Medullary thyroid cancer: diagnosis and treatment

Abstract

Background.Medullar thyroid cancer, rare neuroendocrine malignancy from parafollicular C-cells, remain 1–5% of thyroid cancers. early metastasis association with hereditary syndromes like MEN 2A/2B and resistance to conventional therapies pose diagnostic and therapeutic challenges. This study focusses on these challenges. Objective(s). To assess medullary thyroid cancer's current diagnostic methods and therapeutic approaches, with an emphasis on imaging, biomarkers, and treatment Results. To find efficient treatment methods for MTC. Materials and methods. A literature review analyzed 30 peer-reviewed studies (2000– 2024) from PubMed, PMC, and the American Thyroid Association, focusing on MTC diagnosis (USG, PET/CT, calcitonin screening) and treatment (surgery, targeted therapies). Diagnostic accuracy, sensitivity, and treatment outcomes, including survival rates and biochemical cure, were assessed. Results. USG detects MTC nodules and lymph node metastases with 85–90% sensitivity, but specificity requires fine-needle aspiration. Serum calcitonin and CEA are sensitive biomarkers, with calcitonin doubling time predicting progression. 18F-DOPA-PET/CT and gadoxetic acid-enhanced MRI improve metastasis detection. Total thyroidectomy with neck dissection achieves biochemical cure in 60–70% of early-stage cases. In metastatic MTC, vandetanib and cabozantinib extend progression-free survival by 11–14 months. Selpercatinib, for RET-mutated MTC, shows a 70% response rate. Radiotherapy reduces local recurrence by 50% in unresectable cases. Conclusion(s). Advances in calcitonin screening, RET testing, and imaging enhance MTC diagnosis, enabling early intervention. Surgery remains curative, while tyrosine kinase inhibitors improve outcomes in metastatic disease. Future research must refine imaging for micrometastases address resistance to targeted therapies.