Thyroid Cancer and Thymoma Flashcards
Name the types of thyroid cancer in order of prevalence
Papillary (80%), Follicular (10%), Medullary (5%), Anaplastic, Hurthle cell
What percentage of anaplastic thyroid cancers harbour a BRAF mutation?
25%
What is 5yr OS rate for localised thyroid cancer?
Close to 100% for papillary, medullary and papillary. 35% for anaplastic thyroid cancer.
Average OS for metastatic thyroid cancer, by subtype?
75% papillary, 63% follicular, 40% medullary and 4% anaplastic
When is adjuvant RT suggested following thyroid resection?
Vascular invasion
When is therapeutic radioiodine used following resection?
R1 resection
When might radioiodine be used following complete resection of a thyroid canceR?
Remnant ablation to ensure undetectable serum thyroglobulin which facilitates follow up and surveillance.
What is first line for metastatic thyroid medullary carcinoma? Which mutation confers better response rate?
Cabozantinib, significant survival benefit with RETM918T mutation.
Second line treatment of medullary thyroid cancer?
Selpercatinib, limited evidence for chemotherapy.
When is adjuvant RT indicated following surgical resection of thymoma?
R1 OR R2 resection
When is adjuvant chemotherapy indicated following surgical resection of thymoma?
R2 resection
In unresectable thymoma what would be your first line treatment plan?
Cisplatin and anthyracycline (doxorubicin) followed by reassessment for surgery
Management of metastatic thymoma
Platinum based chemotherapy- carboplatin and paclitaxel. Octreotide can be used in second or third line.
What is the adjuvant treatment for adrenocortical carcinoma?
Radiotherapy followed by mitotane
If thyroglobulin antibodies are rising following resection and ablation what are your next steps?
Arrange neck US, if negative then for CT thorax, if negative for bone scan, if negative then PET-CT.
Can consider therapeutic ablation after that.
