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Papillary thyroid cancer

R Michael Tuttle, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Thyroid follicular epithelial-derived cancers include papillary, follicular, and anaplastic cancer. Papillary and follicular cancers are considered differentiated cancers, and patients with these tumors are often treated similarly despite numerous biologic differences. The general pathogenetic, pathologic, and prognostic features of papillary thyroid cancer and its variants will be discussed here. The treatment of well-differentiated thyroid cancers and an overview of follicular thyroid cancer are discussed separately. (See "Differentiated thyroid cancer: Overview of management" and "Follicular thyroid cancer (including Hürthle cell cancer)".)


In a report based upon the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2012, the incidence of papillary cancer increased from 4.8 to 14.9 per 100,000 (figure 1) [1]. In 2012, there were an estimated 601,789 people living with thyroid cancer in the United States [1]. The age- and gender-adjusted incidence of thyroid cancer has increased faster than that of any other malignancy in recent years, with the increased incidence seen in both genders and all ethnic backgrounds (figure 2 and figure 3) [2,3]. In women, however, the annual rate of increase has fallen from 4.2 percent per year from 1992 to 1999, and 6.9 percent per year from 1999 to 2009, to 2.2 percent per year from 2009 to 2011 [4].

The use of head and neck external beam radiation, commonly used to treat benign childhood conditions between 1910 and 1960, led to an increased incidence of thyroid cancer in the second half of the last century [5] (see "Radiation-induced thyroid cancer"). However, since radiation therapy for benign childhood conditions was largely abandoned in the 1950s to 1960s, it is unlikely that the increasing incidence in thyroid cancer seen in the last 10 to 15 years is associated with childhood radiation exposure. Some authors suggest that the increase in thyroid cancer in the United States and elsewhere may be primarily due to an increased detection of small papillary cancers secondary to more widespread use of neck ultrasonography and fine-needle aspiration (FNA) of very small thyroid nodules [6-8].

Although the increasing incidence probably partially reflects earlier detection of subclinical disease (ie, small papillary cancers), an analysis of the National Cancer Institute's SEER database found an increase in the rates of differentiated thyroid cancer of all sizes, including tumors greater than 4 cm [9]. In addition, incidence-based mortality increased between 1974 and 2013, from 0.40 to 0.46 per 100,000 person-years. These two findings suggest a true increase in the incidence of papillary thyroid cancer.

The usual female-to-male ratio of papillary thyroid cancer is approximately 2.5:1, with most of the female preponderance occurring during the fourth and fifth decades of life. Although the incidence of thyroid cancer is rising, death rates (0.5 per 100,000 men and women per year) have not changed significantly between 2003 and 2012 [1].

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Literature review current through: Nov 2017. | This topic last updated: May 08, 2017.
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