Thyroid Cancer Flashcards

1
Q

what is the definition of thyroid cancer?

A

cancer of the cells in the thyroid

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2
Q

what is the epidemiology of thyroid cancer?

A
  • Not common, but are responsible for 400 deaths annually in the UK
  • More common in FEMALES than males
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3
Q

what is the aetiology of thyroid cancer?

A

radiation

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4
Q

what are the risk factors for thyroid cancer?

A

exposure to radiation, genetic predisposition

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5
Q

what is the brief pathophysiology of thyroid cancer?

A
  • Minimally active hormonally
  • Over 90% secrete thyroglobulin which can be used as a tumour marker after thyroid ablation
  • Carcinomas derived from thyroid epithelium may be:
  • Differentiated - papillary or follicular
  • Undifferentiated - anaplastic
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6
Q

what are the differenet type of thyroid cancer?

A
  • Papillary (70%): Most common, well differentiated, Young people, local spread and good prognosis, Arise from thyroid epithelium
  • Follicular (20%): Middle age, spread to lung/bone, usually good prognosis, Well differentiated, arise from thyroid epithelium
  • Anaplastic (<5%): Very undifferentiated and arise from thyroid epithelium, Aggressive, local spread but poor prognosis
  • Lymphoma (2%)
  • Medullary cell (5%) - arise from calcitonin C cells of thyroid gland
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7
Q

what are the key presentations of thyroid cancer?

A
  • In 90% they present as thyroid nodules
  • Occasionally (5%) they present with cervical lymphadenopathy or with lung, cerebral, hepatic or bone metastases
  • If thyroid gland increases in size, becomes hard and is irregular in shape - think carcinoma
  • Patients may complain of dysphagia or hoarseness of voice due to tumour compression on surrounding structures i.e. oesophageal and laryngeal nerve
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8
Q

what are the signs of thyroid cancer?

A

Thyroid nodules, cervical lymphadenopathy or with lung, cerebral, hepatic or bone metastases, increased size of thyroid, hard thyroid, irregularly shaped thyroid

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9
Q

what are the symptoms of thyroid cancer?

A

dysphagia or hoarseness of voice

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10
Q

what are the first line investigations for thyroid cancer?

A
  • Fine needle aspiration cytology biopsy: to distinguish between benign or malignant nodules
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11
Q

what are the gold standard investigations for thyroid cancer?

A
  • Blood test - to check TFTs (TSH, T4 & T3): To check if hyperthyroid or hypothyroid - needs to be treated before carcinoma surgery
  • Ultrasound of thyroid: Can differentiate between benign or malignant
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12
Q

what are the differential diagnoses for thyroid cancer?

A

goitre

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13
Q

how is thyroid cancer managed?

A
  • Thyroid LOVES iodine so will readily take up radioactive iodine which in turn will locally irradiate and destroy cancer - providing very little radiation damage to other surrounding structures
  • Administer lots of LEVOTHYROXINE (T4) to keep TSH reduced as this is a growth factor for cancer
  • Chemotherapy helps to reduce risk of spread and treats micro-metastases that have been undetected
  • Papillary and follicular carcinomas:
    • Total thyroidectomy
    • Ablative radioactive iodine
  • Anaplastic carcinomas and lymphomas:
    • DO NOT respond to radioactive iodine
    • External radiotherapy provides brief respite - mainly palliative
  • Medullary carcinoma:
    • Thyroidectomy and lymph node removal
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14
Q

how is thyroid cancer monitored?

A

Repeat blood tests, ultrasounds and radioactive scanning of the neck

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15
Q

what are the complications of thyroid cancer?

A

Injury to the voice box and hoarseness after thyroid surgery.
Low calcium level from accidental removal of the parathyroid glands during surgery.
Spread of the cancer to the lungs, bones, or other parts of the body.

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16
Q

what is the prognosis of thyroid cancer?

A

Most patients cured after 5 years, around 90% survival first year, falls slightly after 5 years, 84% expected to survive after 10 years