Suspected Malignancy and Malignant Thyroid Tumors

Thyroid cancer (TC) is the most common endocrine tumor, with an annual incidence of 3.4% of all cancers. An increasing incidence is described in recent years probably due to improved diagnostic techniques. It is crucial to identify the type of cancer and stratify its risk. Among TC, papillary thyroid cancer is the most common and indolent with the best overall prognosis. However, there are some aggressively behaving TC that need to be detected and treated early. These include undifferentiated cancers, among which are poorly differentiated and anaplastic cancer. The surgeon’s challenge is a prompt diagnosis and proper treatment in order to limit recurrence. An important role in the diagnosis is played by ultrasound, which allows risk stratification according to the EU-TIRADS (European Thyroid Association - Thyroid Imaging Reporting and Data Systems) classification and identification of risk classes at cytology according to the Bethesda classification. In nonmetastatic disease, surgery is curative in most cases. It is followed by radiometabolic therapy. In the case of anaplastic cancer or metastatic disease, treatment is chemotherapy or palliative. It is crucial to know the genetic profile of TC to establish a possible chemotherapy treatment or define its aggressiveness profile.