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Otolaryngology > Thyroid cancer > Flashcards

Thyroid cancer Flashcards

1
Q

When do otolaryngologists recommend and perform removal of thyroid nodules?

A

reasonable risk of being cancerous

  1. man (nodules more common in F but more likely to be benign)
  2. Young
  3. Large
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2
Q

The standard accepted and effective method for determination of the contents of a thyroid mass or nodules is ___?

A

Fine needle aspiration biopsy with or without US guidance.
FNAB diagnosis of malignant cells,is an obvious indication for surgery, either a total thyroid lobectomy or a total thyroidectomy

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3
Q

What do you do if the FNAB is indeterminant>

A

a repeat FNAB with the aid of an ultrasound is necessary to ensure sampling efficiency of the tissue

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4
Q

T/F If a patient doesnt have any RF, there is a high degree of probability that the nodule is benign and doesnt need to be followed-up

A

F - Observation

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5
Q

When multiple nodules are found, the thyroid is classified as a what? Which nodule do you biopsy on FNAB?

A

multinodular thyroid or goiter

the dominant or largest nodules are biopsied.

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6
Q

T/F • Radionuclide thyroid scans have become less essential to the diagnostic workup of nodules with the development and refinement of ultrasound and fine-needle aspiration techniques.

A

True

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7
Q

What are the 2 essential classifications of thyroid cancer?

A
  1. Well differentiated (papillary and follicular)

2. Other ( includes less well-differentiated forms of thyroid cancer, including medullary, and anaplastic. Lymphoma)

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8
Q

Make up ~80% of thyroid cancers histologically (Orphan annie cells and psammoma bodies) and often mets to neck LN
What kind of carcinoma is this?

A

Papillary carcinoma

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9
Q

Factors predictive of a better prognosis for papillary carcinoma?

A

small size (less than 1.5 centimeters (cm)) and absence of thyroid gland capsule involvement.

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10
Q

T/F Papillary carcinoma follows a much more indolent course when discovered in people under age 40 but these pts also have high rate of recurrence

A

T

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11
Q

T/F When treating papillary carcinoma total thyroidectomy may significantly decrease the local recurrence rate and mortality vs subtotal

A

T

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12
Q

When treating papillary and follicular carcinoma radioactive iodine and thyroid hormone suppression have a increased incidence of recurrence

A

False - decreased compared to total alone

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13
Q

What are the greatest risks of thyroid surgery?

A
  1. hypoparathyroidism secondary to injury or removal of the parathyroid glands
  2. Recurrent laryngeal nerve injury, which may result in hoarseness, shortness of breath, and reduced exercise tolerance
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14
Q

What carcinoma makes up ~ 15% of thyroid cancers?histologically

A

Follicular carcinoma

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15
Q

What findings in follicular carcinoma are essential for diagnosis and cannot be determined by a FNA? Why cant you use FNA?

A
  1. Capsular and/or lymphovascular invasion

2. Cytopathologically, the cells may also look fairly benign on FNA

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16
Q

Which type of carcinoma metastasizes hematogenously?

A

Follicular carcinoma

17
Q

What are the 3 types of follicular cell carcinoma and which is most aggressive?

A
  1. microinvasive
  2. macroinvasive
  3. Hurthle cell carcinoma (most aggressive)
18
Q

Why is total thyroidectomy plus radioactive iodine the treatment of choice for follicular thyroid cancer?

A

Iodine is concentrated in normal thyroid tissue. If all thyroid tissue is removed this allows a higher dose to be delivered to the remaining tissue while using lower amts.

19
Q

What carcinoma makes up ~ 6-10% of thyroid cancers?

A

Medullary carcinoma

20
Q

What cells are the origin for medullary carcinoma?

A

Parafollicular or C-cells

21
Q

What are 2 forms of medullary carcinoma and are tumors typically unilateral or bilateral?

A
  1. Familial (10-20%) and sporadic)

2. Bilateral

22
Q

Involves parathyroid adenoma, medullary carcinoma, and pheochromocytoma. RET proto-oncogene is positive in most pts with this. Is this MEN IIA medullary carcinoma or MEN IIb?

A

MENIIa

23
Q

What kind of screen should all patients with medullary carcinoma get to determine increase in circulating CATACHOLAMINES?
What happens if this is positive?

A

Urinary metanephrine screen

pheochromocytoma should be located and excised first

24
Q

All first-degree relatives of patients with medullary carcinoma should be tested for ___ levels?

A

Calcitonin

25
Q

does not have a parathyroid component, but includes a Marfanoid habitus and mucosal neuromas. Is this MEN IIA medullary carcinoma or MEN IIb?

A

MEN IIb

26
Q

How can you treat medullary carcinoma?

A

Total thyroidectomy with paratrachceal, central compartment neck dissections

27
Q

T/F Thyroid C-cells do not absorb radioactive iodine?

A

T - So RAI is seldom effective as adjuvant tx

28
Q

What kind of carcinoma is a rare, aggressive cancer with a very poor prognosis?

A

Anaplastic carcinoma

29
Q

What can a surgeon do for anaplastic carcinoma? What other tx are there?

A

Rarely resectable so role of the surgeon is often limited to establishing diagnosis through open biopsy and securing the airway, which usually involves a tracheotomy.
often treated with external beam radiation and systemic chemotherapy, since 50% of patients will have pulmonary metastases at the time of diagnosis.

30
Q

What kind of cancer is a rapidly growing tumor, which frequently compromises the airway and clinically resembles anaplastic carcinoma?

A

Thyroid lymphoma

31
Q

Patients with thyroid lymphoma may have a background of what condition?

A

Hashimoto’s thyroiditis, an autoimmune condition characterized by lymphocytic infiltration

32
Q

What type of lymphocytes are the origin of thyroid lymphomas?

A

Most commonly B-cell

33
Q

How can you tx and cure thyroid lymphomas?

A

usually achieved by using a combination of chemotherapy and radiation

Otolaryngology (15 decks)

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