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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
What is Serum calcitonin useful for in sus Thyroid cancer?
Dx + Monitoring MEDULLARY carcinoma
26
What is the purpose of US thyroid scan? (2 things)
1. Assess nodule 2. Look for cervical lymphadenopathy
27
What are suspicious features you may see on a US thyroid that suggest cancer? (3 things)
1. Microcalcifications 2. Hypoechongenicity (suggest dense material) 3. Irregular margin
28
What will the results of US thyroid give you?
Score from U1-U5
29
What score from U1-U5 suggest malignancy?
U3-U5
30
What should you do with a thyroid lump with a score of U3-U5 on US thyroid?
Fine needle aspiration cytology (FNAC)
31
What will the results of FNAC of a sus Thyroid lump give you?
Score from Thy1-Thy5
32
What do the scores from Thy1-Thy5 from FNAC tell you?
* 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
What is the point of diagnostic hemithyroidectomy for histology done for Thy3 follicular lesions?
To determine between Follicular adenoma (benign) vs Carcinoma
34
Once Dx is confirmed, what staging system is used for Thyroid cancers?
TNM staging
35
Who is involved in the MDT team that manage Thyroid cancer? (5 things)
1. Endocrinologist 2. Histopathologist 3. Radiologist 4. Oncologist 5. ENT surgeon
36
What are the Mx options for Thyroid cancer? (4 things)
1. Surgical 2. Chemo 3. Radio 4. Radio-iodine therapy
37
What are the Surgical Mx options for Thyroid cancer? (2 things)
1. Hemi-thyroidectomy 2. Total thyroidectomy
38
What does Hemi-thyroidectomy involve?
Remove half of thyroid that contains lesion
39
What is the disadvantage of Hemi-thyroidectomy?
Only suitable for certain tumours (small low grade non-metastatic ones)
40
What will pts need to take after a Total Thyroidectomy?
Thyroid hormone replacement
41
What will Thyroid cancer that has locally advanced require, on top of Thyroidectomy?
Neck dissection (to remove lymph nodes)
42
What are the complications of Thyroid surgery? (3 things)
1. Haematomas (leading to airway obstruction aka med emergency) 2. Hypocalcaemia 3. Vocal cord paralysis
43
How can you get Hypocalcaemia in Thyroid surgery?
Damage / removal of parathyroid glands
44
What are the CF of Hypocalcaemia that you should monitor post-thyroid surgery pts for? (2 things)
1. Paraesthesia 2. Tetany
45
What are the NON Surgical Mx options for Thyroid cancer? (2 things)
1. Radioiodine therapy 2. External beam radiotherapy
46
What does Radioiodine therapy?
Administering radioactive iodine solution
47
When is Radioiodine therapy effective?
Only after total thyroidectomy
48
What can External beam radiotherapy used as? (2 things)
1. Primary 1. Adjunct therapy
49
What can External beam radiotherapy used as? (2 things)
1. Primary 1. Adjunct therapy
50
What is the prognosis of the different types of Thyroid cancer? (4 things)
* Papillary – Good * Follicular – Good * Medullary – Good * Anaplastic – Very poor

Y4 Special Senses (11 decks)

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