Thyroid cancer Flashcards
What are the different types of thyroid cancer?
- Papillary: Often in young females, excellent prognosis. Measure thyroglobulin
- Follicular: Invades to lung and bones early. Measure thyroglobulin
- Medullary: Cancer of C cells which produce calcitontin. Part of MEN 2 and has poor prognosis.
- Anaplastic: not responsive to treatment
- Thyroid lymphoma - Core biopsy not FNA
What is the most common type of thyroid cancer?
Papillary
what are the signs and symptoms of thyroid cancer?
- Lump/swelling in neck.
- Difficulty swallowing
- Voice changes
- Persistent cough
- Medullary thyroid cancer can present with hypocalcaemia and diarrhoea
Most common presentation: Women in 30/40s with a painless thyroid nodule.
What are the differentials for thyroid cancer?
- Benign thyroid nodules
- Thyroiditis,
- Thyroid cyst.
- Goiter
What are the risk factors for thyroid cancer?
Head and neck irradiation
Female sex
What are the investigation’s for thyroid cancer?
- Bloods: TFTs, TSH and calcitonin and thyroglobulin levels. Any evidence of a hot nodule (i.e producing T3/4) doesn’t need investigated further as so unlikely to be malignant
- Ultrasound of neck
- Fine needle aspiration
What are signs of malignancy on ultrasound of the thyroid?
Micro-calcifications, irregular margins, hypoechongenicity.
What is the management of thyroid cancer?
- Surgery: thyroidectomy or lobectomy + radioactive iodien.
- Radioactive iodine: Treats thyroid cancer cells throughout the body
- External beam radiation therapy: Used in inoperable or advanced cancer
- Targeted therapy: Tyrosine kinase inhibitors
- Chemotherapy: usually for anaplastic
What are some of the complications of thyroid surgery?
- Hypocalcaemia due to damage of parathyroid gland.
- Hypothyroidism
- Damage to recurrent laryngeal nerve
- Neck haematoma (emergency!!)
- Thyrotoxic storm
What are the symptoms of hypocalcaemia?
Tingling in hands and face, muscle spasms and ventricular arrhythmias if severe
What are some non-surgical management complications of thyroid cancer?
TSH suppression can cause atrial fibrillation and bone mineral loss.
Radioiodine can cause secondary tumours or dry mouths
Describe features of papillary thyroid cancer
- Most common, seen in woman aged 30-50,
- Can have multiple lesions. Spread via lymphatics. Great prognosis
- Histologically have a mixture of papillary and colloid filled folicles
- Rarely encapsulated
Describe features of follicular carcinoma
- Usually seen in women aged 40-60.
- Present as focal encapsulated lesions
- Haematogenous spread to bones and lungs
What is hurthle cell tumours?
Variant of follicular carcinoma
Describe features of medullary carcinoma
- Cancer of parafollicular cells resulting in raised with calcitonin levels.
