Evaluation and treatment of aerodigestive tract invasion by well-differentiated thyroid carcinoma.

BACKGROUND Although rare, invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma can be a source of significant morbidity as well as mortality for the patient. Effective management of patients with invasive thyroid carcinoma requires an understanding of the patterns of invasion and methods of treatment, including surgical resection and adjuvant therapy. METHODS The author reports on experience with invasive well-differentiated thyroid carcinoma, discussing diagnosis (based on physical examination, imaging studies, and endoscopy) as well as treatment options (based on degree of aerodigestive tract invasion). RESULTS Direct intraluminal invasion of thyroid carcinoma requires definitive resection of aerodigestive tract lumen to remove all gross disease. However, when the lumen is not involved, "shaving" tumor from airway or esophagus is an acceptable treatment with a similar locoregional control rate and minimal morbidity when compared to definitive aerodigestive tract resection. CONCLUSIONS Successful treatment of invasive thyroid carcinoma should improve survival and reduce not only the morbidity of the disease, but also the morbidity of the surgical procedure.