Staging of Patients With Medullary Thyroid Cancer

Panelists: Ezra Cohen, MD, University of Chicago; Eric J. Sherman, MD, MSKCC;
Steven I. Sherman, MD, MD Anderson; R. Michael Tuttle, MD, MSKCC;
Lori J. Wirth, MD, Mass General
Published Online: Friday, August 9, 2013
For High-Definition, Click
The staging of a patient with medullary thyroid cancer (MTC) is generally performed during the initial diagnosis. The first step in this process is to check both calcitonin and CEA levels, explains Eric J. Sherman, MD. Following this procedure, imaging of the neck, chest, and liver should be performed to assess tumor size and for the presence of metastases. In general, the type of imaging utilized depends on the CEA and calcitonin levels but in many situations a PET-CT scan is not required, Eric Sherman believes.

In general, calcitonin and CEA are the primary biomarkers in MTC, notes Steven I. Sherman, MD. As patients are followed over time, these markers will change proportionately. As a result, it is important to follow both levels, as a way of verifying the accuracy of testing, believes R. Michael Tuttle, MD. This is further enhanced by inconsistencies in calcitonin assays.

Once calcitonin and CEA levels are assessed, they can be utilized to customize imaging. If both levels are high, Lori J. Wirth, MD believes that performing a PET-CT scan of the neck and chest and an MRI of the liver may help characterize the overall disease burden. Research has suggested, Tuttle adds, that patients with a calcitonin level in the multi-thousands may benefit from a conglomeration of tests, including CT scans of the liver and an MRI of the spine.

In general, bone scans are ineffective for detecting bone metastases in patients with MTC, Steven Sherman notes. Instead, contrast enhanced tomographic imaging is required, to detect the often hypervascular tiny lesions that represent early metastases. As a result, MRI of the spine and pelvis should both be standard procedures, Steven Sherman believes.
View More From This Discussion
Episode 1 Introduction and Overview of MTC Diagnosis Challenges
Episode 2 Customizing Imaging Based on Calcitonin Levels in MTC
Episode 3 Genetic Testing and Screening in Medullary Thyroid Cancer
Episode 4 Genetic Testing and Screening in Advanced MTC
Episode 5 Staging of Patients With Medullary Thyroid Cancer
Episode 6 Nonsurgical Treatment Options for Early-Stage MTC
Episode 7 Multidisciplinary Treatment of Medullary Thyroid Cancer
Episode 8 Treating Advanced Medullary Thyroid Cancer
Episode 9 Mutations and Targeted Therapies in Advanced MTC
Episode 10 Treatment-Related Toxicity in Advanced MTC
Episode 11 Therapies in Development for Medullary Thyroid Cancer
Episode 12 Conclusion: Key Take-Away Points and Final Thoughts
Expert Panelists
Ezra Cohen Moderator

Ezra Cohen, MD

Associate Professor, Section of Hematology/Oncology, Department of Medicine
Co-Director, Head and Neck Cancer Program
Director, Hematology/Oncology Fellowship Program
University of Chicago Medical Center
Chicago, Illinois

Eric J. Sherman, MD

Assistant Professor & Medical Oncologist, Department of Medicine
Memorial Sloan Kettering Cancer Center
New York, New York

Steven I. Sherman, MD

Chair and Professor, Department of Endocrine Neoplasia & Hormonal Disorders
The University of Texas MD Anderson Cancer Center, Houston, Texas

R. Michael Tuttle, MD

Endocrinologist, Endocrinology Service
Memorial Sloan Kettering Cancer Center
New York, New York

Lori J. Wirth, MD

Assistant Professor, Department of Medicine,
Harvard Medical School
Massachusetts General Hospital
Boston, Massachusetts
Online CME Activities
Free CME from PER
PARP Inhibitors: Current and Future Options for Breast and Ovarian Cancer
Rapid Summaries and Commentaries: Update from Chicago - Advances in the Treatment of Lung Cancer
Medical Crossfire®: The JAK-STAT Pathway as a Mediator of Onco-Inflammation
2nd Annual Miami Lung Cancer Conference™ Medical Crossfire® Case Discussion
The content contained in this video is for general information purposes only. The viewer is encouraged to confirm the information presented with other sources. OncLiveTV Peer Exchange makes no representations or warranties of any kind about the completeness, accuracy, timeliness, reliability, or suitability of any of the information, including content or advertisements, contained in this video and expressly disclaims liability for any errors and omissions that may be presented in this video. OncLiveTV Peer Exchange reserves the right to alter or correct any error or omission in the information it provides in this video, without any obligations. OncLiveTV Peer Exchange further disclaims any and all liability for any direct, indirect, consequential, special, exemplary, or other damages arising from the use or misuse of any material or information presented in this video. The views expressed in this video are those of the panelists and do not necessarily reflect the opinion or policy of OncLiveTV Peer Exchange.
More Reading