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Solid Tumor Oncology > Endocrine Cancer > Flashcards

Endocrine Cancer Flashcards

1
Q

What are the two types of differentiated thyroid carcinoma?

A

Papillary and follicular

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2
Q

What is the standard of care treatment algorithm for localized differentiated thyroid cancer?

A

Surgery followed by RaI, then levothyroxine (TSH suppression)

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3
Q

What is the cell of origin for medullary thyroid carcinoma?

A

Parafollicular C cells of thyroid, that produce calcitonin

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4
Q

What is the clinical syndrome of MEN 2A

A

Medullary thyroid carcinoma (>95%)
Parathyroid hyperplasia (20%)
Pheochromocytoma (50%)

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5
Q

What is the clinical syndrome of MEN 2B

A

Medullary thyroid carcinoma (100%)
Mucosal neuromas (GI ganglioneuromas >98%)
Pheochromocytoma (50%)

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6
Q

What is the gene involved in MEN2A and MEN2B?

A

RET

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7
Q

What are the two most common mutations seen in sporadic medullary thyroid carcinoma?

A

RET
RAS (HRAS, then KRAS, then NRAS)

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8
Q

You see a patient with MEN2 prior to development of any malignancy. What do you do?

A

Rule out pheochromocytoma with labs or imaging, then do prophylactic thyroidectomy

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9
Q

In a patient with medullary thyroid carcinoma, what clinical features puts them at high risk for residual disease after surgery?

A

LN+ (90% have residual disease vs 38% in LN-)

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10
Q

In medullary thyroid carcinoma, what is a clue that there is residual disease after surgery?

A

Persistently high calcitonin levels

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11
Q

What is a useful tumor marker for differentiated thyroid cancer?

A

Thyroglobulin
Makes sure you have reflex to TgAb because that can interfere with ability to measure thyroglobulin

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12
Q

You see a patient with metastatic differentiated thyroid cancer. They have a low thyroglobulin. What should you suspect?

A

Poor differentiation and aggressive behavior

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13
Q

What are useful tumor markers in MTC? (2)

A

Calcitonin
CEA

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14
Q

What does a low Calcitonin:CEA ratio mean?

A

Poor differentiation, aggressive

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15
Q

What does a high calcitonin:CEA ratio suggest?

A

Well differentiated disease

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16
Q

What are two treatment options for advanced differentiated thyroid carcinoma?

A

Sorafenib and lenvatinib (preferred)

17
Q

What are two treatment options for 1st line advanced MTC?

A

Vandetanib
Cabozantinib

18
Q

What is the only FDA approved treatment for 2nd line advanced differentiated thyroid cancer?

A

Cabozantinib

19
Q

Treatment for advanced anaplastic thyroid carcinoma with BRAF mutation?

A

Dabrafenib + Trametinib

20
Q

Treatment for advanced papillary thyroid carcinoma with BRAFV600E mutation

A

Dabrafenib + trametinib

21
Q

Indications for dabrafenib + trametinib in thyroid cancer

A

Advanced anaplastic
Advanced papillary

22
Q

2 Treatment options for RET mutated/fusion advanced thyroid cancer?

A

Selpercatinib
Pralsetinib

23
Q

Treatment for advanced thyroid carcinoma with NTRK fusions (2 options)

A

Larotrectinib
Entrectinib

24
Q

What is the difference in treatment of localized differentiated thyroid carcinoma vs medullary or anaplastic?

A

Medullary or anaplastic doesn’t need RAI

25
Q

6 indications for total thyroidectomy in differentiated thyroid cancer?

A

prior radiation (2B)
Extrathyroid extension
poorly diff
lateral cervical LN mets or gross central neck LN
Tumor >4 cm
Known distant mets

26
Q

RAI should not be offered to people with differentiated thyroid carcinoma who meet what 6 criteria?

A

Classic papillary
small tumor <2 cm
No extrathyroid extension
No detectable Tg antibodies
Postoperative thyroglobulin <1 ng/mL
negative postoperative US, if done

27
Q

Indications for adjuvant RAI in differentiated thyroid cancer? 1 of 7

A

N1b disease
extrathyroid extension
Tumor >4 cm
Postoperative thyroglobulin >10
>5 LNs
Vascular invasion
Known or suspected distant mets at presentation

28
Q

preferred management of locoregional recurrence of MTC?

A

Surgery

29
Q

For patients with carcinoid tumors of the appendix, what dictates how large of a surgery they get?

A

Tumors >2 cm (or those with incomplete resection or LN+), they should get scans for metastatic disease. If no mets, then they need a R hemicolectomy.

Tumors <=2 cm, then appendectomy

30
Q

Clinical features of MEN1

A

Hyperparathyroidism
Pancreatic NET (glucagonoma, insulinoma, VIPoma, gastrinoma)

Solid Tumor Oncology (21 decks)

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