Thyroid carcinoma Flashcards by Jack Molyneux

What is meant by differentiated thyroid carcinoma (DTC)?

This is the name given to both papillary and follicular carcinoma as they both have a well-differentiated histological appearance

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How does female risk of thyroid carcinoma changes with age?

Risk increases from 15-40 and then plateaus

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How does male risk of thyroid carcinoma change with age?

Risk increases steadily with age

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What has a strong association with thyroid carcinoma?

Radiation (Clusters found in areas of nuclear incidents)

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What have a weak association with thyroid carcinoma?

Thyroid adenomata
Chronic TSH elevation
Increased parity

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What common carcinogenic factors have no association with thyroid carcinoma?

Diet
Other malignancy
Family history
Smoking

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What is the most common type of thyroid cancer?

Papillary carcinoma

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What are the 4 main types of thyroid carcinoma?

Papillary
Follicular
Anaplastic
Medullary

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What are some conditions associated with papillary carcinoma?

Hashimoto’s thyroiditis
Ionising radiation exposure

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What are some genetic associations with papillary carcinoma?

MAP kinase pathway activation mutations
RET or NTKR1 rearrangements
BRAF point mutations
Ras mutations

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Describe the histology of papillary carcinoma

Most take up iodine and secrete thyroglobulin and are TSH drive

They are usually solitary nodules on the thyroid

They are derived from the follicular epithelium

They can be multifocal, cystic and possibly calcified (Psammoma bodies)

They will most commonly spread through lymphatics and sometimes spread through the blood

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How will papillary carcinoma usually present?

Thyroid or cervical lymph node mass
Local effects:
- Hoarseness
- Hysphagia
- Cough
- Dyspnoea

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Wha is the 10 year mortality for papillary carcinoma?

<5%

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What is the 2nd most common thyroid cancer?

Follicular carcinoma

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Who is more at risk of follicular carcinoma?

Females
Iodine deficient areas

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What are some genetic associations of follicular carcinoma?

PI2K/AKT pathway mutations
Ras mutations
Pax8 and PPARy1 translocations

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How will follicular carcinomas usually present?

Single nodule, which is slow growing, painless and non-functional

What are the 2 main classes of follicular carcinoma?

Widely invasive
Minimally invasive

Describe the histology of widely invasive follicular carcinoma

More solid architecture
Less follicular architecture
More mitotic activity

Describe the histology of minimally invasive follicular carcinoma

Most common
Well-differentiated follicular architecture
May have a part surrounding capsule
Difficult to distinguish from adenoma

How do follicular carcinomas usually metastasise?

Haematogenous to lungs, bones, liver and brain
Rarely lymphatic

How do papillary carcinomas usually metastasise?

Lymphatics
Rarely haematogenous

How will follicular carcinoma present?

Thyroid or cervical lymph node mass
Local effects:
- Hoarseness
- Dysphagia
- Cough
- Dyspnoea

What is the 10 year mortality of follicular carcinoma?

<5%

What are anaplastic carcinomas?

Undifferentated and aggressive tumours derived from the follicular epithelium

How do anaplastic carcinomas usually occur?

De novo or due to de-differentiation of another cancer

What are some genetic associations of anaplastic carcinoma?

- p53 mutations - ß-Catenin mutations - MAP kinase pathway activation mutations - RET or NTKR1 rearrangements - BRAF point mutations - Ras mutations

How will anaplastic carcinoma usually present?

Rapid growing thyroid mass Cervical lymphadenopathy Local effects: - Hoarseness - Dysphagia - Cough - Dyspnoea

How are anaplastic carcinomas investigated?

TSH levels USS US-FNA or biopsy

How is anaplastic carcinoma managed?

Total thyroidectomy if resectable +/- adjuvant radiochemotherapy as needed Do not respond to RAI

What are medullary carcinomas?

Tumours of the parafollicular cells which secrete calcitonin (C-cells)

What are the 3 types of medullary carcinoma?

Sporadic MEN2A/B associated Familial medullary carcinoma associated

At what age do MEN associated medullary carcinomas usually occur?

Very young patients

At what age do sporadic or familial associated medullary carcinomas usually occur?

Middle-aged adults (40-50)

How will sporadic medullary carcinoma usually present?

Solitary thyroid nodule Local effects: - Dysphagia - Hoarseness - Cough - Dyspnoea

How will familial medullary carcinoma usually present?

Bilateral or multi-centric thyroid nodule Local effects: - Dysphagia - Hoarseness - Cough - Dyspnoea

Describe the histology of medullary carcinoma

They are composed of spindle or polygonal cells, arranged into nests, trabeculae or follicles Familial cases will have C-cell hyperplasia

What condition can be caused by medullary carcinoma?

Amyloidosis (Abnormally folded calcitonin)

What are some paraneoplastic syndromes of medullary carcinoma?

Diarrhoea - VIP production Cushing's - ACTH production

What are some factors that increase prognosis of medullary carcinoma?

Young Female Smaller tumour confused to thyroid

What are some factors that decrease prognosis of medullary carcinoma?

Necrosis Many mitoses Squamous metaplasia Small cell morphology Familial forms

What are some investigations required in medullary carcinoma?

- Neck USS and FNA - Measure serum base calcitonin - 24 hour urinary metanephrines - Further imaging to detect localised/advanced disease - Check genetics for MEN