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year 2 > thyroid cancer > Flashcards

thyroid cancer Flashcards

1
Q

what staging does FNA give

A

Thy1-5

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2
Q

what does Thy1 indicate

A

inadequate

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3
Q

what does Thy2/U2 indicate

A

benign

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4
Q

what does Thy3(a/f) / U3 indicate

A

atypical

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5
Q

what does Thy4 / U4 indicate

A

probably malignant

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6
Q

what does Thy5 / U5 indicate

A

malignant

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7
Q

what other staging is used in thyroid cancer

A

TNM

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8
Q

T1

A

< or = 2 cm

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9
Q

T2

A

2 < tumour < or = 4cm

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10
Q

T3

A

tumour > 4cm

limited to thyroid or minimal extra-thyroidal disease

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11
Q

T4a

A

moderately advanced disease - beyond thyroid capsule e.g. larynx/trachea/oesophagus

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12
Q

T4b

A

very advanced disease e.g. invades prevertebral fascia

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13
Q

N0

A

no regional lymph nodes

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14
Q

N1

A

regional lymph nodes

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15
Q

N1a

A

mets to pretracheal/paratracheal/prelaryngeal/delphian lymph nodes

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16
Q

N1b

A

mets to unilateral/bilateral/contralateral cervical or retropharyngeal or superior mediastinal lymph nodes

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17
Q

M0

A

no distant mets

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18
Q

M1

A

distant mets

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19
Q

true/false

differentiated thyroid cancers have the worst prognosis of all cancers

A

false - best prognosis except non-melanoma skin cancers

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20
Q

are females or males more prone to DTC

A

females

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21
Q

when are females most likely to get DTC

A

risk increases 15-40 then plateaus

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22
Q

when are males most likely to get DTC

A

increases with age

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23
Q

do DTCs have an association with diet/smoking/fmhx

A

no

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24
Q

what do DTCs have a high association with

A

radiation

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25
Q

most DTCs take up ____ and secrete ___

A

take up iodine

secrete thyroglobulin

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26
Q

DTCS are ___ driven

A

TSH

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27
Q

how do majority of DTCs present

A

palpable nodules

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28
Q

what is the treatment of choice for DTC

A

surgery

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29
Q

listen the DTCs in order of most common to least

A 
Papillary
Follicular
Medullary
Anaplastic
People Find Me Annoying
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30
Q

what are some investigations done for thyroid cancer

A

USS-FNA - assess likelihood of malignancy
excision biopsy of lymph node
if vocal cord palsy pre-operative laryngoscopy

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31
Q

is FNA used in follicular lesions

A

no - relationship to capsule not assessed

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32
Q

what are follicular lesions automatically graded on FNA

A

Thy3

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33
Q

what does AMES take into account

A

Age
Mets
Extent of primary tumour
Size of primary tumour

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34
Q

what is in AMES low risk group

A

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

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35
Q

what is in AMES high risk

A

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

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36
Q

what is the treatment for AMES low risk

A

thyroid lobectomy and isthmusectomy

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37
Q

what is the treatment for AMES high risk

A

total thyroidectomy

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38
Q

how soon is calcium checked after surgery

A

within 24 hours

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39
Q

when should calcium replacement therapy be initiated

A

if calcium falls below 2

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40
Q

what should be given if calcium falls below 1.8 or if symptomatic

A

IV calcium

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41
Q

what are patients discharged on after thyroid surgery

A

T3 or T4

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42
Q

when is WBIS used and for what

A

patients who have undergone sub-total or total thyroidectomy to determine ability of disease to take up iodine with a view to therapy

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43
Q

when should T4 be stopped prior to scan

A

4 weeks

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44
Q

when should T3 be stopped prior to scan

A

2 weeks

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45
Q

what should TSH be for best results

A

> 20

46
Q

what is given as a capsule in WBIS

A

2-4 mCi I-131 administered 2 days prior

47
Q

what is the treatment if there if iodine uptake > 0.1% in thyroid bed in WBIS

A

thyroid remnant ablation (TRA)

48
Q

what are some precautions with TRA

A

lead lined room
pretreated with rhTSH
disposable cutlery, sheets, clothing
little/no contact with nurses

49
Q

what is the aim for TSH and fT4 after TRA

A

TSH < 0.1

fT4 < 25

50
Q

what is used as a tumour marker in the follow up of TRA

A

thyroglobulin

51
Q

what are 3 side effects of TRA

A

sialadenitis
sore throat
small but significant increase in acute myeloid leukemia

52
Q

what are 2 treatments for people with DTC refractory to iodine therapy

A

sorafenib

lenvatinib

53
Q

what % of thyroid nodules are benign

A

95%

54
Q

what are some examples of benign thyroid nodules

A

cyst
colloid nodule
benign follicular adenoma
hyperplastic nodule

55
Q

what would a discrete solitary mass encapsulated by a surrounding collagen cuff be

A

follicular adenoma

56
Q

what are follicular adenomas composed of

A

neoplastic thyroid follicles

57
Q

what can follicular adenomas secrete and what can this cause

what would be seen on an isotope scan

A

thyroid hormones –> thyrotoxicosis

nodule is hot and rest of gland is suppressed

58
Q

what are 3 genetic mutations that may be seen in follicular adenoma

A

ras
P1K3CA
TSHR signalling pathway - gain of function

59
Q

orphan annie nuclei

A

papillary thyroid carcinoma

60
Q

is papillary thyroid carcinoma usually solitary or multifocal

A

usually solitary but can be multifocal

61
Q

how do papillary thyroid carcinomas usually spread

A

lymphatics

62
Q

what is a risk factor for papillary thyroid carcinoma

A

ionising radiation

63
Q

if a PTC was to spread by blood where would it go

A

lungs, bone, liver, brain

64
Q

how would you describe PTC and what are the bodies of calcification seen called

A

cystic

psammoma bodies

65
Q

most common histological DTC

A

PTC

66
Q

what should you suspect if a lymph node contains thyroid tissue or psammoma body

A

PTC

67
Q

what 4 genes are involved in the genetics of PTC

A

rearrangement of RET or NTKR1
activating point mutation in BRAF
mutation of RAS

68
Q

how does PTC usually present

A

lesion in thyroid gland or cervical lymph node mets (mass)

69
Q

what would be some signs of locally advanced disease

A

hoarse voice
dysphagia
cough
dyspnoea

70
Q

what is the treatment for a microcarcinoma (<1cm)

A

thyroid lobectomy and isthmusectomy

71
Q

what is the treatment if there is macroscopic lymph node disease

A

central compartment clearance and lateral lymph node sampling

72
Q

what is the 10 year mortality rate for PTC

A

< 5%

73
Q

second most common histological DTC is

A

FTC

74
Q

how does FTC usually spread

A

haem –> bones, lung, liver

75
Q

is a FTC usually multifocal or single nodule

A

single nodule

76
Q

are females or males more likely to get FTC

A

females

77
Q

what is the age group of getting FTC

A

40-50 (older than PTC)

78
Q

FTC are seen more in areas of iodine excess/iodine deficiency

A

deficiency

79
Q

what are some genetic mutations seen in FTC

A

P13k / AKT pathway mutation
ras (N-ras) mutation
Pax8 and PPARY1 translocation

80
Q

what are the 2 types of FTC

A

minimally invasive and widely invasive

81
Q

which is more common of the 2 FTCs

A

minimally invasive

82
Q

what is the survival rate at 10 years in MIFTC

A

90%

83
Q

MIFTC are
slowly enlarging/dont enlarge
painless/painful
functional/non-functional

A

slowly enlarging
painless
non-functional

84
Q

what is the architecture of MIFTC

A

follicular architecture well differentiated with a part surrounding capsule

85
Q

what may a MIFTC be difficult to distinguish from

A

follicular adenoma

86
Q

how do most FTC present

A

U3Thy3f lesion and dx on lobectomy

87
Q

what is the treatment for MIFTC

A

thyroid lobectomy + isthmusectomy (capsular invasion only)

88
Q

what is the treatment for FTC is there is vascular invasion

A

total thyroidectomy

89
Q

how does a widely invasive FTC differ in architecture

A

more solid architecture
less follicular
more mitotic activity

90
Q

what is a tumour marker for MTC

A

calcitonin

91
Q

MTC is a tumour of the —— cells which secrete —–

A

tumour of the parafollicular cells that secrete calcitonin

92
Q

how would you describe the cells of MTC

A

spindle or polygonal cells arranged in nests, trabeculae or follicles

93
Q

MTC is associated with deposition of what

A

amyloid

94
Q

how can a MTC present

A

neck mass with local effects or paraneoplastic syndrome

95
Q

what 2 paraneoplastic sydromes can MTC cause

A

VIP production –> diarrhoea

ACTH production –> cushings

96
Q

how is MTC diagnosed

A

FNA - presence of amyloid or calcitonin +ve stains

97
Q

what are the 4 types of MTC

A

sporadic
familial non-MEN
familial MEN 2a
familial MEN 2b

98
Q

what types of MTC are more commonly seen in younger patients

A

familial MEN 2a/b

99
Q

what age group do you see sporadic/familial non-MEN MTC

A

40s-50s

100
Q

what is the treatment of a MTC

A

total thyroidectomy

101
Q

what is seen in the histology of MTC

A

aggressive behaviour - necrosis, many mitoses, small cell morphology

102
Q

what is the 5 year survivial rate of MTC

A

70-80%

103
Q

how would you describe anaplastic thyroid carcinoma

A

undifferentiated and aggressive

104
Q

when is anaplastic thyroid carcinoma seen

A

older patients

may be people with a history of DTC

105
Q

how do ATCs present

A

rapid growth with involvement of neck structures and death

106
Q

what genetics are involved in ATC

A

p53

B-catenin mutation

107
Q

thyroid lymphoma is seen in a background of …

A

hypothyroidism

108
Q

who is most likely to get thyroid lymphoma

A

females 70-80

109
Q

how is thyroid lymphoma diagnosed

A

core biopsy

110
Q

how is thyroid lymphoma treated

A

chemo (R-CHOP)
DXT (adjuvant radiotherapy)
steroids

111
Q

how does a thyroid lymphoma present

A

rapid onset mass in thyroid

year 2 (19 decks)

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