Surgical management of papillary thyroid cancer: review of current evidence  and consensus

Jayarajah, Umesh; Nagodavithane, Kavinda; Basnayake, Oshan; Seneviratne, Sanjeewa

doi:10.4038/sljs.v37i4.8617

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…Majority of cancers are treated based on globally accepted guidelines formulated by well-recognized authorities from the Western world [29,30]. Some of the newer therapeutic modalities related to precision therapy and targeted therapy are not available in Sri Lanka due to cost constraints and the limited benefits in terms of improvement of outcomes.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Cancer services in Sri Lanka: current status and future directions

Jayarajah

Abeygunasekera

2021

J Egypt Natl Canc Inst

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Background The burden of cancer in Sri Lanka is on the rise. The overall incidence of cancer in Sri Lanka has doubled over the past 25 years with a parallel rise in cancer-related mortality. Cancer has become the second commonest cause of hospital mortality in Sri Lanka. In this review, we aim to provide an overview of the current status and future direction of cancer care in Sri Lanka. Main body In Sri Lanka, cancer services are predominantly provided by the state sector free of charge to the general public. With the establishment of national cancer policy on cancer prevention and control, there has been a commendable improvement in the cancer services provided island-wide. An increasing number of breast, oropharyngeal, thyroid, oesophageal, colorectal, lung, and gastric cancers are being diagnosed and treated annually. Primary prevention measures include restrictions in tobacco and HPV vaccination. Screening programs for selected cancers such as breast, oral and cervical cancers are delivered. Medical oncology units with facilities for systemic therapy and adequately supported by surgical, pathology, and radiology departments have been established in each district general hospital island-wide. Although the current progress is commendable, future changes are necessary to overcome the current limitations and to cater the ever increasing burden of cancer. Measures are necessary to enhance the coverage of Sri Lanka Cancer Registry. Timely high-quality research and audits are essential. Community participation in planning strategies for cancer prevention and treatment is minimal. Community-based palliative care facilities and radiation and other systemic therapy should be made available in all provinces. A culture of multi-disciplinary care with proper referral pathways would help to improve the current setting. Conclusion In conclusion, Sri Lanka has a reasonably balanced and continuously expanding program for prevention, screening, and treatment of cancers. Emphasis on preventive strategies related to reducing tobacco smoking, chewing betel, and obesity, making cancers a notifiable disease, involving the community in planning cancer care and prevention strategies, conducting research to evaluate cost-effectiveness of existing treatment and increasing radiotherapy facilities would further improve the cancer services in Sri Lanka.

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Section: Diagnosis and Treatmentmentioning

confidence: 99%

Cancer services in Sri Lanka: current status and future directions

Jayarajah

Abeygunasekera

2021

J Egypt Natl Canc Inst

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“…1 Unlike in differentiated thyroid cancers, the low incidence and limited number of large-scale studies of MTC have resulted in a paucity of highquality evidence to reach a consensus on diagnosis and treatment. 5 Most MTCs are sporadic (75%) although some (25%) are hereditary, either familial or occurring in association with multiple endocrine neoplasia type 2 (MEN 2) syndrome secondary to a germline mutation in the RET proto-oncogene. 6 Total thyroidectomy is the mainstay of treatment, which may be combined with central only or central and lateral neck dissection owing to frequent cervical lymph node metastases.…”

Section: Introductionmentioning

confidence: 99%

“…1 Unlike in differentiated thyroid cancers, the low incidence and limited number of large-scale studies of MTC have resulted in a paucity of high-quality evidence to reach a consensus on diagnosis and treatment. 5…”

Section: Introductionmentioning

confidence: 99%

Management of medullary carcinoma of the thyroid: a review

et al. 2022

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Medullary thyroid carcinoma (MTC) is an uncommon malignancy of neuroendocrine origin derived from the parafollicular C cells. Although infrequent, the interest in this cancer exceeds its incidence owing to its distinctive features and its characteristic association with other endocrine tumors. Although the majority of MTCs are sporadic, hereditary varieties occur in isolation or as a part of multiple endocrine neoplasia type 2 syndrome (MEN 2). Currently, complete surgical resection of the tumor and nodal metastases with a curative intent remains the mainstay of therapy. The role of adjuvant therapy is limited, although radiotherapy and newer targeted therapies are routinely used for metastatic disease. The lack of consensus in the available guidance regarding the most appropriate diagnostic, therapeutic and follow-up strategies has caused substantial variability in clinical practice. Therefore, this review summarizes the latest available evidence and guidelines on the management of MTC with an emphasis on diagnosis, surgical treatment and follow-up.

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“…Radioactive iodine (RAI) ablation following thyroidectomy is the standard of care for most patients who are diagnosed with differentiated thyroid carcinoma [1][2][3]. RAI is administered with the primary objective of eliminating any residual thyroid cancer cells.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic prednisolone for the prevention of early and intermediate adverse effects of radioactive iodine therapy in patients with thyroid cancer: study protocol for a single-centre, phase II/III, randomized, double-blinded, placebo-controlled clinical trial

Jayarajah

Wijekoon

Seneviratne

2020

Trials

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Background Radioactive iodine (RAI) therapy is the standard adjuvant treatment for differentiated thyroid cancer (i.e. papillary and follicular). RAI is associated with troublesome early, intermediate and late adverse effects. Although glucocorticoids are used for the management of these adverse effects, there is little evidence regarding the effectiveness of prophylactic glucocorticoids to prevent these complications. This trial will evaluate the efficacy of a short course of prophylactic glucocorticoids in the prevention of adverse effects of RAI treatment in patients with differentiated thyroid cancer. Methods A phase II/III, single-centre, randomized, double-blinded, placebo-controlled, parallel-arm clinical trial will be conducted. Patients with differentiated thyroid cancer who are referred to RAI therapy at the National Cancer Institute, Sri Lanka, will be randomized into two arms consisting of 200 patients each. The experimental group will receive prophylactic oral prednisolone 0.5 mg/kg and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral prednisolone 0.5 mg/kg and omeprazole 20 mg daily for 3 days. The control group will receive oral placebo and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral placebo and omeprazole 20 mg daily for 3 days. Clinically significant adverse effects assessed as related to RAI as well as prednisolone therapy and the quality of life parameters will be compared between the two groups. Discussion If proven beneficial, this intervention can be incorporated into the standard practice to reduce early and intermediate adverse effects of RAI for thyroid cancer with a potential improvement of quality of life. Trial registration Sri Lanka Clinical Trials Registry SLCTR/2020/009. Registered prospectively on 23 February 2020. Items of the WHO Trial Registration Data Set are provided in the supplementary file.

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Surgical management of papillary thyroid cancer: review of current evidence and consensus

Cited by 4 publications

References 32 publications

Cancer services in Sri Lanka: current status and future directions

Cancer services in Sri Lanka: current status and future directions

Management of medullary carcinoma of the thyroid: a review

Prophylactic prednisolone for the prevention of early and intermediate adverse effects of radioactive iodine therapy in patients with thyroid cancer: study protocol for a single-centre, phase II/III, randomized, double-blinded, placebo-controlled clinical trial

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