Follicular thyroid cancer (including Hürthle cell cancer)
- R Michael Tuttle, MD
R Michael Tuttle, MD
- Professor of Medicine
- Memorial Sloan Kettering Cancer Center
Thyroid follicular epithelial-derived cancers include papillary, follicular, and anaplastic cancer. Papillary and follicular cancers are considered differentiated cancers. Follicular thyroid cancer is less common than papillary thyroid cancer. In iodine-sufficient areas, up to 12 percent of all thyroid cancers are follicular cancers, whereas 85 percent are papillary. The molecular pathogenesis, clinical features, diagnosis, and prognostic features of follicular thyroid cancer will be provided here. Papillary thyroid cancer and the management of differentiated thyroid cancer are discussed separately. (See "Papillary thyroid cancer" and "Differentiated thyroid cancer: Overview of management".)
Follicular thyroid cancer tends to occur in an older population when compared with other differentiated thyroid cancers. Its peak incidence is between ages 40 and 60 years, as compared with papillary thyroid cancer incidence peaking earlier, between the ages of 30 to 50 years. In addition, follicular thyroid cancer is approximately three times more common in women than in men . Iodine may also play a role in the epidemiology of follicular thyroid cancer. In iodine-deficient regions of the world, there is a higher prevalence of follicular cancer compared with iodine-sufficient regions. With the introduction of iodine, some studies showed that the incidence of follicular thyroid cancer decreased, while papillary thyroid cancer increased [2,3].
In a report based upon the Surveillance, Epidemiology, and End Results (SEER) database from 1980 and 2009, there was an increase in follicular thyroid cancer rates among women and men . However, in a report from Poland, rates of follicular thyroid cancer actually decreased between 1982 and 2012, a time during which rates of papillary thyroid cancer were increasing . (See "Papillary thyroid cancer", section on 'Incidence'.)
Risk factors for follicular thyroid cancer are similar to those for papillary thyroid cancer and include a history of radiation exposure during childhood, a history of thyroid cancer in a first-degree relative, or a family history of a thyroid cancer syndrome. Radiation exposure of the thyroid during childhood is the most clearly defined environmental factor associated with benign and malignant thyroid tumors. (See "Papillary thyroid cancer", section on 'Risk factors'.)
Most follicular thyroid cancers are probably of monoclonal origin. In addition, oncogene activation is common. (See "Oncogenes and tumor suppressor genes in thyroid nodules and nonmedullary thyroid cancer", section on 'Follicular thyroid cancer'.)
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- RISK FACTORS
- MOLECULAR PATHOGENESIS
- RAS mutations
- PAX8-PPAR gamma 1
- CLINICAL FEATURES
- Clinical presentation
- Lymph node involvement
- PROGNOSTIC FEATURES
- Tumor characteristics
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS