Thyroid Cancer

Question 1

What is the most common endocrine maligancy?

Answer 1

thyroid cancer

Question 2

mean age of presentation of thyroid cancer

Answer 2

30-40 years old

Question 3

Is thyroid cancer more common in men or women?

Answer 3

women (3x!)

Question 4

The highest incidence of thyroid cancer occurs in what races/sex?

Answer 4

white and Asian women

Question 5

What are the three histiologic types of thyroid cancer? Which of these is most common?

Answer 5

differentiated (most common, 96%!)
medullary
anaplastic

Question 6

What are the three types of differentiated thyroid cancers, and which is most common?

Answer 6

papillary (80%)
follicular
Hurthle

Question 7

risk factors for thyroid cancer

Answer 7

1. Age (45)
2. exposure to ionizing radiation to head/neck
3. personal or FH of thyroid cancer
4. genetics

Question 8

What are the genetic components of thyroid cancer (4 possibilities)?

Answer 8

1. familiar adenamatous polyposis (FAP)
2. Carney complex
3. Cowden’s syndrome
4. multiple endocrine neoplasia, type 2A or 2B

Question 9

signs of thyroid cancer

Answer 9

enlarged goiter; palpable, firm, non-tender nodule in front/side of neck, swollen lymph nodes on side of neck

Question 10

symptoms of thyroid cancer

Answer 10

dysphagia, odynophagia, hoarseness or change in quality of voice, dyspnea while supine, fatigue (with mets), flushing, persistent diarrhea

Question 11

How is thyroid cancer diagnosed?

Answer 11

1. US or sonogram
2. lab tests for TSH and calcitonin
3. clinical features or PE
4. fine needle aspiration (FNE)
5. thyroid radionucleotide scan or technetium

Question 12

What do you do first if you find a nodule via palpation or ultrasound?

Answer 12

Check TSH!

Question 13

If you check a patient’s TSH (when they have a nodule) and it is LOWERED, what could be the problem?

Answer 13

toxic adenoma

Question 14

If you check a patient’s TSH (when they have a nodule) and it is NORMAL, what do you do next?

Answer 14

If the tumor is more than 1.0 or 1.5 cm, do a fine needle biopsy.

Question 15

If you check a patient’s TSH (when they have a nodule) and it is ELEVATED, what could be the problem?

Answer 15

check antithyroid antibody titers to see if there is an autoimmune thyroiditis

Question 16

What do you do if you do a FNA biopsy and the tumor is benign?

Answer 16

monitor it for growth

Question 17

What do you do if you do a FNA biopsy and the tumor is maligant and papillary? Medullary? Thyroid lymphoma?

Answer 17

maligant and papillary = surgery

thyroid lymphoma = radiation or chemo

Question 18

What do you do if you do a FNA biopsy and the tumor is undetermined?

Answer 18

Do an US guided FNA biopsy!

Question 19

What do you do if you do a FNA biopsy and the tumor is anaplastic?

Answer 19

chemo or radiation

Question 20

What does the T stand for in TNM?

Answer 20

primary tumor

Question 21

What are the different stages of T in TNM?

Answer 21

T0 = no primary tumor, T1 = less than 2 cm, T2 = 2-4 cm, T3 = greater than 4 cm, T4a is moderate, and T4b is severe!

Question 22

What does the N stand for in TNM?

Answer 22

regional lymph node status

Question 23

What are the stages of N?

Answer 23

N0 = no mets to region nodes
N1 = mets to regional nodes
N1a and N1b

Question 24

What is the M in TNM, and what are the possibilities?

Answer 24

Distant mets!

M0= none, M1 = mets

Question 25

All anaplastic carcinomas are concerned what stage?

Answer 25

Stage 4