Stage III through IV Medullary Thyroid Cancer Treatment

If you have Stage III or IV medullary thyroid carcinoma (MTC), you will probably be treated with total thyroidectomy. If your cancer has spread to the lymph nodes (tiny bean-shaped organs throughout the body that help fight infections), your doctor might recommend that you have a modified radical or radical neck dissection in addition to the thyroidectomy.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.
• Neck dissection - The surgeon removes lymph nodes in the front and side of the neck that may contain cancer. Neck dissection is sometimes the best way to prevent MTC from spreading or coming back after treatment (recurring).
• Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
• Radical -  The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

You will probably be treated with external beam radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells. It is often used in combination with chemotherapy.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

Your doctor might also recommend chemotherapy, possibly in combination with radiation.  Chemotherapy drugs are used to kill cancer cells. They can sometimes reduce the symptoms of MTC. Although there is no standard chemotherapy or combination of chemotherapy drugs, the following chemotherapies (alone or in combination) are sometimes used to treat MTC:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them.  This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size and blood counts.
• Blenoxane ^® (bleomycin) - Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein, either over 10 minutes or as a continuous infusion for 24 hours, or as a shot into the muscle or under the skin. The dose is based on your size.
• Cytoxan ^® (cyclophosphamide) - Cyclophosphamide belongs to a group of chemotherapy drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Cyclophosphamide can be given by mouth as a pill or liquid, or by a shot into a vein. The dose depends upon your size, your type of cancer, and your blood counts.
• DTIC-Dome ^® (dacarbazine) - Dacarbazine is a chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Dacarbazine is given by a shot in a vein over 20 minutes or longer. The dose and how often you get the medicine depend on your size, your blood counts, and the type of cancer being treated.
• Oncovin ^® (vincristine) - Vincristine belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. It stops cells from dividing, which kills them. Vincristine is given by an injection in a vein over 2 to 5 minutes. The dose and how often you get the medicine depend on your weight, how well your liver is working, and the type of cancer being treated.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

This content has been reviewed and approved by Myo Thant, MD.