DTC

Question 1

what varients of thyroid cancer are DTCs?

Answer 1

Papillary and follicular

Question 2

Papillary cancer is most likely to present with?

Answer 2

Cervical lymphadenopathy (As the spread is lymphatic)

Question 3

What is the most common spread with follicular cancer?

Answer 3

Haematogenous

Question 4

In terms of AMES, if a patient has distant metastases and a primary tumour size >5cm what risk are they?

Answer 4

High risk

Question 5

older patients with a intrathyroid papillary lesion are in the AMES high risk? T or F

Answer 5

F, low risk

Question 6

extrathyroidal disease in patients with papillary cancer is a feature of AMES high risk ? T or F

Answer 6

T

Question 7

what will most patients with DTCs present with?

Answer 7

Palpable nodules.

Question 8

1st line investigation for DTC?

Answer 8

US guided FNA.

Question 9

Surgical management options?

Answer 9

Lobectomy with isthmusectomy
SUbtotal thyroidectomy
Total thyroidectomy

Question 10

Thyroid lobectomy with isthmusectomy is done is what circumstances?

Answer 10

Papilla

Question 11

Which patients would have a lobectomy w/ isthmusectomy?

Answer 11

Those with

• Papillary microcarcinoma ( < 1cm diameter)
• Minimally invasive follicular carcinoma with capsular invasion only
• a AMES low risk group

Question 12

What should DTC patients with extra-thyroidal spread/ distnat metastases/ nodal involvement get?

Answer 12

Subtotal or total thyroidectomy.

Question 13

which patients should undergo lymph node clearance?

Answer 13

those w/ macroscopic lymph node disease

Question 14

Post Op patients are monitored for what?

Answer 14

Ca levels

Question 15

If Ca levels falls below 1.8 mmol/l or if patient is symptomatic what is given?

Answer 15

IV Ca

Question 16

At what level is Ca replacement initiated?

Answer 16

2 mmol/l

Question 17

Which patients undergo whole body iodine scanning?

Answer 17

Those who have had had a subtotal or total thyroidectomy.

Question 18

roughly what happens in whole body iodine scanning?

Answer 18

pre scan stopping T3 and T4 or using rhTSH to avoid this
- injections + capsule to make cancer cells “hungry” iodine
- imaging few days later
-

Question 19

What is the aim of Thyroid Remnant ABlation?

Answer 19

To suppress TSH for protection

Question 20

Why should thyroglobulin be measured pre-op?

Answer 20

Not all subjects secrete Tg.

Question 21

DTC has the best prognosis of all cancers except non-melanoma skin cancer? T or F

Answer 21

T

Question 22

Treatment of DTC involves surgery and TRA? T or F?

Answer 22

111t

Question 23

Is there a need for life long follow up for DTC patients?

Answer 23

Yes to follow up Tg (tumour marker) and TSH

Question 24

does iodine uptake indicate a good prognosis ?

Answer 24

Yes

Question 25

Medullary thyroid carcinoma is a cancer of which cells?

Answer 25

Parafollicular

Question 26

Parafollicular cells secrete what tumour marker?

Answer 26

Calcitonin