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Rosh Internal Medicine Practice Exam

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A 38-year-old woman with papillary thyroid cancer 2.3 cm with regional lymph node metastasis but no distant metastasis is staged as which stage?
Correct Answer:
Stage I
Explanation:
In papillary thyroid cancer, age is a major driver of stage. For younger patients, nodal involvement does not automatically upstage the disease as long as there is no distant metastasis. A 2.3 cm tumor places her in a mid T category, and regional lymph node metastasis (N1) with no distant spread (M0) would still be staged as an early, favorable stage in this age group. So, despite the regional metastasis, she remains Stage I because distant metastasis is absent and her age falls into the group where nodal disease does not by itself elevate the stage. If distant metastasis were present or if the patient were older, the stage would be higher.

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