ABSTRACT
Medullary thyroid cancer is a rare cancer arising from C-cells. RET proto-oncogene testing, serum calcitonin, serum CEA, and ruling out secretary pheochromocytoma are part of the essential pre-operative work-up before surgery. Distant metastatic work-up is done for serum calcitonin level more than 500 pg/ml. Surgery is the mainstay of treatment in medullary thyroid cancer. Systematic compartment oriented neck dissection is done depending on the pre-operative serum calcitonin level. There is no role for Berry picking. Coexistent pheochromocytoma should be addressed first before thyroid surgery is planned.
Serum calcitonin doubling time less than six-months suggests poor survival. Serum calcitonin more than 150 pg/ml post-operatively warrants the evaluation for recurrence. Palliative surgery with minimal morbidity is done to prevent symptoms. Genetic counselling and age-appropriate prophylactic surgery is the way forward in germline mutation-positive individuals.
