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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.