Thyroid Cancer Flashcards
What can be concluded if a thyroid nodule is found?
Most tend to be benign so a diagnosis requires more examination.
What can you do when you find a thyroid nodule?
Radioactive Iodine (I 131) uptake study, if increased uptake then indicative of graves or nodular goiter. If decreased uptake then adenoma and carcinoma.
If thyroid adenoma or carcinoma is suspected what test must be done?
FNA, fine needle biopsy, because biopsy of the thyroid is going to cause excessive bleeding due to extensive vascularaization of the thyroid.
What are the 4 main kinds of Thyroid Carcinomas? List them from most common to least.
Papillary, Follicular, Medullary ,Anaplastic
What is a “Follicular Adenoma?”
Benign proliferation of FOLLICLES surrounded by a fibrous capsule, usually non functional and rarely secretes anything.
** Note, follicular carcinoma is the above but in addition the follicular cell breaches t he fibrous capsule and extends into the adjoining tissues.
What is a major risk factor for papillary carcinoma?
Ionizing radiation exposure during childhood, in things like extreme acne tx.
What is the ABSOLUTE diagnosis of papillary carcinoma?
Microscopic confirmation of the nuclear features, specifically the “Orphan Anne Eyed” nuclei, as well as nuclear grooves and psamomma bodies.
What are “Orphan Anne Eyed” nuclei?
Seen in pappillary carcinoma, the nucleus is somewhat opaque.
Where does papillary carcinoma of the thyroid spread to?
Cervical lymph nodes of the neck, however prognosis is good regardless.
What defines a follicular carcinoma?
Malignant proliferation of follicular cells, similar to folliccular adenoma in that a fibrous capsule surrounds the tumor however the carcinoma variant will breach the capsule.
Can we use FNA to distinguish follicular carcinoma from adenoma?
No, because to do that we would actually need to see the capsule and see if the tumor breaches the capsule, the FNA will just show the follicular cells.
What is the metastasis pattern of follicular carcinoma?
Rather than lymph spread, it loves to go hemotogenously, one of 4 cancers known to do this.
What are the 4 cancers known to spread hematogenously rather than through lymph in terms of metastasis?
Renal cell carcinoma (Renal vein to blood), follicular carcinoma, Hepatocellular carcinoma (Hepatic vein to blood), and Choriocarcinoma quickly spreads to the blood.
What is a “medullary carcinoma?”
Malignant proliferation of the parafollicular C cells (which make calcitonin). Associated with high levels of calcitonin.
What is the function of calcitonin?
Secreted by C cells, its function is to lower the blood levels of calcium by inducing renal excretion of calcium.
