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#Phase 2.2: Special Senses > Thyroid Cancer > Flashcards

Thyroid Cancer Flashcards

1
Q

How common are Thyroid lumps?

A

Common, seen in 5% of population

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2
Q

Are a lot of thyroid lumps cancerous?

A

No, barely any are cancerous

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3
Q

What are the main types of Thyroid cancer? (5 things)

A
  1. Papillary carcinoma (75%)
  2. Follicular carcinoma (15%)
  3. Medullary carcinoma (3%)
  4. Anaplastic thyroid cancer (5%)
  5. Lymphoma (1%)
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4
Q

Which demographic of people is Papillary carcinoma usually seen in? (2 things)

A
  1. 40-50 years
  2. Women
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5
Q

How is Papillary carcinoma commonly spread?

A

Via lymphatics

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6
Q

Which demographic of people is Follicular carcinoma usually seen in? (2 things)

A
  1. 40-60 years
  2. Women
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7
Q

How is Medullary carcinoma commonly spread?

A

Via haematogenous spread (to bones + lungs)

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8
Q

Where do Medullary carcinomas arise?

A

In parafollicular cells (C cells)

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9
Q

What is raised in Medullary carcinomas?

A

Calcitonin levels

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10
Q

How is Medullary carcinoma commonly spread? (2 things)

A
  1. Lymphatic routes
  2. Medullary routes
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11
Q

Which demographic of people is Anaplastic thyroid cancer usually seen in?

A

Elderly

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12
Q

What is bad about Anaplastic thyroid cancer?

A

It’s very aggressive (grows rapidly + early local invasion)

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13
Q

What is the prognosis of Anaplastic thyroid cancer?

A

Poor, tx is often supportive

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14
Q

Which demographic of people are Lymphomas usually seen in?

A

Over 60s

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15
Q

What are the RF for Thyroid Cancer? (4 things)

A
  1. Female
  2. FHx
  3. Radiation exposure @ childhood
  4. Hashimoto’s disease
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16
Q

What does the FHx RF for Thyroid cancer include?

A

Cancer syndromes like MEN syndrome

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17
Q

What type of Thyroid cancer is Hashimoto’s especially a RF for?

A

Lymphoma

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18
Q

How can Thyroid cancer present? (3 things)

A
  1. Palpable lump
  2. Multiple lump
  3. Asymptomatic (found incidentally on imaging)
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19
Q

What are the RED FLAGS for any neck lump that suggest cancer? (5 things)

A
  1. Rapid growth
  2. Pain
  3. Cough / hoarseness / stridor
  4. Multiple enlarged Cervical lymph nods
  5. Lumps tethering to surrounding structures
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20
Q

What are the CF of Thyroid cancer? (5 things)

A
  1. Goitre (neck lump) (90%)
  2. Hoarseness (10%)
  3. Dysphagia (10%)
  4. Stridor (10%)
  5. Dyspnoea (10%)
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21
Q

What are the DDx that present similarly to Thyroid cancer (aka neck lump)? (4 things)

A
  1. Benign thyroid adenoma / thyroid cyst
  2. Toxic Multi-nodular goitre
  3. Non-toxic Multi-nodular goitre
  4. Thyroglossal duct cyst (not in thyroid itself)
22
Q

What investigations should you do for sus Thyroid cancer? (3 things)

A
  1. TFT
  2. Serum calcitonin
  3. US thyroid
23
Q

If TFTs show low TSH / rasied T3 or T4, what does this mean?

A

Evidence of toxic nodule (probs not malignant)

24
Q

What should you do if TFTs show evidence of Toxic nodule?

A

No further investigations needed, bc probs not cancer

25
Q

What is Serum calcitonin useful for in sus Thyroid cancer?

A

Dx + Monitoring MEDULLARY carcinoma

26
Q

What is the purpose of US thyroid scan? (2 things)

A
  1. Assess nodule
  2. Look for cervical lymphadenopathy
27
Q

What are suspicious features you may see on a US thyroid that suggest cancer? (3 things)

A
  1. Microcalcifications
  2. Hypoechongenicity (suggest dense material)
  3. Irregular margin
28
Q

What will the results of US thyroid give you?

A

Score from U1-U5

29
Q

What score from U1-U5 suggest malignancy?

A

U3-U5

30
Q

What should you do with a thyroid lump with a score of U3-U5 on US thyroid?

A

Fine needle aspiration cytology (FNAC)

31
Q

What will the results of FNAC of a sus Thyroid lump give you?

A

Score from Thy1-Thy5

32
Q

What do the scores from Thy1-Thy5 from FNAC tell you?

A
  • Thy1 = Inconclusive, req further sample
  • Thy2 = Non-malignant
  • Thy3 = Follicular lesions, req diagnostic hemithyroidectomy for histology
  • Thy4 = Sus, req diagnostic hemithyroidectomy
  • Thy 5 = Malignant
33
Q

What is the point of diagnostic hemithyroidectomy for histology done for Thy3 follicular lesions?

A

To determine between Follicular adenoma (benign) vs Carcinoma

34
Q

Once Dx is confirmed, what staging system is used for Thyroid cancers?

A

TNM staging

35
Q

Who is involved in the MDT team that manage Thyroid cancer? (5 things)

A
  1. Endocrinologist
  2. Histopathologist
  3. Radiologist
  4. Oncologist
  5. ENT surgeon
36
Q

What are the Mx options for Thyroid cancer? (4 things)

A
  1. Surgical
  2. Chemo
  3. Radio
  4. Radio-iodine therapy
37
Q

What are the Surgical Mx options for Thyroid cancer? (2 things)

A
  1. Hemi-thyroidectomy
  2. Total thyroidectomy
38
Q

What does Hemi-thyroidectomy involve?

A

Remove half of thyroid that contains lesion

39
Q

What is the disadvantage of Hemi-thyroidectomy?

A

Only suitable for certain tumours (small low grade non-metastatic ones)

40
Q

What will pts need to take after a Total Thyroidectomy?

A

Thyroid hormone replacement

41
Q

What will Thyroid cancer that has locally advanced require, on top of Thyroidectomy?

A

Neck dissection (to remove lymph nodes)

42
Q

What are the complications of Thyroid surgery? (3 things)

A
  1. Haematomas (leading to airway obstruction aka med emergency)
  2. Hypocalcaemia
  3. Vocal cord paralysis
43
Q

How can you get Hypocalcaemia in Thyroid surgery?

A

Damage / removal of parathyroid glands

44
Q

What are the CF of Hypocalcaemia that you should monitor post-thyroid surgery pts for? (2 things)

A
  1. Paraesthesia
  2. Tetany
45
Q

What are the NON Surgical Mx options for Thyroid cancer? (2 things)

A
  1. Radioiodine therapy
  2. External beam radiotherapy
46
Q

What does Radioiodine therapy?

A

Administering radioactive iodine solution

47
Q

When is Radioiodine therapy effective?

A

Only after total thyroidectomy

48
Q

What can External beam radiotherapy used as? (2 things)

A
  1. Primary
  2. Adjunct therapy
49
Q

What can External beam radiotherapy used as? (2 things)

A
  1. Primary
  2. Adjunct therapy
50
Q

What is the prognosis of the different types of Thyroid cancer? (4 things)

A
  • Papillary – Good
  • Follicular – Good
  • Medullary – Good
  • Anaplastic – Very poor

#Phase 2.2: Special Senses (11 decks)

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