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Endocrinology > Thyroid carcinoma > Flashcards

Thyroid carcinoma Flashcards

1
Q

What is meant by differentiated thyroid carcinoma (DTC)?

A

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

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2
Q

How does female risk of thyroid carcinoma changes with age?

A

Risk increases from 15-40 and then plateaus

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3
Q

How does male risk of thyroid carcinoma change with age?

A

Risk increases steadily with age

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4
Q

What has a strong association with thyroid carcinoma?

A

Radiation (Clusters found in areas of nuclear incidents)

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5
Q

What have a weak association with thyroid carcinoma?

A

Thyroid adenomata
Chronic TSH elevation
Increased parity

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6
Q

What common carcinogenic factors have no association with thyroid carcinoma?

A

Diet
Other malignancy
Family history
Smoking

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7
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

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8
Q

What are the 4 main types of thyroid carcinoma?

A

Papillary
Follicular
Anaplastic
Medullary

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9
Q

What are some conditions associated with papillary carcinoma?

A

Hashimoto’s thyroiditis
Ionising radiation exposure

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10
Q

What are some genetic associations with papillary carcinoma?

A
  • MAP kinase pathway activation mutations
  • RET or NTKR1 rearrangements
  • BRAF point mutations
  • Ras mutations
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11
Q

Describe the histology of papillary carcinoma

A

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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12
Q

How will papillary carcinoma usually present?

A

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

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13
Q

Wha is the 10 year mortality for papillary carcinoma?

A

<5%

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14
Q

What is the 2nd most common thyroid cancer?

A

Follicular carcinoma

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15
Q

Who is more at risk of follicular carcinoma?

A

Females
Iodine deficient areas

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16
Q

What are some genetic associations of follicular carcinoma?

A
  • PI2K/AKT pathway mutations
  • Ras mutations
  • Pax8 and PPARy1 translocations
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17
Q

How will follicular carcinomas usually present?

A

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

18
Q

What are the 2 main classes of follicular carcinoma?

A

Widely invasive
Minimally invasive

19
Q

Describe the histology of widely invasive follicular carcinoma

A
  • More solid architecture
  • Less follicular architecture
  • More mitotic activity
20
Q

Describe the histology of minimally invasive follicular carcinoma

A
  • Most common
  • Well-differentiated follicular architecture
  • May have a part surrounding capsule
  • Difficult to distinguish from adenoma
21
Q

How do follicular carcinomas usually metastasise?

A

Haematogenous to lungs, bones, liver and brain
Rarely lymphatic

22
Q

How do papillary carcinomas usually metastasise?

A

Lymphatics
Rarely haematogenous

23
Q

How will follicular carcinoma present?

A

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

24
Q

What is the 10 year mortality of follicular carcinoma?

A

<5%

25
Q

What are anaplastic carcinomas?

A

Undifferentated and aggressive tumours derived from the follicular epithelium

26
Q

How do anaplastic carcinomas usually occur?

A

De novo or due to de-differentiation of another cancer

27
Q

What are some genetic associations of anaplastic carcinoma?

A
  • p53 mutations
  • ß-Catenin mutations
  • MAP kinase pathway activation mutations
  • RET or NTKR1 rearrangements
  • BRAF point mutations
  • Ras mutations
28
Q

How will anaplastic carcinoma usually present?

A

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

29
Q

How are anaplastic carcinomas investigated?

A

TSH levels
USS
US-FNA or biopsy

30
Q

How is anaplastic carcinoma managed?

A

Total thyroidectomy if resectable +/- adjuvant radiochemotherapy as needed

Do not respond to RAI

31
Q

What are medullary carcinomas?

A

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

32
Q

What are the 3 types of medullary carcinoma?

A

Sporadic
MEN2A/B associated
Familial medullary carcinoma associated

33
Q

At what age do MEN associated medullary carcinomas usually occur?

A

Very young patients

34
Q

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

A

Middle-aged adults (40-50)

35
Q

How will sporadic medullary carcinoma usually present?

A

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

36
Q

How will familial medullary carcinoma usually present?

A

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

37
Q

Describe the histology of medullary carcinoma

A

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

38
Q

What condition can be caused by medullary carcinoma?

A

Amyloidosis (Abnormally folded calcitonin)

39
Q

What are some paraneoplastic syndromes of medullary carcinoma?

A

Diarrhoea - VIP production
Cushing’s - ACTH production

40
Q

What are some factors that increase prognosis of medullary carcinoma?

A

Young
Female
Smaller tumour confused to thyroid

41
Q

What are some factors that decrease prognosis of medullary carcinoma?

A

Necrosis
Many mitoses
Squamous metaplasia
Small cell morphology
Familial forms

42
Q

What are some investigations required in medullary carcinoma?

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

Endocrinology (42 decks)

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