Radiation Oncology/Thyroid/Staging
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Thyroid: Main Page | Workup | Staging | Papillary and follicular | Medullary | Hurthle cell | Anaplastic | |
Thyroid Cancer Staging
AJCC Staging
editAJCC 7th Edition (2009)
Primary tumor
- T0 - No evidence of primary tumor
- T1 - Tumor 2 cm or less, limited to the thyroid
- T1a - Tumor 1 cm or less
- T1b - Tumor >1 cm but <= 2 cm
- T2 - Tumor >2 cm but <=4 cm, limited to the thyroid
- T3 - Tumor >4 cm, limited to the thyroid, or any tumor with minimal extrathyroidal extension (e.g. extension to sternothyroid muscle or perithyroid soft tissues)
- T4a - Tumor extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal N
- T4b - Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels
Anaplastic carcinoma: All anaplastic carcinomas are considered T4 tumors
- T4a - Intrathyroidal anaplastic carcinoma
- T4b - Anaplastic carcinoma with gross extrathyroid extension
Nodes
- N0 - no regional lymph node metastasis
- N1 - regional lymph node metastasis
- N1a - Metastasis to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
- N1b - Metastasis to unilateral, bilateral, or contralateral cervical (Levels I-V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)
Distant Metastasis
- M0 - none
- M1 - yes
Stage grouping
- Papillary or follicular
- (Age under 45 years)
- Stage I - Any T, Any N, M0
- Stage II - Any T, Any N, M1
- Papillary or follicular
- (45 years and older)
- Stage I - T1 N0 M0
- Stage II - T2 N0 M0
- Stage III - T3 or N1a
- Stage IVA - T4a or N1b
- Stage IVB - T4b, Any N, M0
- Stage IVC - M1
- Medullary carcinoma (all age groups)
- Stage I - T1 N0 M0
- Stage II - T2-T3 N0 M0
- Stage III - T1-3 N1a M0
- Stage IVA - T4a or N1b
- Stage IVB - T4b, Any N, M0
- Stage IVC - M1
- Anaplastic carcinoma
All anaplastic carcinomas are considered Stage IV
- Stage IVA - T4a, Any N, M0
- Stage IVB - T4b, Any N, M0
- Stage IVC - M1
Changes from 6th edition
- Subdivided T1 into T1a and T1b
Other Staging Systems
edit- See also: Thyroid cancer prognostic indices (e.g. AMES, AGES, MACIS)
National Thyroid Cancer Treatment Cooperative Study (NTCTCS) Staging Classification
| Papillary Carcinoma | Follicular Carcinoma | |||
|---|---|---|---|---|
| Age < 45 | Age ≥ 45 | Age < 45 | Age ≥ 45 | |
| Primary tumor size (cm) | ||||
| <1 | I | I | I | II |
| 1-4 | I | II | I | III |
| >4 | II | III | II | III |
| Primary tumor characteristics | ||||
| Microscopic multifocal | I | II | I | III |
| Macroscopic multifocal or Macroscopic tumor capsule invasion |
I | II | II | III |
| Microscopic extraglandular invasion | I | II | I | III |
| Macroscopic extraglandular invasion | II | III | II | III |
| Poorly differentiated | NA | NA | III | III |
| Metastases | ||||
| Cervical lymph node metastases | I | III | I | III |
| Extracervical (distant) metastases | III | IV | III | IV |