thyroid cancers Flashcards
who usually gets thyroid lymphoma
females aged 70-80
what do patients with thyroid lymphoma often have a history of
auto-immune hypothyroidism
clinical presentation of thyroid lymphoma
rapid onset mass in thyroid
investigation of thyroid lymphoma
core biopsy
management of thyroid lymphoma
chemo (R-CHOP), radiotherapy or steroids
what is medullary carcinoma
tumour of c-cells
what are c-cells
parafollicular cells which secrete calcitonin
what are the majority of medullary carcinomas caused by
sporadic
what can medullary carcinomas be associated with
MEN2
genetic feature of medullary carcinomas
Germline RET mutations
clinical presentation of medullary carcinoma
neck mass with local effects
diarrhoea
cushings
name 3 local effects associated with a neck mass
dysphagia, hoarseness, airway compromise
investigations for medullary carcinoma
fine needle biopsy guided by US
serum base calcitonin
24 hour urinary metanephrines
genetic screening for MEN
local management of medullary carcinoma
total thyroidectomy
management of advanced medullary carcinoma
may involve tyrosine kinase inhibitors
what is anaplastic carcinoma
Undifferentiated and aggressive tumours derived from follicular epithelium
genetic mutations associated with anaplastic carcinoma
p53 and β-catenin mutations
clinical presentation of anaplastic carcinoma
- Thyroid nodule
- Features of local infiltration/compression
- Cervical lymphadenopathy
- Signs of distant metastases
what can be used to confirm anaplastic carcinoma
US-FNA or biopsy
management of anaplastic carcinoma
total thyroidectomy +/- adjuvant radiochemotherapy
what is the most common type of thyroid cancer
papillary carcinoma
what is papillary carcinoma associated with (2)
hashimoto’s thyroiditis
ionising radiation
what is the second most common thyroid cancer
follicular carcinoma
genetic associations with papillary carcinoma
BRAF, ras, RET
who is more likely to get follicular carcinoma
40-50 yr females
where is there a higher incidence of follicular carcinoma
regions of iodine deficiency
genetic associations with follicular carcinoma
PI3K/AKT, ras
what is associated with psammoma bodies
papillary carcinoma
histology of follicular carcinoma
slowly enlarging, painless, non-functional tumour
how do papillary carcinomas tend to spread
via lymphatics
how do follicular carcinomas tend to spread
haematogenous
investigation of papillary and follicular carcinoma
US-FNA
management of thyroid cancer in low risk patients
thyroid lobectomy
management of thyroid cancer in high risk patients
subtotal/total thyroidectomy
consider radioactive iodine
who gets whole body iodine scanning
patients who have had sub-total or total thyroidectomy
what is whole body iodine scanning used for
to determine incomplete incision or present of occult metastases
inform need for further investigation/ treatment
role of RAI ablation in the management of thyroid cancer
Ablate residual thyroid tissue in order to destroy occult microfoci
possible complication of RAI ablation
Small but significant incidence of acute myeloid leukaemia
what is follicular adenoma
benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous (collagenous) capsule
who usually gets follicular adenoma
women, incidence increases with age
what is associated with follicular adenoma
increased incidence in regions of iodine deficiency
genetic factors associated with follicular adenoma
mutant ras or PIK3CA
what can follicular adenoma develop into
toxic adenoma
clinical presentation of follicular adenoma
discrete solitary mass in an otherwise normal thyroid gland
may present with local symptoms
investigations for follicular adenoma
US-FNA, serum TSH
management of follicular adenoma
lobectomy with biopsy
