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Endocrinology > Thyroid cancer > Flashcards

Thyroid cancer Flashcards

1
Q

What is the effect of thyroid adenomas?

A

usually non functional

can secrete T3/T4 (leads to thyrotoxicosis)

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2
Q

What is the macroscopic appearance of a thyroid adenoma?

A

discreet solitary mass
encapsulated by collagen cuff
neoplastic thyroid follicles (follicular adenoma)

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3
Q

What is the mutation causing follicular adenomas?

A

Mutation in TSHR signalling pathway

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4
Q

What can follicular adenoma be mistaken for?

A

follicular carcinoma

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5
Q

What is the most common differentiated thyroid cancer?

A

papillary carcinoma

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6
Q

How do papillary carcinomas present?

A

Solitary nodule
maybe multifocal
usually cystic
may often be calcified

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7
Q

What mutation causes papillary carcinoma?

A

MAP kinase pathway activation

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8
Q

What is the prognosis with papillary carcinoma?

A

95% 10 year survival

good because it’s differentiated

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9
Q

What conditions are associated with papillary carcinoma?

A

Hashimoto’s thyroiditis

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10
Q

What is the mode of metasteses in papillary carcinoma

A

lymphatic

haematogenous

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11
Q

Where does papillary carcinoma metastasise to?

A

bones, lungs, liver, brain

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12
Q

What is the second most common differentiated thyroid cancer?

A

follicular carcinoma

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13
Q

What is the presentation of a follicular carcinoma?

A

single nodule
painless
slow growing
non functional

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14
Q

What is the mode of mets in follicular carcinoma?

A

Haematogenous

need vascular or capsular invasion

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15
Q

Where does follicular carcinoma metasts to?

A

bone, liver, lungs

nb, blood brain barrier?

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16
Q

What is the prognosis for follicular carcinoma?

A

depends on level of invasion

minimal invasion the 90% survival at 10 years

17
Q

What is the etiology in Medullary thyroid carcinoma?

A

sporadic (40s+50s)
multiple endocrine neoplasia (MEN) (young)
Familial (40s+50s)

18
Q

What is the mutation in MTC?

A

c cell mutation

secretes calcitionin

19
Q

What is the presentation of MTC?

A

sporadic: solitary nodule
familial: bilateral/multicentric (c cells)

20
Q

What is the histolgical appearance of MTC?

A

spindle cell
nest arrangement
trabeculae/follicles

21
Q

What are the local symptoms of MTC?

A

dysphagia
hoarseness
airway obstruction

22
Q

What are the paraneoplastic signs of MTC?

A

diarrhoea

Cushings signs

23
Q

What is MTC associated with?

A

amyloid deposition

24
Q

How common are MTCs? What grade are they?

A

Rare

High grade

25
Q

What is the etiology of anaplastic tumours?

A

older patients

PMHx differentiated tumour

26
Q

Why are anaplastic tumours aggressive?

A

undifferetiated

27
Q

Why is survival poor with anaplastic tumours?

A

Rapid growth

Invades neck structures

28
Q

What factors increase the likelihood of a thyroid tumour being malignant?

A 
Male
New nodule 
50 years
Vocal cord palsy
Nodule increasing in size
lesion >4cm
Hx neck radiation
29
Q

What investigations do you do in a suspected thyroid tumour?

A

US guided FNA
laryngoscopy if vocal nerve palsy
excision and biopsy lymph node

30
Q

What test(s) is NOT done in suspected thyroid tumour?

A

NO isotope scan

NO CT/MRI?

31
Q

How do you assess cytology and what sample is needed?

A

Thy1-Thy5

FNA

32
Q

What is the grading of Thy1-Thy5?

A 
Thy1-insufficient sample
Thy2-benign
Thy3-atypical, suspected benign
Thy4-atyplical, suspected malignancy
Thy5-malignant
33
Q

What grade are follicular lesions and why?

A

All Thy3
difficult to assess
no capsule

34
Q

What are the surgical options for thyroid cancer?

A

lobectomy and isthmusectomy
subtotal thyroidectomy
total thyroidectomy

35
Q

When is lobectomy and isthmusectomy appropriate?

A

papillary microcarcinoma
<1cm
minimally invasive follicular carcinoma
low risk AMES

36
Q

When is (sub)total thyroidectomy appropriate?

A 
DTC and nodes
DTC and distant mets
Bilateral/multifocal DTC
DTC with extrathyroidal spread
High risk AMES
37
Q

When should lymph nodes be removed?

A

Showing signs of macroscopic disease

use judgement

Endocrinology (17 decks)

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