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The primary role for surgery in advanced medullary thyroid cancer (MTC) is local control in the neck and metastatic sites, believes R. Michael Tuttle, MD. In advanced disease, surgery does not represent a curative treatment option. Moreover, Tuttle remarks, in advanced disease, surgery does not prolong survival; however, it could improve quality of life, by preventing fractures or local airway control issues.
If excessive complications are associated with surgery, radiation therapy may be an option for local control, says Eric J. Sherman, MD. However, MTC is not generally a radiation sensitive disease. As a result, it should be reserved for quickly growing or bulky disease.
For slowly progressive or stable disease, watchful waiting may be an appropriate option until a curative treatment is found, notes Steven I. Sherman, MD. As part of this approach, the occurrence of several distinct symptoms should be monitored, these include: diarrhea, Cushing's syndrome, ACTH production, bone pain, neurologic symptoms, and flushing. Additionally, the calcitonin and CEA doubling times should be monitored for these patients.
Calcitonin and CEA doubling times provide information about prognosis but not necessarily as it relates to systemic therapy, Lori J. Wirth, MD, points out. It is important not to translate increases in these markers with a need to initiate systemic therapy. Instead, Wirth notes, disease burden can be utilized to indicate a need for systemic therapy. Moreover, Tuttle notes, even in the case of disease that is not progressive, if the tumor burden is high, there may be a need to initiate treatment, to avoid serious symptoms, such as Cushing's syndrome.
In addition to these factors, the location makes a considerable difference, notes Eric Sherman. A rapidly progressing tumor in the lung may not cause as many issues as one in the neck, he adds.