Endocrine Abstracts

This topic will be discussed taking into consideration the need to incorporate the continuously increasing molecular data in the old frame (imagiology, cyto and histopathology and biochemistry). Using this strategy three practical issues may be addressed: diagnosis, prognosis/therapy selection and surveillance.

Out of the above mentioned issues we will focus the discussion of the usefulness of molecular markers in two steps of the management of patients with thyroid tumours:

i) In the initial evaluation of thyroid nodules together with sonography and cytopathology data; the latter obtained by fine needle aspiration biopsy (FNAB) since core biopsy methods have not proved (yet?) their value in thyroid oncology.

ii) In the definitive characterization of the tumours after surgery, in conjunction with all the available clinical, imagiological and laboratorial data and with the huge amount of information that can be obtained by the thorough histopathological study of the surgical specimens.

When discussing these two ‘steps’ one has to be aware of the relatively few possible options from the therapeutic standpoint. Oversimplifying the issues (I am pathologist…) and avoiding the problems raised by poorly differentiated/undifferentiated (anaplastic) carcinomas, I would summarize the critical questions as follows: i) To operate or not? ii) If yes, what is the adequate extention of the thyroidectomy? iii) What to do about regional lymph nodes? iv) Radioactive iodine: Yes or no? v) What to do in radioactive iodine-refractory tumours? vi) When and how to use the new targeted biologic approach therapies?

In case there is time, we will also discuss the role molecular biomarkers may play in the new therapeutic approaches. Besides addressing the MAPK pathway (and its networks), oncologists will also try to target the blood supply using antiangiogenesis drugs and/or HIF1a upregulation, as well as to counterbalance the metabolic shift of neoplastic cells towards glycolysis. Most likely, oncologists will try to apply to thyroid cancer the new strategies that the studies of epigenetics and microRNA are generating in the oncology field.