Prophylactic thyroidectomy: Who needs it, when, and why

Advances in the recognition and management of hereditary cancer

INTRODUCTION

Constitutional mutations in genes controlling DNA repair, cell-cycle regulation and cell apoptosis can determine an individual's tendency to develop cancer. Hereditary cancer predisposition syndromes present with multiple cancers at a young age and underlie a significant burden of morbidity and mortality. Recent advances in the recognition and management of hereditary cancer will be illustrated with specific examples of developments in diagnosis and treatment.

SOURCES OF DATA

Key recent published literature.

AREAS OF AGREEMENT

The identification of individuals with hereditary cancer offers important opportunities for cancer prevention, early intervention and personalized management.

AREAS OF CONTROVERSY

Individuals at risk of hereditary cancer remain under-recognized. There is a need to develop evidence-based guidelines for the recognition and management of hereditary cancer predisposition conditions.

GROWING POINTS

The study of Mendelian cancer susceptibility syndromes has added to our understanding of hereditary and sporadic cancers and facilitated the development of targeted agents directed against cancer-driving mutations. Increasingly, cancer patients with constitutional gene mutations treated with targeted therapies have improved clinical outcomes.

AREAS FOR TIMELY RESEARCH

Building the infrastructure to enable constitutional gene mutation testing to become integrated into routine cancer care, including the parallel development of robust referral pathways alongside genomic sequencing technologies.

Initial surgical management of medullary thyroid cancer

Medullary thyroid cancer (MTC) accounts for 5–10% of thyroid cancer. The majority, 75–80%, of MTC are sporadic with the remainder being hereditary secondary to a mutation in the RET proto-oncogene. Hereditary MTC may be isolated as in familial medullary thyroid cancer or associated with multiple endocrine neoplasia syndrome types 2A and 2B. The primary treatment modality for sporadic MTC is total thyroidectomy and central compartment neck dissection; consideration of lateral neck dissection should be based on preoperative imaging findings. The timing of prophylactic thyroidectomy is dependent on the specific RET codon mutation.