Medullary and anaplastic thyroid cancers, which together make up about 3% of all thyroid cancers, are more likely to spread. If there is distant spread to other parts of the body, it is called metastatic disease. The 5-year survival rate for metastatic papillary thyroid cancer is 75%. For metastatic follicular thyroid cancer, the rate is 63%. The rate for metastatic medullary thyroid cancer is 40%. For metastatic anaplastic thyroid cancer, the rate is 4%.

It is important to remember that statistics on the survival rates for people with thyroid cancer are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. This means the estimate may not reflect the results of advancements in how thyroid cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts & Figures 2022 and Cancer Facts & Figures 2020, the ACS website, and the International Agency for Research on Cancer website. (All sources accessed January 2022.)

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by thyroid cancer. Use the menu to choose a different section to read in this guide.

Treatment of stage IV - metastatic and recurrent Thyroid Cancer

Treatment of stage IV - metastatic and recurrent Thyroid Cancer

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

Stage IV thyroid cancer—also 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 patient’s chance of cure and prolonging survival.

Treatment is usually a combination of treatment techniques including surgery to remove cancer and radioactive iodine treatment. Surgery for typically consists of removing the entire thyroid if it has not already been performed.

Radioactive Iodine Treatment; Research indicates that treatment with radioactive iodine improves survival for patients with thyroid cancer that has spread to nearby lymph nodes or to distant locations in the body.1,2

Metastatic disease that is radiation resistant is treated with systemic “chemotherapy” medications called multi-kinase inhibitors and precision cancer medicines.

Anaplastic and Medullary Thyroid Cancer

Anaplastic and medullary thyroid carcinoma are inherently non-sensitive to radioactive iodine treatment,2 and require treatment with precision cancer medicines or participation in a clinical trial.

Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body and consists of chemotherapy and precision cancer medicines. Chemotherapy has not been very effective but newer precision cancer medicines appear promising.3-9

Precision Cancer Medicines

The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the thyroid cancer cells with specific abnormalities, leaving normal cells largely unharmed.6-8

Patients should discuss the role of genomic-biomarker testing for the management of their cancer with their treating oncologist.

• Precision Cancer Medicines used to Treat Advanced Thyroid Cancer
• Cancer driving mutations that can be measured and targeted with precision cancer medicines and immunotherapy.

The FDA has approved Cabometyx for the treatment of adult and pediatric patients aged 12 years and older with locally advanced or metastatic differentiated thyroid cancer that has progressed after prior VEGF-targeted therapy and who are radioactive iodine–refractory or ineligible.13,14

Surgery

If patients with recurrent thyroid cancer have not already had their thyroid removed, they will likely undergo a total thyroidectomy to remove the rest of their thyroid and any other cancer in the neck region. Patients who have had their thyroid removed also often have recurrent cancer in the neck region and will undergo surgery to have as much of the cancer as possible removed.

Surgery to remove metastases: Surgery to remove metastases from thyroid cancer has been shown to benefit some patients. In a clinical trial, metastases from thyroid cancer were removed from the mediastinum (area behind the breast bone), lung, bone, kidneys, and brain of 29 patients with advanced thyroid cancer. All patients were also treated with multiple radioiodine treatments. External-beam radiation therapy, chemotherapy, and other measures to relieve symptoms of the cancer were used.4

Strategies to Improve Treatment

Iodine Resensitization: Radioactive iodine (RAI) is widely used in the treatment of advanced follicular cell-derived thyroid cancers, but patients may become develop radiation resistant disease. This occurs because of down regulation of the sodium-iodide symporter gene (SLC5A5, more commonly known as NIS).

Researchers have figured out how to turn or enhance “redifferentiation” of NIS so that: the cancer cells can be treated with radioiodine again. Retinoids, Selumetinib (a MEK inhibitor) and Dabrafenib (BRAF inhibitor) have been shown to restore RAI uptake in advanced patients.10-12

References:

1. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid. Surgery. 2005;128(6):1072-6.
2. Rosenbluth BD, Serrano V, Happersett L, et al. Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer. International Journal of Radiation Oncology Biology Physics. 2005;63(5):1419-26.
3. De Besi P, Busnardo B, Toso S, et al. Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. Journal of Endocrinology Investigation. 1991;14(6):475-80.
4. Pak H, Gourgiotis L, Chang WI, et al. Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. Journal of Surgical Oncology. 2003;82(1):10-8.
5. Schlumberger M, Makoto T, Wirth L, et al. The New England Journal of Medicine; 372:621-630 February 12, 2015.
6. Brose MS, Sherman SI, Schöffski P, et al. Correlative analyses of RET and RAS mutations in a phase III study of cabozantinib in patients with progressive, metastatic medullary thyroid cancer. Presented at the 83rd Annual Meeting of the American Thyroid Association, October 16- 20, 2013, in San Juan, Puerto Rico. Thyroid. October 2013, 23(S1): A-1-A-114. Abstract 4.
7. FDA approves Nexavar to treat type of thyroid cancer. [FDA News Release]. U.S. Food and Drug Administration website. Available at:
8. Advanced Thyroid Cancer Responds to Targeted Therapy with Sunitinib [press release]. Endocrine Society website. Available at: .
9. De Besi P, Busnardo B, Toso S, et al. Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. Journal of Endocrinology Investigation. 1991;14(6):475-80.
10. Kogai T, Brent GA. The sodium iodide symporter (NIS): regulation and approaches to targeting for cancer therapeutics. Pharmacol Ther. 2012;135(3):355–370. doi: 10.1016/j.pharmthera.2012.06.007.[
11. Ho AL, et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med. 2013;368(7):623–632. doi: 10.1056/NEJMoa1209288.
12. Rothenberg SM, et al. Redifferentiation of iodine-refractory <em>BRAF</em> V600E-mutant metastatic papillary thyroid cancer with Dabrafenib. Clin Cancer Res. 2015;21(5):1028–1035. doi: 10.1158/1078-0432.CCR-14-2915.
13. Exelixis announces US FDA approval of CABOMETYX (cabozantinib) for patients with previously treated radioactive iodine-refractory differentiated thyroid cancer. News release. Exelixis. September 17, 2021. Accessed September 17, 2021.
14. //bit.ly/3kiaxa8 Brose MS, Robinson B, Sherman SI, et al. Cabozantinib versus placebo in patients with radioiodine-refractory differentiated thyroid cancer who have progressed after prior VEGFR-targeted therapy: results from the phase 3 COSMIC-311 trial. J Clin Oncol. 2021;39(suppl 15):6001. doi:10.1200/JCO.2021.39.15_suppl.6001