# Papillary thyroid cancer

Source: https://onco.cc/cancers/papillary-thyroid-cancer/  
OnCo record `papillary-thyroid-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Papillary thyroid cancer is the commonest and most curable thyroid cancer. Most people are treated with surgery, some with radioactive iodine afterwards, and many small tumours can simply be watched. Only the rare tumours that stop taking up iodine need targeted drugs.

## Summary

Papillary thyroid cancer arises from the follicular cells and often spreads to neck lymph nodes but rarely kills. About 60 percent carry a BRAF V600E mutation and others RET or NTRK fusions or RAS mutations. Treatment is lobectomy or total thyroidectomy, with radioactive iodine reserved for intermediate- and high-risk disease after the ESTIMABL2 and IoN trials showed low-risk patients do as well without it; TSH suppression with levothyroxine and thyroglobulin monitoring follow. Japanese studies established that papillary microcarcinomas under a centimetre can be kept under active surveillance, and guidelines now allow it. The minority whose recurrent or metastatic disease no longer takes up iodine are treated with lenvatinib or sorafenib, or with selpercatinib, larotrectinib or dabrafenib-trametinib when the matching alteration is found.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Papillary thyroid carcinoma; PTC; Papillary microcarcinoma (under 1 cm)
- Tags: subtype-page
- Group: endocrine
- Burden: About four in five thyroid cancers; incidence tripled over three decades in many countries mainly through ultrasound detection of small tumours, while deaths barely changed; more than nine in ten patients are alive at ten years.
- Subtypes: Classic papillary; Follicular variant; Tall cell, columnar and hobnail variants (more aggressive); Papillary microcarcinoma (under 1 cm); Diffuse sclerosing variant
- Biomarkers: BRAF V600E (about 60 percent); RET and NTRK fusions; TERT promoter mutation (worse outlook, especially with BRAF); Thyroglobulin after surgery; ATA risk category (low, intermediate, high)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/papillary-thyroid-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/papillary-thyroid-cancer/#overview [4 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/papillary-thyroid-cancer/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/papillary-thyroid-cancer/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/papillary-thyroid-cancer/#treating-it [4 settings, 1 decision with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/papillary-thyroid-cancer/#evidence [4 key papers, 6 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/papillary-thyroid-cancer/#science [20 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/papillary-thyroid-cancer/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/papillary-thyroid-cancer/#living-with-it [14 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/papillary-thyroid-cancer/coming/ [7 medicines, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/papillary-thyroid-cancer/data/ [47 connected records]

## Standard of care

- Papillary microcarcinoma: Active surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series. ([Active surveillance](https://onco.cc/technologies/active-surveillance/))
- Low risk: Lobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up. ([Thyroid cancer](https://onco.cc/cancers/thyroid/))
- Intermediate and high risk: Total thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression. ([Radioiodine therapy and whole-body iodine scanning](https://onco.cc/technologies/radioiodine-therapy/), [TSH receptor (TSHR)](https://onco.cc/targets/tshr/))
- Iodine-refractory advanced disease: Lenvatinib (SELECT) or sorafenib (DECISION); selpercatinib for RET fusions, larotrectinib or entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF V600E. ([Lenvatinib](https://onco.cc/drugs/lenvatinib/), [Sorafenib](https://onco.cc/drugs/sorafenib/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Trametinib](https://onco.cc/drugs/trametinib/), [Radioiodine-refractory (RAI-R) thyroid cancer](https://onco.cc/terms/rai-refractory/))

## State of the art

- Two randomised trials showed that low-risk patients can skip radioactive iodine without harm, ending decades of routine ablation.
- Active surveillance of microcarcinomas is accepted practice and is reducing overtreatment.
- Fusion-directed drugs give deep, durable responses in the few iodine-refractory patients who carry RET or NTRK fusions.
- Redifferentiation with BRAF or MEK inhibitors can restore iodine uptake in some refractory tumours.

## Open problems

- Overdiagnosis and overtreatment of small tumours found by imaging.
- Which intermediate-risk patients truly benefit from radioactive iodine.
- Resistance to kinase inhibitors in refractory disease.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Papillary_thyroid_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Papillary_thyroid_cancer
- American Thyroid Association guidelines: https://www.thyroid.org/professionals/ata-professional-guidelines/

## Connected records

- cancers: [Anaplastic thyroid cancer](https://onco.cc/cancers/anaplastic-thyroid-cancer/), [Follicular thyroid cancer](https://onco.cc/cancers/follicular-thyroid-cancer/), [Medullary thyroid cancer](https://onco.cc/cancers/medullary-thyroid-cancer/), [Thyroid cancer](https://onco.cc/cancers/thyroid/)
- key papers: [2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer](https://onco.cc/key-papers/paper-ata-2015-thyroid-nodules-dtc-haugen-thyroid-2016/), [Active surveillance of papillary thyroid microcarcinoma at Kuma Hospital: patient age and progression](https://onco.cc/key-papers/paper-ito-kuma-active-surveillance-microcarcinoma-thyroid-2014/), [ESTIMABL2: thyroidectomy without radioiodine in patients with low-risk thyroid cancer](https://onco.cc/key-papers/paper-estimabl2-leboulleux-nejm-2022/), [SELECT: lenvatinib versus placebo in radioiodine-refractory differentiated thyroid cancer](https://onco.cc/key-papers/paper-select-lenvatinib-nejm-2015/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Radioiodine therapy and whole-body iodine scanning](https://onco.cc/technologies/radioiodine-therapy/), [Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up](https://onco.cc/technologies/thyroid-cancer-markers/)
- targets: [AFF3](https://onco.cc/targets/aff3/), [ARHGAP5](https://onco.cc/targets/arhgap5/), [BRAF](https://onco.cc/targets/braf/), [COL2A1](https://onco.cc/targets/col2a1/), [DGCR8](https://onco.cc/targets/dgcr8/), [EIF1AX](https://onco.cc/targets/eif1ax/), [FAM135B](https://onco.cc/targets/fam135b/), [PABPC1](https://onco.cc/targets/pabpc1/), [PDCD1LG2](https://onco.cc/targets/pdcd1lg2/), [PICALM](https://onco.cc/targets/picalm/), [TSH receptor (TSHR)](https://onco.cc/targets/tshr/), [USP9X](https://onco.cc/targets/usp9x/)
- drugs: [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Lenvatinib](https://onco.cc/drugs/lenvatinib/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [Sorafenib](https://onco.cc/drugs/sorafenib/), [Trametinib](https://onco.cc/drugs/trametinib/)
- terms: [Radioiodine-refractory (RAI-R) thyroid cancer](https://onco.cc/terms/rai-refractory/)
- people: [Bryan R. Haugen](https://onco.cc/people/bryan-haugen/)
- biomarkers: [RET fusion and RET mutation](https://onco.cc/biomarkers/ret-fusion/)

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JSON: https://onco.cc/api/v1/entities/papillary-thyroid-cancer.json