Endocrine Tumors Flashcards
What is the function of the endocrine system?
Complex Metabolic Functions
What are the 3 primary organs of the endocrine system?
Pituitary, Thyroid, and Adrenal
What other 2 structures are also a part of the endocrine system?
Parathyroid Gland and Pancreas
What structure controls the endocrine system?
Pituitary
What organ directs the pituitary?
Hypothalamus
How does the endocrine transport hormones?
Hormones are deposited and transported through the blood
What is the function of the endocrine system in terms of looking at the body holistically?
Maintain Metabolic Homeostasis
What is the name of the process in which homeostasis is achieved as a result of this process?
Negative Feedback Loop
Explain the negative feedback loop
In terms of negative feedback, once the body sense there is a high volume of certain hormones then a organ will be limited in creating that hormone
What is a function of the endocrine system that activates bases on external factors?
Ability to respond to stresses
Endocrine dysfunction can result in minor or life-threatening situations. True or False?
True
What is an example of a situation resulting from endocrine dysfunction?
Diabetes, Graves Disease, PCOS
What occurs as a result of neoplastic development in the endocrine system?
Metabolic function altering
What results from the metabolic function being altering from neoplastic developments?
Paraneoplastic syndromes
Primary Malignancies in the Endocrine System are common. True or False?
False, they are rare
What is the most common endocrine malignancy?
Thyroid Cancer
What percentage of endocrine tumors are those of the thyroid?
Over 90 %
What is the most common histology of thyroid cancer?
Papillary
What is the 5-year survival rate for thyroid cancer?
98.3%
What event is the most known etiological association to Thyroid Cancer?
Exposure to external radiation pre-puberty
History of Goiter has been shown to be related to the cause of thyroid cancer? True or Fales
True
What geographical areas have been more prone to the development of thyroid cancer and why?
Chernobyl and Marshall Islands. Chernobyl is due to the nuclear reactor disaster that occurred and Marshall Islands are due to the denotation of nuclear arms
Why have those that grew up in the 30s,40s, and 50s shown more occurrence of Thyroid Cancer than other generations?
With X-Ray being a new development, there was widespread usage such as in the shoe industry
What are the prognostic factors of Thyroid Cancer?
Age, Histological Subtype, Capsular Invasion
In terms of histology and tumor margin, what has the best outcome?
Well Differentiated and Tumors confined to the gland
Anatomically the thyroid is separated into?
Right and Left lobes
What structure does the thyroid lay anteriorly to?
Trachea
What 4 lymphatic chains does the thyroid drain to?
Internal Jugular Chain, Anterior Cervical Node, Pre-Wtracheal and Para-tracheal nodes
For Thyroid Cancer, when superior mediastinal nodes are involved, what does the mean?
Significant Regional Spread
What are the 7 lymphatics of the neck?
Superior Deep Cervical, Inferior Deep Cervical, Submental, Submandibular,, pre-laryngeal, para-tracheal, Pre-tracheal
What two biological components are metabolized by the thyroid?
Carbohydrates and Proteins
Most clinical disorders are a result of what two thyroid-related conditions?
Hyperthyroidism and Hypothyroidism
Hypothyroidism causes what two disorders?
Cretinism and Myxedema
What are some symptoms of Cretinism?
Appears in infants, Stunted growth, abnormal bone formation, retardation
What are some symptoms of Myxedema?
Low metabolic rate, Mental Slowness, Weight Gain, peri-orbital edema
Hyperthyroidism causes what two disorders?
Graves and Goiter
What are some symptoms of Grave disease?
Elevated Metabolism, abnormal weight, excessive perspiration, exophthalmos
What are some symptoms of Goiter?
Signs of Enlarged Thyroid, Over stimulation causes enlargement of thyroid cells
What is the clinical presentation of Thyroid Cancer?
Palpable mass, and 25% exhibit palpable cervical nodes
What should be performed on persistently enlarged nodes?
Biopsy
Why are biopsies so important for thyroid tumors?
Give definitive diagnosis
What two types of biopsies are performed on thyroid tumors?
Fine Needle Aspiration and Core needle biopsy
What can a sonograph determine on a thyroid tumor?
Solid mass versus cystic mass
What can a ct scan determine on a thyroid tumor?
Local or Regional Extent
What can an MRI determine on a thyroid tumor?
Margins and Extent
What can radionuclide imaging determine for thyroid malignancy?
Evaluate location and function of nodule, detect primary disease and distant mets
What radioisotopes are used in radionuclide imaging and what is the meaning behind uptake?
Iodine and Technetium, uptake is measured and the more uptake indicates likelihood of malignancy
What can nuclear imaging determine in terms of thyroid nodules?
Hot, Warm and Cold Nodules
What are the 4 types of thyroid histology?
Papillary, Follicular, Medullary, Anaplastic
What are the most common thyroid histologies?
Papillary, Mixed papillary-follicular and Follicular
What staging system is used for thyroid cancer?
TNM staging
What 2 factors are taken into account when staging for thyroid cancer?
Histology and age of patient
What percentage of patients have positive cervical nodes at dx and does that have an effect on the prognosis?
50-70% and there is no worsening of the prognosis
Where does papillary/mixed papillary-follicular typically met to?
Regional nodes through lymphatics
Where does Follicular typically met to?
Vascular Channels (Liver, lung, bone and brain)
Where does medullary typically met to and the behavior exhibited?
indolent or very aggressive and hematogenously/lymphatically
Where does anaplastic typically met to and the behavior exhibited?
Adjacent structures such as trachea, skin invasion, neck nodes
What is the treatment of choice for thyroid cancer?
Thyroidectomy, Partial or Total
What are the two other treatments utilizing radiation for thyroid cancer?
I-131 Radio-ablation, EBRT w/ or w/o I-131
What histologies of thyroid cancer are more radioresistant?
Papillary and Mixed Papillary-Follicular then follicular
What histologies of thyroid cancer are less responsive to radiation therapy?
Medullary is less responsive and Anaplastic is not responsive
Can EBRT be used with I-131 or Surgery?
Alone or with both
What is the common dosage for thyroid cancer?
6000-7000 cGy (180-200 cGy daily)
What structures are included in the thyroid tx field?
Entire T-gland, neck, superior mediastinum
Why is it important for the neck to be extended for thyroid treatment?
To avoid irradiating the mouth or lower portion of the head
Pituitary tumors are less aggressive of CNS tumors? True or False.
True
What portion of the pituitary gland do most tumors occur in?
Anterior pituitary gland
What is the importance of hormone production in Pituitary tumors?
Diagnostic tool and also an indication of any type of response measure
What are the two types of pituitary tumors in terms of functionality?
Over functioning and non functioning
What are the types of hormone tumors?
Prolactin Secreting, Growth Hormone, TSH secreting
What are some hormones that are secreted by the pituitary?
Prolactin, Growth Hormone, TSH, ADH, ACTH, Oxytocin, FSH, LH
What does ADH stand for and whats its function?
Anti-diuretic Hormone and regulates fluid balance
what is oxytocin’s function?
Smooth muscle contraction, often during childbirth
What does FSH stand for and whats its function?
Follicle Stimulating Hormone and it stimulates the production of egg and sperm
What does LH stand for and whats its function?
Luteinizing Hormone and stimulates sexual and reproductive activities
Where is the pituitary locates on the brain?
Base of brain
What structure does the pituitary lie in?
Sella Turcica
What are some critical structures associated with the pituitary gland?
Optic Chiasma, Brain stem,
What are some of the clinical presentations of pituitary gland?
Hormonal effects, pressure effects, Endocrine abnormalities,
Explain the pressure effects exhibited by those that have pituitary tumors?
Headaches and vision impairments when the pituitary is outside of the sella turcica, which puts pressure on the optic chiasma and also the brain
How is pathology of pituitary tumors decided?
Based on size of the tumor
What is the difference in micro vs. macro adenomas?
Micro is 10 mm or less and Macro is 10 mm or more
