Follicular thyroid cancer
Follicular thyroid cancer looks like a benign nodule on a needle biopsy, so the diagnosis is usually made only after surgery. It spreads through the bloodstream rather than to neck nodes, is treated like papillary cancer with surgery and radioactive iodine, and has a good outlook when caught early.
Overview
Follicular thyroid cancer is separated from a benign follicular adenoma only by invasion of the capsule or blood vessels, which a fine-needle biopsy cannot show; a follicular result on biopsy therefore leads to diagnostic lobectomy, and molecular tests on the aspirate now help decide who needs it. RAS mutations and the PAX8-PPARG fusion are common, and TERT promoter mutations mark aggressive disease. Minimally invasive tumours are cured by lobectomy; widely invasive tumours receive total thyroidectomy and radioactive iodine, which also treats the lung and bone metastases the disease favours. Oncocytic (Hurthle cell) carcinoma, once a follicular variant, is a separate entity in the 2022 WHO classification and takes up iodine poorly. Iodine-refractory disease is treated as in papillary cancer with lenvatinib or sorafenib.
State of the art
- Molecular testing of indeterminate nodules spares many patients a diagnostic operation.
- Most follicular cancers are cured by surgery alone; the widely invasive minority drives the deaths.
- Oncocytic carcinoma's separation as its own entity reflects its distinct genetics and poor iodine avidity.
Anatomy and lymph node drainage
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
- Oral cavity and tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- ThyroidOncocytic (Hurthle cell) carcinoma (separate entity since WHO 2022)
- level I (submandibular)
- level II (upper jugular)
- level III-IV (jugular)
- level V (posterior)
- level VI (central, thyroid)
- retropharyngeal (nasopharynx)
Same organ: Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4)
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About one in ten thyroid cancers, commoner where iodine is scarce; it spreads through the blood to bone and lung rather than to neck nodes, and survival is somewhat lower than for papillary cancer but still high.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Molecular testing of the aspirate; diagnostic lobectomy when suspicious.
Lobectomy alone in most cases; completion surgery and iodine only for high-risk features.
Total thyroidectomy, radioactive iodine, TSH suppression; bone metastases may need surgery or radiotherapy.
Lenvatinib or sorafenib; clinical trials of redifferentiation.
Subtypes & biomarkers
top- Minimally invasive (capsular invasion only)
- Encapsulated angioinvasive
- Widely invasive
- Oncocytic (Hurthle cell) carcinoma (separate entity since WHO 2022)
- RAS mutations
- PAX8-PPARG fusion
- TERT promoter mutation
- Molecular tests on indeterminate aspirates (Afirma, ThyroSeq)
- Thyroglobulin
How often this target appears
- 1946Radioactive iodine treats metastatic follicular cancer
- 2000PAX8-PPARG fusion discovered
- 2022WHO separates oncocytic carcinoma from follicular cancer
What is in development for Follicular thyroid cancer, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Telling adenoma from carcinoma without surgery.
Bone metastases respond poorly to iodine.
and how the field plans to fix it →What is being done about thisAdvanced and metastatic diseaseAvailable now- Palliative radiotherapyStandard of care
- Bone-modifying agents (bisphosphonates, denosumab)Standard of care
- DordaviproneApproved
- HIPEC / PIPAC (intraperitoneal chemotherapy)Established
- Laser interstitial thermal therapy (LITT)Established
- Liquid biopsy (ctDNA)Standard of care
In trials- ACTIONRecruiting
- CAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target)Phase 1
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
- DESTINY-Breast12Positive
- DYNAMICPositive
- EF-14Positive
Ideas and roadmaps- A billion-dollar prize for the first durable cure of a lethal metastatic cancer
- A blood test for the pre-metastatic niche
- A global rapid tissue donation network for metastatic disease
- A national rapid research autopsy network for end-stage cancer
- A regulatory endpoint for drugs that block spread, not tumours
- A ring-fenced metastasis programme with metastasis-specific endpoints
Background: Blood-brain barrier (BBB), Circulating tumour DNA (ctDNA), EGFRvIII, Epithelial-mesenchymal transition & drug efflux, H3 K27M (diffuse midline glioma). Also on OnCo: Atlas of advanced disease · Invasion and metastasis.
Few trials specific to follicular histology.
Trials
topTrials recruiting now
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Expert centres
topExpert centres
- via Thyroid cancer
- via Thyroid cancer
- via Thyroid cancer
- ASST Spedali Civili di BresciaBrescia, ITvia Thyroid cancer
- Cancer Research UKLondon, GBvia Thyroid cancer
- First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, CNvia Thyroid cancer
- via Thyroid cancer
- National Cancer Center KoreaGoyang, KRvia Thyroid cancer
- Peking Union Medical College HospitalBeijing, CNvia Thyroid cancer
- Tawam HospitalAl Ain, AEvia Thyroid cancer
Questions to ask
topQuestions to ask your oncologist about Follicular thyroid cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example RAS mutations, PAX8-PPARG fusion, TERT promoter mutation, Molecular tests on indeterminate aspirates, Thyroglobulin), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Minimally invasive, Encapsulated angioinvasive, Widely invasive.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Indeterminate follicular nodule
- For my situation (indeterminate follicular nodule), which of the standard options do you recommend and why?Why: Guideline options include: Molecular testing of the aspirate; diagnostic lobectomy when suspicious.
Minimally invasive
- For my situation (minimally invasive), which of the standard options do you recommend and why?Why: Guideline options include: Lobectomy alone in most cases; completion surgery and iodine only for high-risk features.
Widely invasive or metastatic
- For my situation (widely invasive or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Total thyroidectomy, radioactive iodine, TSH suppression; bone metastases may need surgery or radiotherapy.
Iodine-refractory
- For my situation (iodine-refractory), which of the standard options do you recommend and why?Why: Guideline options include: Lenvatinib or sorafenib; clinical trials of redifferentiation.
- Am I a candidate for Lenvatinib, Sorafenib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Telling adenoma from carcinoma without surgery”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Bone metastases respond poorly to iodine”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
4targets
5drugs
2companies
4terms
1Latest papers
topQuery for this cancer: (TITLE:"Follicular thyroid cancer" OR ABSTRACT:"Follicular thyroid cancer" OR TITLE:"Follicular thyroid carcinoma" OR ABSTRACT:"Follicular thyroid carcinoma" OR TITLE:"FTC" OR ABSTRACT:"FTC" OR TITLE:"Oncocytic Hurthle cell carcinoma" OR ABSTRACT:"Oncocytic Hurthle cell carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Follicular thyroid cancer, not a curated reading list.
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