Thyroid Cancer Flashcards
What is the most common endocrine maligancy?
thyroid cancer
mean age of presentation of thyroid cancer
30-40 years old
Is thyroid cancer more common in men or women?
women (3x!)
The highest incidence of thyroid cancer occurs in what races/sex?
white and Asian women
What are the three histiologic types of thyroid cancer? Which of these is most common?
differentiated (most common, 96%!)
medullary
anaplastic
What are the three types of differentiated thyroid cancers, and which is most common?
papillary (80%)
follicular
Hurthle
risk factors for thyroid cancer
- Age (45)
- exposure to ionizing radiation to head/neck
- personal or FH of thyroid cancer
- genetics
What are the genetic components of thyroid cancer (4 possibilities)?
- familiar adenamatous polyposis (FAP)
- Carney complex
- Cowden’s syndrome
- multiple endocrine neoplasia, type 2A or 2B
signs of thyroid cancer
enlarged goiter; palpable, firm, non-tender nodule in front/side of neck, swollen lymph nodes on side of neck
symptoms of thyroid cancer
dysphagia, odynophagia, hoarseness or change in quality of voice, dyspnea while supine, fatigue (with mets), flushing, persistent diarrhea
How is thyroid cancer diagnosed?
- US or sonogram
- lab tests for TSH and calcitonin
- clinical features or PE
- fine needle aspiration (FNE)
- thyroid radionucleotide scan or technetium
What do you do first if you find a nodule via palpation or ultrasound?
Check TSH!
If you check a patient’s TSH (when they have a nodule) and it is LOWERED, what could be the problem?
toxic adenoma
If you check a patient’s TSH (when they have a nodule) and it is NORMAL, what do you do next?
If the tumor is more than 1.0 or 1.5 cm, do a fine needle biopsy.
If you check a patient’s TSH (when they have a nodule) and it is ELEVATED, what could be the problem?
check antithyroid antibody titers to see if there is an autoimmune thyroiditis
What do you do if you do a FNA biopsy and the tumor is benign?
monitor it for growth
What do you do if you do a FNA biopsy and the tumor is maligant and papillary? Medullary? Thyroid lymphoma?
maligant and papillary = surgery
thyroid lymphoma = radiation or chemo
What do you do if you do a FNA biopsy and the tumor is undetermined?
Do an US guided FNA biopsy!
What do you do if you do a FNA biopsy and the tumor is anaplastic?
chemo or radiation
What does the T stand for in TNM?
primary tumor
What are the different stages of T in TNM?
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!
What does the N stand for in TNM?
regional lymph node status
What are the stages of N?
N0 = no mets to region nodes
N1 = mets to regional nodes
N1a and N1b
What is the M in TNM, and what are the possibilities?
Distant mets!
M0= none, M1 = mets
