Management of Advanced Thyroid Cancer in Children

PROGRAM DESCRIPTION: The incidence of thyroid cancer in young children and adolescents has risen over the past twenty years. For males, the rate per 1,000,000/persons rose from 2.77 in 1990 to 9.63 in 2009. For females, the rate per 1,000,000/persons rose from 18.35 in 1987 to 50.99 in 2009. With the increased incidence of pediatric thyroid cancer, Otolaryngologists are more commonly seeing younger patients with thyroid cancer and extensive local/regional disease. In addition, a delay in management or inappropriate management may lead to worse outcomes for a disease that traditionally has a high 5-year survival rate.
A team-based approach can lead to streamlined processes for timely diagnosis, evidence-based treatment decisions, and adherence to current guidelines. This panel will highlight specific aspects of caring for children with advanced thyroid cancer in a case-based format, drawing on the expertise of pediatric otolaryngologists from head and neck high volume centers. The focus of this panel will be challenging patient scenarios that fall outside of standard practice and ATA recommendations. This will include laboratory evaluation, imaging modalities as well as medical and surgical treatment algorithms. In addition, each patient scenario will illustrate models of how different institutions across the country practice team-based care. Special focus will be placed on emerging concepts in the field of pediatric thyroid cancer including oncogene analysis and targeted therapies. The cases will provide insight regarding the management recurrent laryngeal nerve involvement, retropharyngeal lymph nodes, extensive lateral cervical lymphadenopathy, and tumors that are locally invasive.

OUTCOME OBJECTIVE 1: To understand the medical and surgical approaches to treating a child with advanced thyroid cancer.

OUTCOME OBJECTIVE 2: To review surgical techniques for the management of recurrent laryngeal nerve involvement, retropharyngeal lymph nodes, extensive lateral cervical lymphadenopathy, and tumors that are locally invasive

OUTCOME OBJECTIVE 3: To understand the evolving role of targeted medical therapy in the management of advanced thyroid cancer in children.

BACKGROUND STATEMENT: Otolaryngologists are more commonly seeing younger patients with advanced thyroid cancer, and delays in diagnosis or inappropriate management may have serious implications for 5-year survival rates and other outcomes.