thyroid cancer Flashcards
1
Q
what staging does FNA give
A
Thy1-5
2
Q
what does Thy1 indicate
A
inadequate
3
Q
what does Thy2/U2 indicate
A
benign
4
Q
what does Thy3(a/f) / U3 indicate
A
atypical
5
Q
what does Thy4 / U4 indicate
A
probably malignant
6
Q
what does Thy5 / U5 indicate
A
malignant
7
Q
what other staging is used in thyroid cancer
A
TNM
8
Q
T1
A
< or = 2 cm
9
Q
T2
A
2 < tumour < or = 4cm
10
Q
T3
A
tumour > 4cm
limited to thyroid or minimal extra-thyroidal disease
11
Q
T4a
A
moderately advanced disease - beyond thyroid capsule e.g. larynx/trachea/oesophagus
12
Q
T4b
A
very advanced disease e.g. invades prevertebral fascia
13
Q
N0
A
no regional lymph nodes
14
Q
N1
A
regional lymph nodes
15
Q
N1a
A
mets to pretracheal/paratracheal/prelaryngeal/delphian lymph nodes
16
Q
N1b
A
mets to unilateral/bilateral/contralateral cervical or retropharyngeal or superior mediastinal lymph nodes
17
Q
M0
A
no distant mets
18
Q
M1
A
distant mets
19
Q
true/false
differentiated thyroid cancers have the worst prognosis of all cancers
A
false - best prognosis except non-melanoma skin cancers
20
Q
are females or males more prone to DTC
A
females
21
Q
when are females most likely to get DTC
A
risk increases 15-40 then plateaus
22
Q
when are males most likely to get DTC
A
increases with age
23
Q
do DTCs have an association with diet/smoking/fmhx
A
no
24
Q
what do DTCs have a high association with
A
radiation
25
most DTCs take up ____ and secrete ___
take up iodine
| secrete thyroglobulin
26
DTCS are ___ driven
TSH
27
how do majority of DTCs present
palpable nodules
28
what is the treatment of choice for DTC
surgery
29
listen the DTCs in order of most common to least
```
Papillary
Follicular
Medullary
Anaplastic
People Find Me Annoying
```
30
what are some investigations done for thyroid cancer
USS-FNA - assess likelihood of malignancy
excision biopsy of lymph node
if vocal cord palsy pre-operative laryngoscopy
31
is FNA used in follicular lesions
no - relationship to capsule not assessed
32
what are follicular lesions automatically graded on FNA
Thy3
33
what does AMES take into account
Age
Mets
Extent of primary tumour
Size of primary tumour
34
what is in AMES low risk group
young patients with no mets (men < 40, women < 50)
older patients with intrathyroidal papillary lesion or minimally invasive follicular lesion
primary tumour < 5 cm and no mets
35
what is in AMES high risk
all patients with distant mets
extrathyroidal disease with papillary cancer
significant capsular invasion with follicular carcinoma
primary tumour > 5cm in older patients
TSH < 1 mU/L
36
what is the treatment for AMES low risk
thyroid lobectomy and isthmusectomy
37
what is the treatment for AMES high risk
total thyroidectomy
38
how soon is calcium checked after surgery
within 24 hours
39
when should calcium replacement therapy be initiated
if calcium falls below 2
40
what should be given if calcium falls below 1.8 or if symptomatic
IV calcium
41
what are patients discharged on after thyroid surgery
T3 or T4
42
when is WBIS used and for what
patients who have undergone sub-total or total thyroidectomy to determine ability of disease to take up iodine with a view to therapy
43
when should T4 be stopped prior to scan
4 weeks
44
when should T3 be stopped prior to scan
2 weeks
45
what should TSH be for best results
> 20
46
what is given as a capsule in WBIS
2-4 mCi I-131 administered 2 days prior
47
what is the treatment if there if iodine uptake > 0.1% in thyroid bed in WBIS
thyroid remnant ablation (TRA)
48
what are some precautions with TRA
lead lined room
pretreated with rhTSH
disposable cutlery, sheets, clothing
little/no contact with nurses
49
what is the aim for TSH and fT4 after TRA
TSH < 0.1
| fT4 < 25
50
what is used as a tumour marker in the follow up of TRA
thyroglobulin
51
what are 3 side effects of TRA
sialadenitis
sore throat
small but significant increase in acute myeloid leukemia
52
what are 2 treatments for people with DTC refractory to iodine therapy
sorafenib
| lenvatinib
53
what % of thyroid nodules are benign
95%
54
what are some examples of benign thyroid nodules
cyst
colloid nodule
benign follicular adenoma
hyperplastic nodule
55
what would a discrete solitary mass encapsulated by a surrounding collagen cuff be
follicular adenoma
56
what are follicular adenomas composed of
neoplastic thyroid follicles
57
what can follicular adenomas secrete and what can this cause
| what would be seen on an isotope scan
thyroid hormones --> thyrotoxicosis
| nodule is hot and rest of gland is suppressed
58
what are 3 genetic mutations that may be seen in follicular adenoma
ras
P1K3CA
TSHR signalling pathway - gain of function
59
orphan annie nuclei
papillary thyroid carcinoma
60
is papillary thyroid carcinoma usually solitary or multifocal
usually solitary but can be multifocal
61
how do papillary thyroid carcinomas usually spread
lymphatics
62
what is a risk factor for papillary thyroid carcinoma
ionising radiation
63
if a PTC was to spread by blood where would it go
lungs, bone, liver, brain
64
how would you describe PTC and what are the bodies of calcification seen called
cystic
| psammoma bodies
65
most common histological DTC
PTC
66
what should you suspect if a lymph node contains thyroid tissue or psammoma body
PTC
67
what 4 genes are involved in the genetics of PTC
rearrangement of RET or NTKR1
activating point mutation in BRAF
mutation of RAS
68
how does PTC usually present
lesion in thyroid gland or cervical lymph node mets (mass)
69
what would be some signs of locally advanced disease
hoarse voice
dysphagia
cough
dyspnoea
70
what is the treatment for a microcarcinoma (<1cm)
thyroid lobectomy and isthmusectomy
71
what is the treatment if there is macroscopic lymph node disease
central compartment clearance and lateral lymph node sampling
72
what is the 10 year mortality rate for PTC
< 5%
73
second most common histological DTC is
FTC
74
how does FTC usually spread
haem --> bones, lung, liver
75
is a FTC usually multifocal or single nodule
single nodule
76
are females or males more likely to get FTC
females
77
what is the age group of getting FTC
40-50 (older than PTC)
78
FTC are seen more in areas of iodine excess/iodine deficiency
deficiency
79
what are some genetic mutations seen in FTC
P13k / AKT pathway mutation
ras (N-ras) mutation
Pax8 and PPARY1 translocation
80
what are the 2 types of FTC
minimally invasive and widely invasive
81
which is more common of the 2 FTCs
minimally invasive
82
what is the survival rate at 10 years in MIFTC
90%
83
MIFTC are
slowly enlarging/dont enlarge
painless/painful
functional/non-functional
slowly enlarging
painless
non-functional
84
what is the architecture of MIFTC
follicular architecture well differentiated with a part surrounding capsule
85
what may a MIFTC be difficult to distinguish from
follicular adenoma
86
how do most FTC present
U3Thy3f lesion and dx on lobectomy
87
what is the treatment for MIFTC
thyroid lobectomy + isthmusectomy (capsular invasion only)
88
what is the treatment for FTC is there is vascular invasion
total thyroidectomy
89
how does a widely invasive FTC differ in architecture
more solid architecture
less follicular
more mitotic activity
90
what is a tumour marker for MTC
calcitonin
91
MTC is a tumour of the ------ cells which secrete -----
tumour of the parafollicular cells that secrete calcitonin
92
how would you describe the cells of MTC
spindle or polygonal cells arranged in nests, trabeculae or follicles
93
MTC is associated with deposition of what
amyloid
94
how can a MTC present
neck mass with local effects or paraneoplastic syndrome
95
what 2 paraneoplastic sydromes can MTC cause
VIP production --> diarrhoea
| ACTH production --> cushings
96
how is MTC diagnosed
FNA - presence of amyloid or calcitonin +ve stains
97
what are the 4 types of MTC
sporadic
familial non-MEN
familial MEN 2a
familial MEN 2b
98
what types of MTC are more commonly seen in younger patients
familial MEN 2a/b
99
what age group do you see sporadic/familial non-MEN MTC
40s-50s
100
what is the treatment of a MTC
total thyroidectomy
101
what is seen in the histology of MTC
aggressive behaviour - necrosis, many mitoses, small cell morphology
102
what is the 5 year survivial rate of MTC
70-80%
103
how would you describe anaplastic thyroid carcinoma
undifferentiated and aggressive
104
when is anaplastic thyroid carcinoma seen
older patients
| may be people with a history of DTC
105
how do ATCs present
rapid growth with involvement of neck structures and death
106
what genetics are involved in ATC
p53
| B-catenin mutation
107
thyroid lymphoma is seen in a background of ...
hypothyroidism
108
who is most likely to get thyroid lymphoma
females 70-80
109
how is thyroid lymphoma diagnosed
core biopsy
110
how is thyroid lymphoma treated
chemo (R-CHOP)
DXT (adjuvant radiotherapy)
steroids
111
how does a thyroid lymphoma present
rapid onset mass in thyroid
