Chapter 57: Thyroid Gland- Medullary Carcinoma

Question 1

What percentage of all thyroid cancers does it comprise?

Answer 1

≈5%

Question 2

With what other conditions is it associated?

Answer 2

MEN type II; autosomal-dominant genetic transmission

Question 3

Histology?

Answer 3

Amyloid (aMyloid = Medullary)

Question 4

What does it secrete?

Answer 4

Calcitonin (tumor marker)

Question 5

What is the appropriate stimulation test?

Answer 5

Pentagastrin (causes an increase in calcitonin)

Question 6

Describe the route of spread.

Answer 6

Lymphatic and hematogenous distant metastasis

Question 7

How is the diagnosis made?

Answer 7

FNA

Question 8

131I uptake?

Answer 8

Poor uptake

Question 9

What is the associated genetic mutation?

Answer 9

RET proto-oncogene

Question 10

What is the female-to-male ratio?

Answer 10

Female > male; 1.5:1

Question 11

What is the 10-year survival rate?

Answer 11

80% without LN involvement
45% with LN spread

Question 12

What should all patients with medullary thyroid cancer also be
screened for?

Answer 12

MEN II: pheochromocytoma, hyperparathyroidism

Question 13

If medullary thyroid carcinoma and pheochromocytoma are found,
which one is operated on first?

Answer 13

Pheochromocytoma

Question 14

What is the treatment?

Answer 14

• Total thyroidectomy and median LN dissection
• Modified neck dissection, if lateral cervical nodes are positive

Question 15

What are the “M’s” of medullary carcinoma?

Answer 15

Medullary cancer:

1. MEN II
2. aMyloid
3. Median LN dissection
4. Modified neck dissection if lateral nodes are positive