Surgical Management of Follicular Cancer

Abstract

Follicular thyroid cancers are derived from follicular epithelium within the thyroid gland, accounting for about 10 % of all thyroid cancers, though the incidence seems to be decreasing. Follicular thyroid cancers differ from the more common follicular adenomas because the follicular cells in the cancers invade the vessels, capsule, or both. These tumors are usually unifocal and encapsulated. In contrast to papillary thyroid cancers that often metastasize to regional lymph nodes, follicular thyroid cancers infrequently involve the lymph nodes (<10 % of patients) but more frequently hematogenously metastasize to the lung and bones. Patients with follicular thyroid cancer generally have a worse prognosis than patients with papillary thyroid cancer. However, most of the difference in prognosis is associated with patients’ older age and more advanced tumor stage at presentation.

The principles of surgical management of follicular thyroid carcinomas are similar to those for papillary thyroid cancer: a thorough initial operation tailored to the patient’s extent of disease and to the value of subsequent adjuvant therapy or surveillance tools. For example, patients with small minimally invasive follicular tumors rarely have extension of disease beyond the thyroid gland and are usually completely treated by thyroid lobectomy. Conversely, patients with widely invasive follicular tumor may require extensive resection for local disease and to allow adjuvant radioiodine therapy and thyroglobulin measurement in follow-up.