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endocrine > thyroid cancers > Flashcards

thyroid cancers Flashcards

1
Q

who usually gets thyroid lymphoma

A

females aged 70-80

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2
Q

what do patients with thyroid lymphoma often have a history of

A

auto-immune hypothyroidism

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3
Q

clinical presentation of thyroid lymphoma

A

rapid onset mass in thyroid

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4
Q

investigation of thyroid lymphoma

A

core biopsy

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5
Q

management of thyroid lymphoma

A

chemo (R-CHOP), radiotherapy or steroids

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6
Q

what is medullary carcinoma

A

tumour of c-cells

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7
Q

what are c-cells

A

parafollicular cells which secrete calcitonin

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8
Q

what are the majority of medullary carcinomas caused by

A

sporadic

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9
Q

what can medullary carcinomas be associated with

A

MEN2

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10
Q

genetic feature of medullary carcinomas

A

Germline RET mutations

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11
Q

clinical presentation of medullary carcinoma

A

neck mass with local effects
diarrhoea
cushings

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12
Q

name 3 local effects associated with a neck mass

A

dysphagia, hoarseness, airway compromise

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13
Q

investigations for medullary carcinoma

A

fine needle biopsy guided by US
serum base calcitonin
24 hour urinary metanephrines
genetic screening for MEN

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14
Q

local management of medullary carcinoma

A

total thyroidectomy

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15
Q

management of advanced medullary carcinoma

A

may involve tyrosine kinase inhibitors

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16
Q

what is anaplastic carcinoma

A

Undifferentiated and aggressive tumours derived from follicular epithelium

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17
Q

genetic mutations associated with anaplastic carcinoma

A

p53 and β-catenin mutations

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18
Q

clinical presentation of anaplastic carcinoma

A
  • Thyroid nodule
  • Features of local infiltration/compression
  • Cervical lymphadenopathy
  • Signs of distant metastases
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19
Q

what can be used to confirm anaplastic carcinoma

A

US-FNA or biopsy

20
Q

management of anaplastic carcinoma

A

total thyroidectomy +/- adjuvant radiochemotherapy

21
Q

what is the most common type of thyroid cancer

A

papillary carcinoma

22
Q

what is papillary carcinoma associated with (2)

A

hashimoto’s thyroiditis
ionising radiation

23
Q

what is the second most common thyroid cancer

A

follicular carcinoma

24
Q

genetic associations with papillary carcinoma

A

BRAF, ras, RET

25
Q

who is more likely to get follicular carcinoma

A

40-50 yr females

26
Q

where is there a higher incidence of follicular carcinoma

A

regions of iodine deficiency

27
Q

genetic associations with follicular carcinoma

A

PI3K/AKT, ras

28
Q

what is associated with psammoma bodies

A

papillary carcinoma

29
Q

histology of follicular carcinoma

A

slowly enlarging, painless, non-functional tumour

30
Q

how do papillary carcinomas tend to spread

A

via lymphatics

31
Q

how do follicular carcinomas tend to spread

A

haematogenous

32
Q

investigation of papillary and follicular carcinoma

A

US-FNA

33
Q

management of thyroid cancer in low risk patients

A

thyroid lobectomy

34
Q

management of thyroid cancer in high risk patients

A

subtotal/total thyroidectomy
consider radioactive iodine

35
Q

who gets whole body iodine scanning

A

patients who have had sub-total or total thyroidectomy

36
Q

what is whole body iodine scanning used for

A

to determine incomplete incision or present of occult metastases
inform need for further investigation/ treatment

37
Q

role of RAI ablation in the management of thyroid cancer

A

Ablate residual thyroid tissue in order to destroy occult microfoci

38
Q

possible complication of RAI ablation

A

Small but significant incidence of acute myeloid leukaemia

39
Q

what is follicular adenoma

A

benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous (collagenous) capsule

40
Q

who usually gets follicular adenoma

A

women, incidence increases with age

41
Q

what is associated with follicular adenoma

A

increased incidence in regions of iodine deficiency

42
Q

genetic factors associated with follicular adenoma

A

mutant ras or PIK3CA

43
Q

what can follicular adenoma develop into

A

toxic adenoma

44
Q

clinical presentation of follicular adenoma

A

discrete solitary mass in an otherwise normal thyroid gland
may present with local symptoms

45
Q

investigations for follicular adenoma

A

US-FNA, serum TSH

46
Q

management of follicular adenoma

A

lobectomy with biopsy

endocrine (15 decks)

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