Stage Grouping for Papillary or Follicular Thyroid Carcinoma

All staging systems have found that older people have a greater chance of dying from papillary or follicular thyroid cancer. The TNM stage groupings for papillary and follicular carcinomas take this fact into account and places all people under age 45 years with papillary thyroid cancer in stage I if they have no distant spread and stage II if they have distant metastases beyond the neck or upper mediastinal lymph nodes.

Patients younger than 45 years

Stage I: Any T, any N, M0: The cancer can be any size and may or may not have spread to lymph nodes. It has not spread to distant sites.

Stage II: Any T, any N, M1: The cancer can be any size and may or may not have spread to lymph nodes. It has spread to distant sites.

Patients 45 years and older

Stage I: T1, N0, M0: The cancer is less than 2 cm and has not spread to lymph nodes or distant sites.

Stage II: T2, N0, M0: The cancer is 2 to 4 cm and has not spread to lymph nodes or distant sites.

Stage III: T1-3, N0-N1a, M0: The cancer is larger than 4 cm or has grown slightly outside the thyroid and has not spread to lymph nodes or distant sites; or it is any size and has spread to local neck nodes but not to distant sites.

Stage IVA: T1-4a, N0-1b, M0: Tumor of any size and has grown beyond the thyroid gland to invade nearby tissues of the neck and may or may not have spread to local lymph nodes but not to distant sites; or it is any size and has spread to lymph nodes in the upper chest (upper mediastinal lymph nodes) but not to distant sites.

Stage IVB: T4b, Any N, M0: Tumor has grown either back to the spine or into nearby large blood vessels, may or may not have spread to lymph nodes, but has not spread to distant sites.

Stage IVC: Any T, any N, M1: Tumor is any size and may or may not have spread to lymph nodes, but it has spread to distant sites.