Thyroid Cancer Flashcards
Risk factors
- ionising radiation
- MEN Syndrome (for MTC)
Clinical features of Thyroid Cancer
- usually asymptomatic
Compressive effects:
- hoarseness
- dyspnea
- dysphagia
- lymphadenopathy may be present
Diagnosis of Thyroid Cancer
- Palpation
- Thyroid function test
- Echo: hypoechogeneus node,
microcalcifications, peripheral halo
absence, irregular borders, intranodular
vascularisation- > 1cm node on US
- FNAB
- Scintigraphy (99mTc-pertehnetat+MIBI
scan) - Tg+antiTgAB for DTC
- Calcitonin and CEA for MTC
Types of Thyroid Cancer
Differentiated:
- Papillary
- Follicular
Undifferentiated:
- medullary
- anaplastic
Basic Treatment of Differentiated Thyroid Cancer? (papillary and follicular)
- Total or hemi thyroidectomy
- Possible need for Radioablative treatment
- Assess levels of serum thyroglobulin and thyroglobulin antibody during post-op
Basic Treatment of Undifferentiated Thyroid Cancer?
- Total thyroidectomy
- LN dissection only in pre-op finding
- Serum calcitonin and CEA levels
Tumour staging of Thyroid Cancer
T1: less than 2cm (limited to thyroid)
T2: more than 2cm (limited to thyroid)
T3: tumour > 4cm (extends beyond)
T4: tumour invades nearby organs
Nodal Staging of Thyroid Cancer
N0- no regional metastasis
N1a - metastasis at level VI
N1b - cervical or mediastinal involvement
Metastasis Staging of Thyroid Cancer
M0- no metastasis present
M1- distant metastasis present
When is radioablative therapy indicated?
RAI is indicated only in high-risk and intermediate-risk TC following total thyreoidectomy
What is the method of choice for radioablative therapy for DTC?
Administration of 131I
Drug choice for RAI refractory, advanced symptomatic DTC?
Single Lesion - local regional therapy
Multiple lesions - local regional therapy plus lentinivib/sorafenib
What is the Bethesda System? What are the indicated treatment?
6 categories
1) Unsatisfactory (repeat US every 3 months)
2) Benign (clinic and US follow up)
3) Atypia of un-determined significance (repeat US)
4) Follicular nodule/suspicious FN (molecular testing/lobectomy)
5) Suspicion of malignancy (surgical lobectomy/ total thyroidectomy)
6) Malignant (total thyroidectomy)
What is the treatment for non-resectable anaplastic TC?
BRAF
mutated:
- Dabrafenib + trametinib
wild type:
- supportive care
- palliative external beam radiotherapy
What is the treatment for resectable anaplastic TC?
- total thyroidectomy +/- neck dissection
- consider post-op radiotherapy
