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- Thyroid Cancer
- Thyroid Cancer Stages
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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.
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