The surgical treatment of medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) is a unique disease in solid tumor oncology due to its ability to secrete calcitonin (iCT), a highly sensitive and specific serum marker of persistent or recurrent disease even at a microscopic level. The relatively long duration of survival experienced by most patients with MTC combined with the visible nature of surgical complications, when they occur, has caused most surgeons to take a conservative approach to the operative management and follow-up of patients with MTC. In contrast, the patient, family physician, and endocrinologist watch the iCT slowly rise, indicative of persistent and usually progressive invasive cancer. Amidst this clinical dilemma, we developed a standardized diagnostic and operative strategy to maximize local-regional tumor control and facilitate patient management.