Thyroid Cancer Stages
A cancer’s stage refers to how large the primary tumor is and how far the cancer has spread in the patient’s body. Knowing the stage helps the care team understand the disease and develop an appropriate treatment plan. It also impacts the patient’s prognosis, or chance for a successful treatment.
TNM stages
The TNM staging system is used for most cancers.
TNM staging describes cancer based on three main factors:
- The size of the primary tumor (T) and whether it has invaded nearby tissues.
- The cancer’s spread to nearby lymph nodes (N).
- Whether the cancer has metastasized (M), or spread, to distant parts of the body.
Each TNM factor is assigned a number that reflects the extent of the cancer. Tumors (T) are scored between 1-4, nodes (N) 1-3, and metastasis (M) 0-1.
After all diagnostic and staging procedures are performed, your doctor should know the TNM stage of your cancer and be able to explain how this stage impacts your treatment and prognosis.
0 to IV stages
Often, TNM staging can be simplified into stages four stages (I-IV). For some cancers, there is also a stage 0. Larger numbers mean the cancer is more advanced and is generally more difficult to treat.
- Stage 0 reflects the presence of abnormal cells that have not spread to tissue that is immediately nearby. Stage 0 is considered precancerous, though it could become cancer in the future. This stage is also called “in-situ,” which means “in its original place.” Not all cancers have a stage 0.
- Stage I cancers are typically small and confined to the area where they began.
- Stage II and Stage III cancers have spread to nearby tissue and/or lymph nodes.
- Stage IV cancer has spread to distant areas of the body. This is also called metastatic cancer. Stage IV cancer often cannot be cured, but frequently can be managed like a chronic disease.
Stages of Thyroid Cancer
Papillary and follicular thyroid cancer in patients younger than 55 years
(source: National Cancer Institute)
People who are less than 55 years old have only Stage I or Stage II papillary or follicular thyroid cancer.
Stage I: In stage I papillary and follicular thyroid cancer, the tumor is any size and may have spread to nearby tissues and lymph nodes. Cancer has not spread to other parts of the body.
Stage II: In stage II papillary and follicular thyroid cancer, the tumor is any size and cancer may have spread to nearby tissues and lymph nodes. Cancer has spread from the thyroid to other parts of the body, such as the lungs or bones.
Papillary and follicular thyroid cancer in patients 55 years and older
(source: National Cancer Institute)
Stage I: In stage I papillary and follicular thyroid cancer, cancer is found in the thyroid only and the tumor is 4 centimeters or smaller.
Stage II: In stage II papillary and follicular thyroid cancer, one of the following is found:
- cancer is found in the thyroid and the tumor is 4 centimeters or smaller; cancer has spread to nearby lymph nodes;
- or cancer is found in the thyroid, the tumor is larger than 4 centimeters, and cancer may have spread to nearby lymph nodes;
- or the tumor is any size and cancer has spread from the thyroid to nearby muscles in the neck and may have spread to nearby lymph nodes.
Stage III: In stage III papillary and follicular thyroid cancer, the tumor is any size and cancer has spread from the thyroid to soft tissue under the skin, the esophagus, the trachea, the larynx, or the recurrent laryngeal nerve (a nerve that goes to the larynx). Cancer may have spread to lymph nodes.
Stage IV: Stage IV papillary and follicular thyroid cancer is divided into stages IVA and IVB.
- In stage IVA, the tumor is any size and cancer has spread to tissue in front of the spine or has surrounded the carotid artery or the blood vessels in the area between the lungs. Cancer may have spread to lymph nodes.
- In stage IVB, the tumor is any size and cancer has spread to other parts of the body, such as the lungs or bones. Cancer may have spread to lymph nodes.
Anaplastic thyroid cancer stages
(source: National Cancer Institute)
Anaplastic thyroid cancer grows quickly and usually has spread within the neck when it is found. Anaplastic thyroid cancer is considered stage IV thyroid cancer. Stage IV anaplastic thyroid cancer is divided into stages IVA, IVB, and IVC.
In stage IVA, cancer is found in the thyroid only and the tumor may be any size.
In stage IVB, one of the following is found:
- cancer is found in the thyroid and the tumor may be any size; cancer has spread to nearby lymph nodes; or
- the tumor is any size and cancer has spread from the thyroid to nearby muscles in the neck and may have spread to nearby lymph nodes; or
- the tumor is any size and cancer has spread from the thyroid to soft tissue under the skin, the esophagus, the trachea, the larynx, the recurrent laryngeal nerve (a nerve that goes to the larynx), or tissue in front of the spine, or has surrounded the carotid artery or the blood vessels in the area between the lungs; cancer may have spread to lymph nodes.
In stage IVC, the tumor is any size and cancer has spread to other parts of the body, such as the lungs or bones. Cancer may have spread to lymph nodes.
Medullary thyroid cancer stages
(source: National Cancer Institute)
Stage I: In stage I medullary thyroid cancer, cancer is found in the thyroid only and the tumor is 2 centimeters or smaller.
Stage II: In stage II medullary thyroid cancer, one of the following is found:
- cancer is in the thyroid only and the tumor is larger than 2 centimeters; or
- the tumor is any size and cancer has spread from the thyroid to nearby muscles in the neck.
Stage III: In stage III medullary thyroid cancer, the tumor is any size and cancer may have spread from the thyroid to nearby muscles in the neck. Cancer has spread to lymph nodes on one or both sides of the trachea or larynx.
Stage IV: Stage IV medullary thyroid cancer is divided into stages IVA, IVB, and IVC.
- In stage IVA, either of the following is found:
- the tumor is any size and cancer has spread from the thyroid to soft tissue under the skin, the esophagus, the trachea, the larynx, or the recurrent laryngeal nerve (a nerve that goes to the larynx); cancer may have spread to lymph nodes on one or both sides of the neck; or
- the tumor is any size and cancer may have spread from the thyroid to nearby muscles in the neck; cancer has spread to lymph nodes on one or both sides of the neck.
- In stage IVB, the tumor is any size and cancer has spread to tissue in front of the spine or to the spine or has surrounded the carotid artery or the blood vessels in the area between the lungs. Cancer may have spread to lymph nodes.
- In stage IVC, the tumor is any size and cancer has spread to other parts of the body, such as the lungs or liver. Cancer may have spread to lymph nodes.
Medullary thyroid cancer survivor trusts MD Anderson for long-term care
In March 2019, Dana Reeves was preparing for several milestones. Her daughter was getting ready to graduate from high school. Her husband was about to retire from the military. And her family was preparing to move from Germany back to the United States.
Something she hadn’t planned for? A medullary thyroid cancer diagnosis. But at age 46, that’s exactly what she faced.
Bloodwork leads to medullary thyroid cancer diagnosis
In 2006, Dana was diagnosed with sarcoidosis, an inflammatory disease in which groups of cells form tiny growths, called granulomas, in different organs in the body.
“It was built into our military orders that I had to be checked yearly for sarcoidosis,” she says. “After I received a great checkup from my doctor, I asked for bloodwork to provide to my civilian doctor since we were about to retire from the military.”
The bloodwork revealed something odd in Dana’s parathyroid gland. She was referred to an endocrinologist in Germany, who performed an ultrasound.
“Once he started the ultrasound, he said, ‘You have a lump on the right side of your thyroid, and I’m pretty sure it’s cancer,’” she recalls. “I was shocked.”
Dana had a biopsy the next day. Pathology reports confirmed that she had stage III medullary thyroid cancer.
“I wanted to see my daughter graduate, and I didn’t want her to have a memory of her mom suffering with cancer,” says Dana. “My husband and I grabbed each other’s hands. We didn’t crumble. We didn’t fall apart. We just relied on what we’d always had – our faith.”
Surgery to treat medullary thyroid cancer
After receiving her diagnosis, Dana was referred to an ear, nose and throat specialist in Germany. The doctor did not feel comfortable treating the advanced cancer and recommended a thyroid cancer surgeon in Florida.
So, Dana was transported by a military medical airlift to Florida on April 22 and had surgery the next day.
“My calcitonin levels were at 2,200 – up from 1,200 a month earlier. That’s how fast the cancer was growing,” she says. “By that point, it should have spread everywhere. But my surgeon discovered that it was just located in my right thyroid.”
Dana had a total thyroidectomy with a central neck dissection. The surgeon removed Dana’s entire thyroid as well as 17 lymph nodes. They all came back clear.
Returning to the U.S. and receiving specialized care at MD Anderson
Dana had returned to Germany when her surgeon called with the news that all the cancer was gone.
“I asked him, ‘Where do I go from here?’ I told him I was moving back to Texas, and I’d never received any specialty care other than for sarcoidosis,” she says. “Without hesitating, he said I should see Dr. Mimi Hu at MD Anderson. My life had been in his hands, and he’d treated me so well that I trusted what my surgeon said. So, I said, ‘I’m going to MD Anderson.’”
But not before seeing her daughter graduate high school and celebrating her husband’s retirement from 24 years in the military.
In July, Dana’s family moved back to Texas, settling near the Dallas/Fort Worth area. It was centrally located to her daughter’s college, her parents’ home and MD Anderson.
“MD Anderson knows what they’re doing. You get in and do your bloodwork and scans and see the doctor all in the same day,” says Dana, who now only comes once a year for checkups. “Dr. Hu, her nurses and the entire crew at MD Anderson have been phenomenal. The nurses make you feel like you’re their only patient. They answer all of my questions.”
MD Anderson helps manage treatment side effects
Because Dana no longer has a thyroid, she takes an oral synthetic thyroid hormone called levothyroxine daily. When her levels are off, sometimes she experiences fatigue or a change in mood.
“When that happens, I just log into MD Anderson’s portal and tell them that I think my levels are off,” says Dana. “They’ll send me a lab slip through MyChart, then I’ll visit a local lab and my results are sent to MD Anderson. My care team will tweak my dosage as needed.”
Dana’s also dealt with both weight loss and weight gain since her surgery and gone into early menopause.
“I literally went into surgery at my goal weight and came home 10 pounds heavier,” she says. “I’ve probably gained 30 pounds in this journey of back and forth and up and down. It’s frustrating, but I will take a little bit of weight gain over having cancer any day.”
Embarking on survivorship
Dana is thankful for the care she has received at MD Anderson.
“Even though I have a family doctor locally, I run everything by Dr. Hu,” she says. “I value and trust her opinion.”
Dana’s most recent checkup was in February. She was with her husband, and Hu’s nurse practitioner Rebekah Puls was going over the results.
“I remember telling my husband that I think it had been five years since my diagnosis and wondered at what point do they cut you loose,” says Dana.
Moments later, Hu entered the room and shared some wonderful news.
“Dr. Hu said, ‘Mrs. Reeves, your levels for five years have not only been stable, they’ve also been undetectable. I wanted to let you know that we’re going to move you from cancer patient to cancer survivor,’” recalls Dana. “My husband and I started bawling. So was Rebekah. And when I shared with Dr. Hu that when I was first diagnosed, my wish was to see my daughter graduate high school, she started crying.”
Dana was presented with her survivorship certificate, and Hu explained what it meant and what Dana’s care might look like going forward. She is excited about transitioning to survivorship.
“I’m happy to share my experience because now that I’m on the other side of it, I can give somebody hope and reassurance that they can get through this,” she says. “MD Anderson is the standard. Put yourself in their hands, and they will walk with you through every stage.”
Request an appointment at MD Anderson online or call 1-877-632-6789.