The Present-Day Problem of Cancer of the Thyroid*

RECENT experiences in the surgical management of a large number of patients with thyroid disease have emphasized the fact that carcinoma of the thyroid is being seen more frequently and its treatment has been undergoing needed changes in order to improve the end results. In spite of the fact that a considerable number of patients are seen who have a relatively low grade of thyroid malignancy, many are encountered with extensive malignant involvement leading to early death in spite of the best recognized combined surgical and radiation treatment. For those physicians who see relatively few thyroid patients the problem of carcinoma of the thyroid may not seem important, but as a result of a considerable experience at the Lahey Clinic in the treatment of carcinoma of the thyroid, questions have arisen which we believe could be clarified by a review of recently treated patients. For example, in what percentage of cases can a clinical diagnosis of carcinoma of the thyroid be made? Can carcinoma of the thyroid exist without signs or symptoms? Is carcinoma of the thyroid increasing in frequency? What is the present incidence of carcinoma in discrete nodules and in diffuse nodular goiter? Has there been an appreciable increase in papillary tumors? What changes in surgical treatment have occurred? Should the number of radical neck dissections be increased?