H J Biersack et al (eds)
Published by Springer (2001)
294 pages plus index.
There have been several books published on thyroid cancer in recent years, raising the interest of the reviewer as to why a cancer which is rare (<1% of all cancers) and of excellent prognosis, excites such intense interest. It is, however, the commonest endocrine cancer, the cause of more deaths than all other endocrine tumours combined, and is the subject of considerable clinical, technical and molecular biological interest.
This volume is primarily from clinics in Germany, with some input from the US, and the editors’ essay that there are new diagnostic and therapeutic changes over the last 10 years. These are addressed in this comprehensive compact text.
The book is divided into three parts, each addressing a significant area of interest and facilitating easy reference: the basics, differentiated thyroid cancer and medullary thyroid cancer, and thyroid cancer of children from Chernobyl.
Attention is drawn to the need for high-level quality in diagnosis at clinical, technological and histological levels if credible data is to be recorded. The cost of collecting data is noted as a deterrent to the accurate accumulation of incidence material. It is reported that the increasing incidence of thyroid cancer in both sexes, especially in its early stages, is at least in part due to improved diagnostic techniques that lead to earlier detection. The increase is mainly due to papillary thyroid cancer Conversely, anaplastic cancer has fortunately become rare. Where there has been established iodine deficiency, which has been supplemented, there has been a marked increase in papillary cancer.
For those clinicians with an interest in the thyroid gland the histopathology, immunohisto-chemistry and molecular biology are clearly and succinctly addressed, the role of fine needle aspiration biopsy (FNAB) being appropriately acknowledged and molecular techniques that may enhance FNAB in pre-surgical decision-making clearly identified. Pathogenesis, anatomical and molecular malignant transformation, invasion and metastases are addressed.
The published reports on familial differentiated thyroid cancer are reviewed, and advice on management of patients and their families is proposed.
Diagnosis of thyroid cancer by conventional means is clearly outlined, together with emphasis on prevalence and risk assessment. The wide range of prevalence of thyroid nodules diagnosed by ultrasound is reported as being due to the use of different equipment.
In the current surgical approach to non-medullary thyroid cancer, the arguments for and against total thyroidectomy are clearly stated and clearance of all lymph tissue from the central cervical compartment along the tracheo-oesophogeal groove is recommended as part of the primary surgery to prevent recurrence. This approach is being embraced in Australia. The effect of removal of lymph nodes on survival is not known.
Part two of the book is devoted to treatment of differentiated thyroid cancer, follow-up protocols, functional imaging and magnetic resonance imaging. A special chapter is given over to thyroid cancer in Chernobyl children and reports that the children have excellent prognosis if optimally treated (ie like adults).
Radioiodine therapy is recommended for patients with assumed residual or recurrent thyroid cancer, and consideration is given to the dilemma in regards to RAI131 therapy in patients with an elevated thyroglobulin and negative radioiodine scan.
Ablation is not considered necessary when tumours less than 1.5cm are completely confined to the thyroid gland.
The side effects of radioiodine are clearly addressed.
Percutaneous radiotherapy (EBRT) remains an arguable form of treatment, with an increasing number of proponents than hitherto. It is suggested that a prospective trial to determine benefit of EBRT adjuvant to surgery and radioiodine therapy is urgently required.
Thyroid hormone is supported as life-long therapy at the lowest level of effective TSH suppression.
A chapter is given to redifferentiation therapy of thyroid carcinomas and retinoic acid. This approach is based on experimental data that differentiated functions of thyrocytes and of iodine metabolism can be reinduced by retinoic acids. The results of clinical application in 49 patients are encouraging and worthy of study.
Follow-up is discussed around the view that surgical excision of as much thyroid as possible, ablation of remnants or metastases, and surveillance are the key stones and various protocols can be successfully built around them.
Functional imaging and magnetic resonance imaging are well presented, although illustrations of MRI are somewhat cramped and some are moderately difficult to interpret.
The Chernobyl accident and resultant thyroid cancer in young children from Belarus are well covered.
Part three addresses medullary cancer of the thyroid (MCT), and is comprehensive and authoritative. It is essayed that MCT comprises 8-12% of thyroid cancer and presents in sporadic and hereditary forms.
It is also stressed that family history may not lead to a diagnosis of hereditary disease. Genetic and biochemical screening may be required to differentiate it from sporadic disease. Missing from the disease constellation is the description of bronchial carcinoid, well-described in the work of the late Professor Joe Shepherd of Hobart.
The importance of calciton in diagnosis, a road map to imaging, together with sound therapeutic advice based on surgical clearance of the thyroid and a directed follow-up program complete this useful book.
The book is compact, well-edited, authoritative and has an extensive bibliography. It would be useful on the shelves of a surgical department with a strong interest in endocrine surgery, or to the endocrinologist with an interest in thyroid cancer.