Management of Medullary Thyroid Carcinoma: Integrating World Health Organization Grading and Molecular Targets for Precision Therapy.

Medullary thyroid carcinoma (MTC) is a clear example of how molecular understanding can reshape traditional cancer management. The World Health Organization (WHO) 2022 histologic grading system has introduced much-needed consistency in evaluating tumor aggressiveness and now provides a reliable foundation for clinical decision making. When combined with insight into genetic and epigenetic alterations such as rearranged during transfection (RET), rat sarcoma viral oncogene family (RAS), and delta-like ligand 3 (DLL3), this framework enables more accurate prognostication and supports the rational use of selective targeted therapies. Circulating biomarkers including calcitonin, carcinoembryonic antigen, circulating tumor DNA, and microRNA-375, are redefining postoperative surveillance. These tools shift follow-up from a static, stage-based approach to a dynamic model that reflects the biological behavior of the tumor. The integration of histologic, molecular, and liquid-biopsy information is steadily moving MTC care toward a more precise and individualized discipline. Meaningful progress in the coming years will depend on multicenter collaboration, standardization of molecular and histologic assessment, and clinical trials that link biologic grading with treatment outcomes. Establishing a unified framework that connects pathology, genomics, and patient response will help translate scientific advances into improved survival and quality of life for individuals living with MTC.