AACE MENA 2025-What’s New in Medullary Thyroid Cancer?

Video Transcription

Video Summary

Dr. Tamer provided a comprehensive update on medullary thyroid cancer (MTC), highlighting advances in diagnosis, prognosis, imaging, surgery, and systemic therapies. MTC, originating from thyroid C cells, exhibits heterogeneity from indolent to aggressive disease forms. The International MTC Grading System aids prognosis beyond TNM staging, identifying high-grade tumors with worse survival and recurrence. Calcitonin and CEA tumor markers are vital pre- and post-operatively for diagnosis and monitoring, with undetectable calcitonin post-surgery predicting better outcomes. RET genetic testing, both germline and somatic, guides therapy choices, especially for selective RET inhibitors, now preferred first-line for RET-mutated cases due to superior efficacy and tolerability over multikinase inhibitors. Imaging relies on anatomical scans initially, supplemented by functional PET imaging when needed. Surgical controversies include potential hemithyroidectomy for sporadic cases and tailored lymph node dissection guided by calcitonin levels. Postoperative radiation therapy's role is limited due to lack of survival benefit and treatment toxicities. Emerging systemic therapies are being explored for neoadjuvant use to improve resectability in advanced MTC, with ongoing trials aiming to refine management strategies and address RET-negative patient needs.

Keywords

medullary thyroid cancer

MTC grading system

calcitonin and CEA markers

RET genetic testing

selective RET inhibitors

surgical management of MTC