Medullary thyroid cancer arises from so called “C-Cells,” or nests of non-thyroidal cells, located within the thyroid gland. These cells produce a hormone called Calcitonin which assists in regulating calcium metabolism. Far more rare than papillary or follicular cancer, Medullary cancer occurs as both a sporadic non-hereditary event and as an inherited disease. Most commonly, it occurs with no known family history. Those that are inherited are often part of Hereditary syndromes known as Multiple Endocrine Neoplasia (MEN), either type 1 or 2. Details of these is beyond the scope of this brief essay. Suffice to say, when there is a defined family history of MEN, medullary cancer can be detected and aggressively treated early in life to improve the patient’s chance for survival. All Medullary cancers produce an excessive amount of Calcitonin and can be identified and followed using the blood level of this hormone.
Nowadays, sophisticated genetic testing can also be done for those suspect of having the familial form of the disease. Medullary thyroid cancer can spread both to lymph nodes and via the bloodstream to distant organs, and thus mandates aggressive treatment. Total thyroidectomy with removal of regional lymph nodes is indicated for most patients. Careful pot-operative monitoring of calcitonin is then done by the thyroid specialist. Radioactive iodine is not indicated for this cancer, but occasionally radiation therapy or specific targeted therapies may be given for more advanced disease.