Chapter 57: Thyroid Gland- Papillary Adenocarcinoma Flashcards
What is papillary carcinoma’s claim to fame?
Most common thyroid cancer (Think: Papillary = Popular) = 80% of all thyroid
What is the environmental risk?
Radiation exposure
What is the average age?
30 to 40 years
What is the sex distribution?
Female > male; 2:1
What are the associated histologic findings?
Psammoma bodies (Remember, P = Psammoma = Papillary)
Describe the route and rate of spread
Most spread via lymphatics (cervical adenopathy); spread occurs slowly
131I uptake?
Good uptake
What is the 10-year survival rate?
≈95%
What is the treatment for:
<1.5 cm and no history of neck radiation exposure?
Options:
- Thyroid lobectomy and isthmectomy
- Near-total thyroidectomy
- Total thyroidectomy
What is the treatment for:
>1.5 cm, bilateral, + cervical node metastasis OR a history of
radiation exposure?
Total thyroidectomy
What is the treatment for:
Lateral palpable cervical LNs?
Selective neck dissection (ipsilateral)
What is the treatment for:
Central?
Central neck dissection
Do positive cervical nodes affect the prognosis?
NO!
What is a “lateral aberrant thyroid” in papillary cancer?
Misnomer—it is metastatic papillary carcinoma to a LN
What postoperative medication should be administered?
Thyroid hormone replacement, to suppress TSH
What is a postoperative treatment option for papillary carcinoma?
Postoperative 131I scan can locate residual tumor and distant metastasis that can be treated with ablative doses of 131I
What is the most common site of distant metastases?
Pulmonary (lungs)
What are the “P’s” of papillary thyroid cancer (7)?
Papillary cancer:
- Popular (most common)
- Psammoma bodies
- Palpable LNs (spreads most commonly by lymphatics, seen in ≈33% of patients)
- Positive 131I uptake
- Positive prognosis
- Postoperative 131I scan to diagnose/treat metastases
- Pulmonary metastases
