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BREAST CANCER > ENDOCRINE TUMORS > Flashcards

ENDOCRINE TUMORS Flashcards

1
Q

What is the epidemiology of thyroid cancer?

A
  • Thyroid cancer being 94% of all new endocrine cases, but represent only 2% of all cancer types.
  • F&raquo_space; M
  • 25 to 65 years old
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2
Q

What are the etiological factors for thyroid cancer?

A
  • External Radiation, particularly before puberty. Back in the 1930s and on, external radiation was given to trear acne, tonsilitis, therefore radiation was given at early age.
  • Iodine defficiency
  • Genetic factor
  • Long standing history of goiter (due to hyperthyroidism)
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3
Q

What are the prognostic factors for thyroid cancer?

A
  • Age
  • Gender
  • Histologic subtype
  • NOT LYMPH NODE INVOLVEMENT
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4
Q

What are the 4 lymphatic capillaries arranged throughout the thyroid gland?

A
  • Internal jugular chain
  • Delphian (anterior cervical) node
  • Pretracheal nodes
  • Paratracheal nodes
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5
Q

What are the two principal hormones produced by the thyroid gland?

A
  • Thyroxine (T4)
  • Triiodothyronine (T3)

Both are responsible of metabolic regulation.

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6
Q

What are the functional disorders of the thyroid gland characterized by hyperthyroidism?

A
  • Grave’s disease, characterized by elevated metabolic rate, abnormal weight loss and exophthalmos (proptosis)
  • Goiter, sign of enlarged thyroid gland, overstimulation by TSH associated with increased hormone production and toxic goiter.
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7
Q

What are the functional disorders of the thyroid gland characterized by hyporthyroidism?

A
  • Cretinism, abnormal bone formation, retarded mental development
  • Myxedema, swollen tissues caused by excess body fluid.
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8
Q

What are the most common clinical presentation for thyroid cancer?

A
  • Palpable neck mass, detected during routine physical examination
  • Asymptomatic painless mass (medullary carcinoma)
  • Pain, dysphagia, dyspnea, stridor hoarseness (anaplastic carcinoma)
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9
Q

What are the Detection tools for thyroid cancer?

A
  • Biopsy (the most important)
  • CT
  • MRI
  • Radionuclide thyroid imaging
  • Sonography (ultrasound), can determine solid vs. cystic thyroid nodule
  • Needle biopsy, needle aspiration or core-needle biopsy with 10% false-positive incidence
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10
Q

What are the 4 most common radiopharmaceuticals used in radionuclide imaging for thyroid cancer?

A
  • Iodine-131
  • Iodine-125
  • Technetium-99m
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11
Q

What are the three ways a thyroid nodule can appear on a radionuclide thyroid imaging?

A
  • cold thyroid nodule (no radionuclide uptake)
  • warm thyroid nodule (slightly higher concentration than rest of thyroid gland)
  • hot thyroid nodule (radionuclide uptake much higher than rest of thyroid gland)
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12
Q

What is the most common histopathology for thyroid cancer?

A

Well-differentiated carcinoma:
-papillary and mixed-papillary-follicular (33-73%)
-follicular (14-33%)
-medullary (5-10%)
Undifferentiated carcinoma:
-anaplastic carcinoma(10%), worst prognosis

Iodine-131 and thyroid hormone suppression treatments given for papillary and mixed papillary-follicular and follicular

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13
Q

What are the common spread routes for the different histopathology in thyroid cancer?

A
  • Papillary and medullary carcinoma = through regional lymph nodes
  • Follicular carcinoma = hematogenously
  • Anaplastic = invasion locally to trachea
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14
Q

What is the most common site of distant METS for thyroid cancer?

A

Lungs

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15
Q

What is the common lymph node spread for thyroid cancer?

A
  • Para-laryngeal
  • Para-tracheal
  • Pre-laryngeal

secondary METS: mid to lower jugular nodes and supraclavicular

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16
Q

What is the treatment of choice for thyroid cancer?

A
  • Surgery (primary approach) thyroidectomy
  • Iodine-131 (Nuclear Medicine)
  • Hormone therapy, thyroid hormone suppression
  • Radiation Therapy

Rx + or - I-131

17
Q

What are the side effects of Iodine-131 therapy?

A
  • Inflammation of salivary glands
  • Nausea
  • Vomiting
  • Fatigue
  • Bone Marrow suppression (after repeated administrations)
18
Q

What is the rationale of Thyroid Hormonal therapy for thyroid cancer?

A

-Differentiated thyroid carcinomas grow by TSH stimulation, therefore if we reduce the TSH levels, the tumor activity should also decrease.

19
Q

What is the rationale of Radiation Therapy for thyroid cancer?

A

Radiation Therapy:
The responsiveness to Rx varies according to the histological type.

Papillary and mixed papillary-follicular = RADIOSENSTIVE
Follicular and medullary is more resistant than above
Anaplastic is not very responsive to Rx.

20
Q

What is a typical Rx treatment dosage for thyroid cancer?

A
  • 65 Gy / 7 weeks , AP/PA or now IMRT, CURATIVE
  • 35 to 45 Gy / 3 to 5 weeks, BONE METS INVOLVEMENT

Target Volume: entire thyroid, neck and superior mediastinum

21
Q

What is required to be out of the field when simulating a thyroid cancer patient?

A

The ORAL CAVITY, needs to be out of field by extending the head (using the appropriate head rest on U-frame)

22
Q

What is Grave’s disease?

A

a disease resulting from an overactive thyroid gland, causing toxic goiter, it;s a type of hyperthyroidism
-Exophthalmos and dry eye feeling

-Antibodies bind to surface of thyroid cells and stimulate them to overproduce thyroid hormones

23
Q

What is the epidemiology/etiology of Grave’s disease?

A
  • M
  • middle age
  • genetic predisposition
  • infections or stress related
24
Q

What are the clinical symptoms of Grave’s disease?

A
  • Fatigue
  • Weight loss
  • Restlessness
25
Q

What is Pterygium?

A
  • A benign disease (non-cancerous), pinkish, triangular-shaped tissue growth on the cornea
  • slowly growing and rarely cover the pupil of the eye
26
Q

What is the epidemiology/etiology for Pterygium?

A
  • affects 20-50 years old

- UV exposure and dust

27
Q

What is the treatment of choice for Pterygium?

A
  • Surgery excision + Radiation (post-operative)
  • Recurrence 20-30% if not given with Rx, <2% if given with Rx.
  • Rx given usually within 48 hours post-operative
28
Q

What element is used to treat Pterygium?

A 
Strontium-90 for Rx
T1/2 = 28.1 years
0.54 MeV
Dose rapidly attenuated
at 2mm = 38% of dose
at 4 mm = 10% of dose
29
Q

What is a typical dose to treat Pterygium with Rx?

A
  • 18 Gy / 1 fx
  • 60 Gy / 10 fx
  • 24 Gy / 3 fx (0-7-14)

BREAST CANCER (9 decks)

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