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Pathology: Endocrine Tumors > Thyroid Cancer > Flashcards

Thyroid Cancer Flashcards

1
Q

What is the structure of the thyroid gland?

A

The thyroid gland consists of a right and left lobe and lies over the deep structures of the neck.

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2
Q

What structures are close to the thyroid gland?

A

The thyroid gland is close to the larynx, trachea, parathyroid glands, and esophagus.

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3
Q

Where is the thyroid gland located in relation to the carotid artery, jugular vein, and vagus nerve?

A

The thyroid gland is anterior and medial to the carotid artery, jugular vein, and vagus nerve.

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4
Q

What is the approximate length of the thyroid lobes?

A

The 2 large lateral lobes are approximately 5cm in length.

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5
Q

To what anatomical structures do the thyroid lobes extend?

A

The thyroid lobes extend to the level of the midthyroid cartilage superiorly and the 6th tracheal ring inferiorly.

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6
Q

How are the thyroid lobes connected?

A

The lobes are connected in the midline by the isthmus at the level of the 2nd to 4th tracheal rings.

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7
Q

What is the role of lymphatic capillaries in the thyroid gland?

A

Lymphatic capillaries are arranged throughout the gland and drain to many nodal sites.

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8
Q

What are some nodal sites that drain lymph from the thyroid gland?

A

Nodal sites include the internal jugular chain, Delphian node, pretracheal nodes, and paratracheal nodes.

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9
Q

What can be considered the lowest part of the cervical lymphatic chain?

A

Superior mediastinal lymphatics can be considered the lowest part of the cervical lymphatic chain.

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10
Q

What does involvement of superior mediastinal lymphatics indicate?

A

Involvement of this represents significant regional spread of disease.

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11
Q

What is the thyroid cartilage?

A

The thyroid cartilage has nothing to do with the thyroid gland or its processes. It plays a role in the production of the human voice.

The thyroid cartilage forms the Adam’s apple, which often appears as a lump on the front of the neck.

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12
Q

Where is the thyroid gland located?

A

The thyroid gland is an endocrine gland located at the level of the cricoid cartilage.

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13
Q

What is the function of the thyroid gland?

A

The thyroid helps regulate growth and metabolism.

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14
Q

What are the main hormones produced by the thyroid gland?

A

The main hormones produced are T3 (triiodothyronine) and T4 (thyroxine).

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15
Q

How is thyroid function regulated?

A

Thyroid function is regulated by pituitary and hypothalamic hormones, responding to complex systemic negative feedback mechanisms based on metabolic needs.

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16
Q

What is the role of TSH?

A

TSH (thyroid stimulating hormone) is produced in the pituitary gland and stimulates thyroid cells to produce and release hormones critical for carbohydrate and protein metabolism.

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17
Q

What does the production of thyroid hormones rely on?

A

The production of thyroid hormones relies on the thyroid gland’s ability to remove iodine from the blood.

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18
Q

What can happen with insufficient iodine?

A

Insufficient iodine can lead to a deficiency in thyroid hormone production, causing several clinical disorders.

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19
Q

What are the functional disorders of the thyroid gland?

A

Functional disorders are characterized by overproduction of hormones (hyperthyroidism) or underproduction of hormones (hypothyroidism).

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20
Q

What is the most common type of endocrine malignancy?

A

Thyroid cancer is the most common endocrine malignancy and accounts for 96% of new endocrine cancers.

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21
Q

What percentage of endocrine cancer deaths is attributed to thyroid cancer?

A

Thyroid cancer accounts for 67% of endocrine cancer deaths.

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22
Q

At what age is thyroid cancer commonly diagnosed?

A

Thyroid cancer is commonly diagnosed at a younger age than other adult cancers, around age 30+.

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23
Q

How much more likely are women to develop thyroid cancer compared to men?

A

Women are 3 times more likely to develop thyroid cancer than men.

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24
Q

What is the only well-documented etiologic factor for thyroid cancer?

A

External radiation to the thyroid, particularly before puberty.

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25
Q

What increases the risk of developing thyroid cancer in young patients?

A

Receiving radiation for malignant conditions, such as mantle irradiation for Hodgkin lymphoma.

26
Q

What is the minimum latent period for thyroid cancer in infants after radiation exposure?

A

4 years.

27
Q

What is the average latent period for adolescents after radiation exposure?

A

10 years.

28
Q

What is a common clinical presentation of thyroid cancer?

A

A lump in the neck.

29
Q

How is thyroid cancer often detected?

A

During a routine physical exam.

30
Q

What percentage of young people with differentiated thyroid carcinoma present with a palpable cervical lymph node metastasis?

A

Almost 25%.

31
Q

What are other symptoms of thyroid cancer?

A

Swelling in the neck, hoarseness or other voice changes that do not go away, trouble swallowing, trouble breathing, and a constant cough that is not due to a cold.

32
Q

What is necessary for the confirmation of the diagnostic suspicion of thyroid cancer?

A

A biopsy, specialized imaging studies, and laboratory testing are necessary.

33
Q

What lab studies are involved in the diagnosis of thyroid cancer?

A

Analysis of the thyroglobulin and calcitonin levels.

34
Q

What imaging studies are used for thyroid cancer diagnosis?

A

PET, US, CT, MRI.

35
Q

What is the purpose of radionuclide thyroid imaging?

A

It evaluates the function and anatomic location of a palpable thyroid nodule through the localization of ‘hot’ or ‘cold’ spots.

36
Q

How does radionuclide imaging assist in thyroid cancer detection?

A

It allows for improved detection of occult cancers in high-risk patients and detection of locoregional or distant metastatic disease.

37
Q

How are patients previously treated for thyroid cancer monitored?

A

They are typically monitored with repeat radionuclide-based imaging.

38
Q

What are the four categories of thyroid cancer pathology?

A

Papillary Carcinoma, Follicular Carcinoma, Medullary Carcinoma, Anaplastic Carcinoma.

39
Q

What is the prognosis of Papillary Carcinoma?

A

It is slow growing, nonaggressive, and has an excellent prognosis.

40
Q

How does Follicular Carcinoma compare to Papillary Carcinoma?

A

It has a worse overall prognosis than papillary carcinoma.

41
Q

What is the prognosis of Medullary Carcinoma?

A

It has a worse prognosis than papillary, mixed papillary-follicular, and possibly follicular cancers, but better than anaplastic carcinoma.

42
Q

What is the prognosis of Anaplastic Carcinoma?

A

It has the worst overall prognosis and is more aggressive, with a typical life expectancy of 1 year or less.

43
Q

What is the staging system for thyroid cancer?

A

AJCC American Joint Committee on Cancer and TNM

***stages range from 1-4

44
Q

What are the routes of spread for Papillary and mixed papillary-follicular carcinomas?

A

They metastasize to regional lymph nodes through lymphatic channels and occur early in the development of the disease.

45
Q

What is the significance of nodal metastases in older patients with Thyroid Cancer?

A

Nodal metastases are associated with poorer outcomes in older patients.

46
Q

How do Follicular carcinomas metastasize?

A

They metastasize via the bloodstream to distant sites including the bone, lung, liver, and brain.

47
Q

What is a characteristic of Anaplastic carcinomas?

A

They display local invasion of structures like the trachea and skin invasion, leading to dermal lymphatic metastases on the chest and abdominal walls.

48
Q

What are common distant metastasis sites for Thyroid Cancer?

A

Common distant metastasis occurs to the lung, bone, liver, brain, and kidneys.

49
Q

What is the challenge in assessing regional node status in Thyroid Cancer?

A

The primary tumor is often so extensive that the regional node status is difficult to assess.

50
Q

What is the main treatment for nearly every case of thyroid cancer?

A

Surgery is the main treatment in nearly every case of thyroid cancer, except for anaplastic thyroid cancers.

51
Q

What is a thyroidectomy?

A

Thyroidectomy is surgery to remove the thyroid gland and it’s the most common surgery for thyroid cancer.

52
Q

What happens if cancer has spread to nearby lymph nodes during thyroid surgery?

A

If cancer has spread to nearby lymph nodes in the neck, these will be removed at the same time surgery is done on the thyroid.

53
Q

How are small deposits of cancer cells treated after surgery?

A

Any small deposits of cancer cells that may be left are treated with radioactive iodine I-131.

54
Q

How does medullary thyroid cancer respond to treatment compared to papillary carcinoma?

A

Medullary thyroid cancer is less radiosensitive than papillary carcinoma.

55
Q

What is the general response of anaplastic carcinomas to treatment?

A

In general, anaplastic carcinomas are not responsive to any treatment.

56
Q

What is EBRT and when can it be used with Thyroid cancer?

A

EBRT can be used alone or in conjunction with I-131 and surgery.

57
Q

What are the indications for the use of EBRT?

A

Indications for use of EBRT include:
- Inoperable lesion
- Patient physically unfit for surgery
- Incomplete surgical removal of thyroid carcinoma
- Superior vena cava syndrome
- Skeletal metastases in which minimal accumulation of I-131 occurred
- Residual disease involving the trachea, larynx, or esophagus.

58
Q

What should treatment planning for external beam radiation therapy include?

A

The use of CT for simulation and any additional information from diagnostic CT, PET-CT, or MRI to evaluate anatomy and disease extent.

59
Q

Where does the CT simulation typically begin and extend to?

A

It typically begins at the apex of the skull and extends inferiorly to the carina, or even includes all of the lungs.

60
Q

What should CT simulation of a patient with thyroid cancer involve?

A

Extension of the neck and careful immobilization of the head.

61
Q

What is the benefit of extending the neck during CT simulation?

A

It allows avoidance of more of the oral cavity.

Pathology: Endocrine Tumors (4 decks)

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