Papillary thyroid cancer
Papillary thyroid cancer is the commonest and most curable thyroid cancer. Most people are treated with surgery, some with radioactive iodine afterwards, and many small tumours can simply be watched. Only the rare tumours that stop taking up iodine need targeted drugs.
Overview
Papillary thyroid cancer arises from the follicular cells and often spreads to neck lymph nodes but rarely kills. About 60 percent carry a BRAF V600E mutation and others RET or NTRK fusions or RAS mutations. Treatment is lobectomy or total thyroidectomy, with radioactive iodine reserved for intermediate- and high-risk disease after the ESTIMABL2 and IoN trials showed low-risk patients do as well without it; TSH suppression with levothyroxine and thyroglobulin monitoring follow. Japanese studies established that papillary microcarcinomas under a centimetre can be kept under active surveillance, and guidelines now allow it. The minority whose recurrent or metastatic disease no longer takes up iodine are treated with lenvatinib or sorafenib, or with selpercatinib, larotrectinib or dabrafenib-trametinib when the matching alteration is found.
State of the art
- Two randomised trials showed that low-risk patients can skip radioactive iodine without harm, ending decades of routine ablation.
- Active surveillance of microcarcinomas is accepted practice and is reducing overtreatment.
- Fusion-directed drugs give deep, durable responses in the few iodine-refractory patients who carry RET or NTRK fusions.
- Redifferentiation with BRAF or MEK inhibitors can restore iodine uptake in some refractory tumours.
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
- ThyroidClassic papillary · Follicular variant · Papillary microcarcinoma (under 1 cm)
- 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, Follicular 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)
About four in five thyroid cancers; incidence tripled over three decades in many countries mainly through ultrasound detection of small tumours, while deaths barely changed; more than nine in ten patients are alive at ten years.
- 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.
Active surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series.
Lobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up.
Total thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression.
Lenvatinib (SELECT) or sorafenib (DECISION); selpercatinib for RET fusions, larotrectinib or entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF V600E.
Subtypes & biomarkers
top- Classic papillary
- Follicular variant
- Tall cell, columnar and hobnail variants (more aggressive)
- Papillary microcarcinoma (under 1 cm)
- Diffuse sclerosing variant
- BRAF V600E (about 60 percent)
- RET and NTRK fusions
- TERT promoter mutation (worse outlook, especially with BRAF)
- Thyroglobulin after surgery
- ATA risk category (low, intermediate, high)
How often this target appears
- 1946Radioactive iodine first treats thyroid cancer
- 2003BRAF V600E found in papillary thyroid cancer
- 2010Kuma Hospital reports safe observation of microcarcinomas
Ito and Miyauchi's series of over a thousand patients.
- 2014Sorafenib approved for iodine-refractory disease (DECISION)
- 2015Lenvatinib approved (SELECT)
- 2022ESTIMABL2 and IoN: no radioactive iodine for low-risk disease
Both trials found equivalent outcomes without ablation.
What is in development for Papillary 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
Overdiagnosis and overtreatment of small tumours found by imaging.
Which intermediate-risk patients truly benefit from radioactive iodine.
Resistance to kinase inhibitors in refractory disease.
and how the field plans to fix it →What is being done about thisResistance to treatmentAvailable now- AmivantamabApproved
- CamizestrantApproved
- Comprehensive genomic profilingStandard of care
- Liquid biopsy (ctDNA)Standard of care
- LorlatinibApproved
- MRD / molecular residual disease testingEstablished
In trials- ADC payload neutralisersPhase 1
- BGB-16673Phase 3
- Bispecific ADCPhase 3
- BRUIN CLL-321Positive
- CaDAnCe-304Recruiting
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
Ideas and roadmaps- A clone report from blood at every treatment cycle
- A fast route to the matched drug when it is licensed for another cancer
- A multi-cancer platform trial of adaptive (dose-holiday) therapy
- A national rapid research autopsy network for end-stage cancer
- A standard evolvability score for every tumour
- A standing platform trial that assigns treatment by how the tumour escaped
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance atlas · Lines of therapy.
Trials
topTrials recruiting now
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Expert centres
topExpert centres
- via Thyroid cancer
- via Thyroid cancer
- via Thyroid cancer
- via Larotrectinib, Entrectinib
- 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
- Wellcome Sanger InstituteHinxton, GBvia BRAF
Questions to ask
topQuestions to ask your oncologist about Papillary 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 BRAF V600E, RET and NTRK fusions, TERT promoter mutation, Thyroglobulin after surgery, ATA risk category), 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 Classic papillary, Follicular variant, Tall cell, columnar and hobnail variants.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Papillary microcarcinoma
- For my situation (papillary microcarcinoma), which of the standard options do you recommend and why?Why: Guideline options include: Active surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series.
Low risk
- For my situation (low risk), which of the standard options do you recommend and why?Why: Guideline options include: Lobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up.
Intermediate and high risk
- For my situation (intermediate and high risk), which of the standard options do you recommend and why?Why: Guideline options include: Total thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression.
Iodine-refractory advanced disease
- For my situation (iodine-refractory advanced disease), which of the standard options do you recommend and why?Why: Guideline options include: Lenvatinib (SELECT) or sorafenib (DECISION); selpercatinib for RET fusions, larotrectinib or entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF V600E.
- Am I a candidate for Lenvatinib, Sorafenib, Selpercatinib or related drugs, 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 “Overdiagnosis and overtreatment of small tumours found by imaging”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Which intermediate-risk patients truly benefit from radioactive iodine”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
5targets
10drugs
7companies
7terms
1Latest papers
topQuery for this cancer: (TITLE:"Papillary thyroid cancer" OR ABSTRACT:"Papillary thyroid cancer" OR TITLE:"Papillary thyroid carcinoma" OR ABSTRACT:"Papillary thyroid carcinoma" OR TITLE:"PTC" OR ABSTRACT:"PTC" OR TITLE:"Papillary microcarcinoma under 1 cm" OR ABSTRACT:"Papillary microcarcinoma under 1 cm") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Papillary thyroid cancer, not a curated reading list.
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