Thyroid cancer Flashcards
differentiated thyroid cancers
meaning good prognosis compared to other solid tumours
refers to histiological appearance but also physiological characteristcs
refers to a group of cancers that arise from follicular cells
subtypes of DTC
papillary thyroid carcinoma
follicular thyroid carcinoma
papillary thyroid cancer charcateristcs
slow growing and often spreads to lymph nodes
more comon type
Assoc with hashmitotos
Assoc with ionising radiation
which is associated with hashimotos
papillary thyroid carcinoma
which type is more haematoligically spread
follicular thyroid carcinoma
follicular thyroid carcinoma characteristcs
Second commonest
incidence higher in iodine deficiency places
Spreads haematogenously
Higher incidence in females
presents later in life
epidemiology of DCT
Uncommon In children
Males steady increase
Females rates increase 15-40 then plateau
Investigations in DCT
best being us
can involve excision biopsy of lymph node- fine needle aspiration for cytology
predictors of malignancy
- New nodule <20 or >50
- Male
- Increasing in size
>4cm
most common treatment
surgery
presentation
- Palpable nodules
- Chance findings on histological tissue
Local or disseminated metastases; hoarseness, dysphagia, cough- suggest advanced disease
- Chance findings on histological tissue
post op care
- Calcium checked within 24hrs
○ Replacement if coreected calcium falls below 2mmol
○ Iv calcium for levels below 1.8/ symptomatic
Patient discharged on t3 or t4
what does whole body iodine scanning detect
thyroid tissue to see if recurrence of thyroid cancer in body after thyroid removed
who is iodine scanning performed in
Used in patients who have undergone sub total or total thyroidectomy ; 3-6 months post op
what is stopped prior to iodine scanning
○ T4 stopped 4 weeks prior to scan
T3 stopped 2 weeks prior
thyroid remnant ablation
Aimed at eliminating any residual thyroid tissue following thyroidectomy
what mustnt you be for thyroid remnant ablation to be performed
pregnant
follow up after thyroid remnant ablation
- Patients maintained on t4
Aim to suppress tsh to <0.1 and have ft4 below 25
how is recurrent disease detected
by rising tg or by imaging
what is recurrence in cervical lymph nodes more common in
papillary thyroid carcinoma
what is haematognous spread recurrence more common in
follicular thyroid carcinoma
follow up care
In both the low and high risk groups, measure TSH and Tg every 6 months for first 5 years, then annually for next 5 years
To minimise risk of recurrence patients are treated with suppressive doses of levothroxane
what is thyroglobulin a protein precurosr of
t4/t3
so can be used as a tumour marker
medullary thyroid cancer
cancer of the parafollicular cells and so secrete calcitonin
what investigation to screen for disease recurrence in medullary cancer
serum calcitonin
