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Health Line
15 hours ago
- Health
- Health Line
Understanding the Stages of Thyroid Cancer
Key takeaways Thyroid cancer staging helps doctors determine the best treatment and predict the likely outcome. It uses the American Joint Committee on Cancer (AJCC)'s TNM system, which assesses tumor size, lymph node involvement, and metastasis. Staging differs among the main types of thyroid cancer, including medullary, follicular, papillary, and anaplastic. Anaplastic thyroid cancer is aggressive and is always stage IV. Early stage cancers generally have better treatment outcomes and survival rates. The American Cancer Society estimates that about 43,800 people in the United States will be diagnosed with thyroid cancer by the end of 2022. Women are affected three times more often than men. Doctors stage thyroid cancer from stage I to stage IV depending on how far along your cancer has progressed. Different staging systems are used for different types of thyroid cancer. Keep reading to learn more about how the most common types of thyroid cancer are staged. How is the staging for thyroid cancer determined? Thyroid cancer is most often staged using the American Joint Committee on Cancer (AJCC) TNM staging system. This staging system considers: T: How big the tumor is and whether it has spread to nearby tissues. N: Whether the cancer has spread into nearby lymph nodes. M: Whether the cancer has metastasized, meaning spread to distant tissues. The AJCC staging system differs depending on which type of thyroid cancer you have. The four main types are: Medullary thyroid cancer: Develops in special cells called C cells that produce the hormone calcitonin. Follicular thyroid cancer: A usually slow-growing cancer that develops in follicular cells. These cells produce and secrete triiodothyronine (T3) and thyroxine (T4). Papillary thyroid cancer: Develops in follicular cells and makes up 80% to 85% of thyroid cancers. It generally has the best outlook. Anaplastic thyroid cancer: Makes up less than 2% of thyroid cancers but is the most aggressive type. It develops in follicular cells. Knowing which stage you're in helps doctors figure out what the best treatment option may be. It can also give you and your healthcare team the best idea of what to expect in terms of life expectancy and chances of being cured. Staging for medullary thyroid cancer The overall 5-year relative survival rate for medullary thyroid cancer is nearly 100% if it's limited to your thyroid and 89% for all stages combined. The 5-year relative survival rate is a measure of how many people with the cancer are alive 5 years later compared to people without the cancer. Here's a look at the AJCC's TNM system for medullary thyroid cancer: Stage TNM groups Description I T1 N0 M0 T1: The cancer is smaller than 0.8 inches across and only found in the thyroid. N0: It has not spread to nearby lymph nodes. M0: It has not spread to distant body parts. II T2 N0 M0 T2: The cancer is bigger than 0.8 inches but smaller than 1.6 inches across. It's only found in the thyroid. N0: It has not spread to nearby lymph nodes. M0: It has not spread to distant body parts. OR II T3 N0 M0 T3: The cancer is larger than 1.6 inches across and is limited to the thyroid or has grown outside the thyroid but hasn't spread to nearby tissues. N0: It has not spread to nearby lymph nodes. M0: It has not spread to distant body parts. III T1, T2, or T3 N1a M0 T1 to T3: The cancer can be any size but hasn't invaded tissues around your thyroid. N1a: The cancer has spread to lymph nodes in your neck. M0: The cancer hasn't spread to any distant body parts. IVA T4a Any N M0 T4a: The cancer is any size and has grown into nearby tissues such as your windpipe or voice box. Any N: It may or may not have spread to nearby lymph nodes. M0: It hasn't spread to distant body parts. OR IVA T1, T2, or T3 N1b M0 T1 to T3: The cancer is any size and may have grown outside the thyroid. It hasn't grown into any nearby structures. N1b: The cancer has spread to lymph nodes in your neck. M0: The cancer has not spread to distant body parts. IVB T4b Any N M0 T4b: The cancer is any size and has either grown toward your spine or into major blood vessels nearby. Any N: The cancer may or may not have spread to lymph nodes. M0: The cancer has not spread to distant body parts. IVC Any T Any N M1 Any T: The cancer is any size and may have grown into nearby structures. Any N: The cancer may or may not have spread into lymph nodes. M1: The cancer has spread into distant areas such as your liver, brain, or bone. Staging for differentiated (papillary and follicular) thyroid cancer Staging for papillary or follicular thyroid cancer depends on whether you're over or under the age of 55. The overall 5-year relative survival rate for people with papillary thyroid cancer is nearly 100% and about 98% for follicular cancer. Stage Age of diagnos is TNM groups Description I younger than 55 years Any T Any N M0 Any T: The cancer is any size. Any N: The cancer may or may not have spread to lymph nodes. MO: It hasn't spread to distant areas. OR I 55 years or older T1 N0 or NX M0 T1: The cancer is smaller than 0.8 inches across and is only found in your thyroid gland. N0 or NX: The cancer hasn't spread to nearby lymph nodes or there isn't enough information to assess if the cancer has spread to lymph nodes. M0: The cancer hasn't spread to distant areas. OR I 55 years or older T2 N0 or NX M0 T2: The cancer is larger than 0.8 inches across but smaller than 1.6 inches. It's limited to your thyroid. N0 or NX: The cancer hasn't spread to nearby lymph nodes or there isn't enough information to assess if the cancer has spread to lymph nodes. M0: The cancer hasn't spread to distant areas. II younger than 55 years Any T Any N M1 Any T: The cancer is any size. Any N: The cancer may or may not have spread to nearby lymph nodes. M1: The cancer has spread to distant body parts like your bone or internal organs. OR II 55 years or older T1 N1 M0 T1: The cancer is smaller than 0.8 inches across and limited to the thyroid. N1: The cancer has spread to nearby lymph nodes. M0: The cancer hasn't spread to distant areas. OR II 55 years or older T2 N1 M0 T2: The cancer is larger than 0.8 inches across but smaller than 1.6 inches. It's limited to your thyroid. N1: The cancer has spread to nearby lymph nodes. M0: The cancer hasn't spread to nearby areas. OR II 55 years or older T3a or T3b Any N M0 T3a or T3b: The cancer is larger than 1.6 inches across but limited to the thyroid or the muscles that support your thyroid. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer hasn't spread to distant sites. III 55 years or older T4a Any N M0 T4a: The cancer is any size and has grown beyond your thyroid into surrounding tissues such as your voice box or windpipe. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer hasn't spread to distant sites. IVA 55 years or older T4b Any N M0 T4b: The cancer has spread extensively beyond your thyroid toward your spine or into large blood vessels in the surrounding area. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer has not spread to distant locations. IVB 55 years or older Any T Any N M1 Any T: The cancer is any size. Any N: The cancer may or may not have spread to nearby lymph nodes. M1: The cancer has spread to distant parts of your body. Staging for undifferentiated (anaplastic) thyroid cancer Anaplastic cancer has the poorest outlook of any thyroid cancer. Its 5-year relative survival rate is 7%. All anaplastic cancers are considered to be stage IV. It's divided into substages depending on its features. Stage Stage grouping Description IVA T1, T2 or T3a N0 or NX M0 T1, T2, or T3a: The cancer can be any size as long as it's contained to your thyroid. N0 or NX: The cancer hasn't spread to nearby lymph nodes or there's not enough information to know if it has. M0: The cancer has not spread to distant parts of your body. IVB T1, T2 or T3a N1 M0 T1, T2, or T3a: The cancer can be any size as long as it's contained to your thyroid. N1: The cancer has spread to nearby lymph nodes. M0: The cancer has not spread to distant parts of your body. OR IVB T3b Any N M0 T3b: The cancer is any size and has grown into the muscles that support your thyroid. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer has not spread to distant parts of your body. OR T4 Any N M0 T4: The cancer has grown beyond the thyroid gland and into nearby tissue such as your voice box or windpipe. It also may have grown toward your spine or large blood vessels nearby. Any N: The cancer may or may not have spread to nearby lymph nodes. M0: The cancer has not spread to distant parts of your body. IVC Any T Any N M1 Any T: The cancer can be any size. Any N: The cancer may or may not have spread to nearby lymph nodes. M1: The cancer has spread into distant body parts such as your bones or internal organs. Takeaway Thyroid cancer is broken into stages depending on how far the cancer has progressed. The AJCC's TNM staging for papillary or follicular thyroid cancer also considers your age. Cancers in early stages are considered easier to treat and have a better outlook. Due to the aggressive nature of anaplastic thyroid cancer, it's always considered stage IV. Knowing what stage of cancer you're in helps doctors understand how to best manage your cancer. It can also give you an idea of your chances of survival. Survival statistics are often based on old data, so your chances of survival might be better than statistics suggest.
Medscape
20 hours ago
- Health
- Medscape
Higher VTE Risk in Cushing vs Other Pituitary Tumours
TOPLINE: Patients with Cushing disease faced a substantially higher risk for venous thromboembolism (VTE) than those with non-functioning pituitary adenomas or acromegaly, with the risk peaking around the time of diagnosis and surgery. A history of diabetes also remained an independent risk factor for VTE. METHODOLOGY: Researchers in England conducted a multicentric retrospective cohort study to evaluate the risk for VTE in patients with Cushing disease compared with that in those with other pituitary tumours. They analysed 827 patients (median age at diagnosis, 54 years; 51.6% men), including 107 with Cushing disease, 502 with non-functioning pituitary adenomas, and 218 with acromegaly. Data on VTE events spanning 4 years prior to the diagnosis of pituitary adenoma through the last follow-up were obtained from patient records, with a median follow-up duration of 13.4 years; if multiple VTE events occurred in a single individual, only the first event was analysed. Demographic and clinical data such as sex, date and age at tumour diagnosis, date of surgery for the pituitary tumour, history of diabetes or impaired glucose tolerance, and specific details of VTE events were also extracted from patient records. TAKEAWAY: VTE events were significantly more common in patients with Cushing disease than in those with non-functioning pituitary adenomas (odds ratio [OR], 21.05; P < .001) or acromegaly (OR, 4.48; P = .002). In the adjusted analysis, Cushing disease was associated with a markedly higher risk for VTE events than non-functioning pituitary adenomas (hazard ratio [HR], 46.87; P < .001); acromegaly also conferred an elevated risk (HR, 6.96; P = .007). Diabetes or impaired glucose tolerance was independently associated with an increased risk for VTE (HR, 3.48; P = .008). Among 12 VTE events that occurred in patients with Cushing disease, eight occurred within 1 year before or after the diagnosis of the condition; moreover, four events occurred within 45 days post-transsphenoidal surgery. IN PRACTICE: "[The study] findings provide further evidence of the need for rigorous thromboprophylaxis in patients with CD [Cushing disease] from the time of diagnosis and subsequently throughout the perioperative period," the authors wrote. SOURCE: This study was led by Kristina Isand, University of Tartu, Tartu, Estonia. It was published online on July 03, 2025, in the European Journal of Endocrinology. LIMITATIONS: The retrospective design of the study may have introduced potential bias. Data on confounding factors, such as oral contraceptive use, pregnancy history, and family history of VTE, were not collected. The small number of VTE events further limited the complexity of multivariable modelling, particularly in subgroup analyses. DISCLOSURES: This study did not receive any funding. One author reported serving on the editorial board of the European Journal of Endocrinology. The other authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
New York Times
a day ago
- Health
- New York Times
How to Find the Right Medical Rehab Services
Rehabilitation therapy can be a godsend after hospitalization for a stroke, a fall, an accident, a joint replacement, a severe burn, or a spinal cord injury, among other conditions. Physical, occupational and speech therapy are offered in a variety of settings, including at hospitals, nursing homes, clinics and at home. It's crucial to identify a high-quality, safe option with professionals who are experienced in treating your condition. What kinds of rehab therapy might I need? Physical therapy helps patients improve their strength, stability and movement and reduce pain, usually through targeted exercises. Some physical therapists specialize in neurological, cardiovascular or orthopedic issues. There are also geriatric and pediatric specialists. Occupational therapy focuses on specific activities (referred to as 'occupations'), often ones that require fine motor skills, like brushing teeth, cutting food with a knife and getting dressed. Speech and language therapy help people to communicate. Some patients may need respiratory therapy if they have trouble breathing or need to be weaned from a ventilator. Will insurance cover rehab? Medicare, health insurers, workers' compensation and Medicaid plans in some states cover rehab therapy, but plans may refuse to pay for certain settings and may limit the amount of therapy you receive. Some insurers may require preauthorization, and some may terminate coverage if you're not improving. Private insurers often place annual limits on outpatient therapy. Traditional Medicare is generally the least restrictive, while private Medicare Advantage plans may monitor progress closely and limit where patients can obtain therapy. Should I seek inpatient rehabilitation? Patients who still need nursing or a doctor's care but can tolerate three hours of therapy five days a week may qualify for admission to a specialized rehab hospital or to a unit within a general hospital. Patients usually need at least two of the main types of rehab therapy: physical, occupational or speech. Stays average around 12 days. How do I choose? Look for a place that is skilled in treating people with your diagnosis; many inpatient hospitals list specialties on their websites. People with complex or severe medical conditions may want a rehab hospital connected to an academic medical center at the vanguard of new treatments, even if it's a plane ride away. Want all of The Times? Subscribe.
Health Line
6 days ago
- Health
- Health Line
Managing Ulcerative Colitis: Why Lifestyle Remedies Aren't Always Enough
Ulcerative colitis (UC) is a chronic disease that causes inflammation and sores in the lining of your colon. It's a complicated disease that can interfere with your quality of life. Ulcerative colitis (UC) can significantly affect your quality of life. You may miss work or school and feel limited by the kinds of activities you can do because of urgent bowel activity. However, remission is possible with UC. Lifestyle changes and certain supplements may make you feel better. Medications and a smart treatment plan may reduce your risk of serious complications and allow you to experience longer periods of remission in a way that lifestyle changes alone cannot. Read on to learn more about the role of lifestyle changes in UC and the reasons for considering medical treatments in the long run. Role of lifestyle changes and supplements UC affects people differently, so you may see an improvement in your condition with lifestyle changes and supplements. These lifestyle changes aren't meant to replace a medication regimen. Talk with a doctor to see if adding these to your daily routine is safe and advisable. Diet doesn't cause UC, but avoiding certain foods may lessen the severity of flare-ups and reduce symptoms. These include greasy foods and vegetables that cause gas, like cauliflower and broccoli. Avoiding high fiber foods, lactose, and caffeine may also improve your symptoms. A 2023 paper states that dietary changes can help reduce symptoms of UC. Some people with UC notice positive changes resulting from light exercise, relaxation techniques, and breathing exercises. These activities may reduce stress levels and help you cope with flare-ups. Some nutritional supplements may also be helpful. Studies have shown that taking fish oil and probiotics may have a role in helping people with UC. Fish oil may help reduce inflammation, and probiotics can add good bacteria to your intestinal tract. While lifestyle changes and supplements may help ease symptoms, they aren't enough to manage UC alone. UC is a chronic condition that can lead to serious complications without proper medical treatment. The primary goal of care is achieving and maintaining remission, which typically requires prescribed therapies alongside supportive measures. Here are some reasons why you can speak with your doctor or gastroenterologist about prescription medications and treatment. Ulcerative colitis complications Lifestyle changes and supplements may not control flare-ups as effectively as prescription medications. As a result, you may continue to have repeated bouts of diarrhea and bloody stool. The more attacks you have, the greater risk you have for complications and the more inflammation you'll experience. Research shows that inflammation plays a key role in the development of colorectal cancer in people with UC. Sores or ulcers in the lining of your colon can bleed and lead to bloody stools, while long-term intestinal bleeding can cause iron deficiency anemia. Symptoms of this condition include dizziness, fatigue, and lightheadedness. Your doctor can recommend iron supplements to correct this deficiency, but it's also important to treat the underlying cause of bleeding. A prescription medication for UC can stop inflammation and heal ulcers in your colon. Chronic diarrhea from UC can also cause problems. Diarrhea can decrease your fluid levels, causing dehydration and electrolyte imbalances. Signs of dehydration include: excessive thirst low urine output headaches dry skin dizziness confusion Drinking more fluids can counter the effects of diarrhea. However, medication can treat the source of the inflammation to control symptoms and stop repeated relapses. Drug therapies There isn't a cure for UC, but remission can make it feel like the condition is no longer affecting your daily life. Several medications are available to help reduce flare-ups and keep symptoms at bay. Talk with your healthcare team about your options. With the right treatment, many people go months or even years with no symptoms. Prescription medications and drug therapies to help manage UC include: Aminosalicylates (5-ASAs): Used primarily for mild to moderate UC, these drugs reduce inflammation in the lining of the colon. Options include sulfasalazine (Azulfidine), mesalamine (Pentasa), olsalazine (Dipentum), and balsalazide (Colazal, Giazo). This class of drugs is also recommended for maintenance treatment to help prevent flare-ups. Tofacitinib (Xeljanz): This is a newer option in a class of medications called Janus kinase (JAK) inhibitors. It works in a unique way to reduce inflammation in people with moderate to severe UC. Corticosteroids: Prescribed for moderate to severe flare-ups, this class of drugs, including prednisone or budesonide, reduces inflammation by suppressing the immune system. Because of potential side effects, they're typically not intended for long-term or maintenance use. Immunomodulators: These medications, also for moderate to severe symptoms, help suppress the immune response and are often used in conjunction with a corticosteroid. A few options include azathioprine (Azasan, Imuran), tacrolimus (Prograf), and 6-mercaptopurine. Biologics: Used for moderate to severe UC that doesn't respond to other treatments, these injections or infusions block the proteins that cause inflammation in your colon. Examples include: anti-TNF agents such as adalimumab (Humira), infliximab (Remicade), golimumab (Simponi) integrin receptor antagonists such as vedolizumab (Entyvio) IL-12/23 inhibitors such as ustekinumab (Stelara) Targeted synthetic small molecules and JAK inhibitors: The first oral JAK inhibitor approved for UC in 2023 by the Food and Drug Administration (FDA), tofacitinib (Xeljanz) is used in moderate to severe cases, particularly when other biologics haven't worked. Newer JAK inhibitors like upadacitinib (Rinvoq) have also been approved more recently. These drugs fall under a broader class known as targeted synthetic small molecules, which also includes newer options like ozanimod (Zeposia) and etrasimod (Velsipity). These medications work by selectively modulating immune pathways involved in inflammation. Newer biologics such as risankizumab-rzaa (Skyrizi), mirikizumab-mrkz (Omvoh), and guselkumab (Tremfya) are also emerging options for people whose UC hasn't responded to older therapies. Surgery is another option, but only as a last resort in severe cases. Surgeons will remove the entire colon in the case of colon rupture or uncontrolled bleeding. High cancer risk is another reason surgery may be recommended. Although the procedure can cure UC, it requires a permanent ileostomy, or creation of a J-pouch. An ileostomy is when the end of the small intestine is connected to an opening in the belly, called a stoma. Waste comes out through this opening into a special bag that sticks to the skin. It's a new way for the body to get rid of waste in the colon's absence. Reduce the risk of colorectal cancer Colorectal cancer is a significant complication of UC. The risk of developing this type of cancer depends on the severity of your symptoms and how long you've had the disease. However, remission may cut your risk of cancer. Lifestyle changes and nutritional supplements aren't meant to replace any recommendations or prescriptions from your doctor. When taken as directed, medications reduce inflammation in your colon and help you achieve remission sooner. The longer your disease remains in remission, the less likely you are to develop colon cancer and precancerous cells. Being under the supervision of a specialist also gives your gastroenterologist the opportunity to monitor your condition over time and schedule appropriate screenings. Once you're diagnosed with UC, you'll need to receive periodic colon cancer screenings — how often depends on your own health and family history.
Al Arabiya
20-06-2025
- Health
- Al Arabiya
Israeli strikes on Iran damaged five hospitals in one week: Head of emergency services
Israeli strikes in the past week have damaged five Iranian hospitals and affected patients receiving care, the head of Iran's emergency services tells State TV. Developing...
