Stage IV thyroid cancer is a difficult condition to treat and the prognosis is not as good as in earlier stages. In some cases, palliative care may be the only option if the cancer has spread to the brain. A complete cure may not be possible once the cancer reaches stage IV. However, most types of thyroid cancer have a 100% cure rate when detected in the early stages (stages I and II).Treatments for stage IV thyroid cancer include surgery, radiation therapy, and targeted therapy medications such as lenvatinib (Lenvima) and sorafenib (Nexavar).
The type of treatment you receive and how well your cancer responds to it can affect your outcome. Medullary thyroid cancer is a neuroendocrine tumor that develops in the C cells of the thyroid. These cells produce a hormone (calcitonin) that helps maintain a healthy level of calcium in the blood. A certain change in the RET gene that is passed from parent to child (hereditary) can cause medullary thyroid cancer. A genetic test is used to check for this modified gene.
The patient is first tested to see if they have the modified gene. If they do, other family members may also be tested to determine if they have an increased risk of medullary thyroid cancer. Family members, including young children, who have the modified gene may have a thyroidectomy (surgery to remove the thyroid) to lower their chance of developing medullary thyroid cancer. Localized medullary thyroid cancer is found only in the thyroid and may have spread to nearby neck muscles. Locally advanced and metastatic thyroid cancer has spread to other parts of the neck or other parts of the body.
Radioactive iodine therapy is not used to treat medullary thyroid cancer. Most people diagnosed with thyroid cancer have an excellent prognosis, since most thyroid cancers can be cured with radioactive iodine treatment. This treatment uses a form of iodine that is radioactive to kill thyroid cells and any remaining thyroid cancer cells after surgery. Radiation therapy is another form of treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. During a fine-needle aspiration biopsy, a long, thin needle is inserted through the skin into the thyroid nodule. The prognosis for a patient under 45 years of age with differentiated thyroid cancer (papillary or follicular) is good.
When palliative care is used in conjunction with all other appropriate treatments, people with cancer can feel better, have a better quality of life, and live longer. Chemotherapy is another form of treatment that uses drugs to stop the growth of cancer cells, either by destroying them or preventing them from multiplying. For more information on treatments for stage IV thyroid cancer, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-623).Staging guidelines developed by the American Joint Committee on Cancer (AJCC) are often used to stage thyroid cancers. When cancer has spread to other parts of the body such as the lungs and bones, treatment usually doesn't cure it but it can relieve symptoms and improve quality of life. Doctors use diagnostic tests to determine the stage of the cancer, so staging may not be complete until all tests have been completed. The staging system for thyroid cancer is very similar for elderly patients with differentiated tumors and those with medullary thyroid cancer.
The operation that the health care team might recommend depends on the type of thyroid cancer, its size, and whether it has spread beyond the thyroid to lymph nodes. Your multidisciplinary team will work with you to develop a personalized plan that fits your individual needs and goals. For information on childhood thyroid cancer, see the PDQ summary on Childhood Thyroid Cancer Treatment. For example, if the 5-year relative survival rate for a specific stage of thyroid cancer is 90%, it means that people who have that cancer are on average about 90% more likely than people who do not have that cancer to live for at least 5 years after diagnosis. When chemotherapy is taken by mouth or injected into a vein or muscle, it enters the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).