Cancer

Question 1

A 45-year-old woman presented to the GP with a single nodule on her neck. She explains to the GP she had head irradiation as a child. The GP explains that he is keen to rule out thyroid cancer as a possible diagnosis

What is the most common type of thyroid cancer?

Answer 1

Papillary thyroid cancer

Question 2

A 46-year-old female who previously well attended the endocrine clinic with a neck swelling anteriorly. She is clinically well and there is no neck discomfort or other clinical features such as swallowing problems and no features of thyroid hormone discomfort

She undergoes a neck ultrasound scan which shows a nodular thyroid mass with signs of increased vascularity and calcium deposits. These findings raise suspicion of a thyroid malignancy.

Which type of thyroid cancer carries the worst prognosis?

Answer 2

Anaplastic thyroid cancer

Question 3

A 71-year-old visits her GP with a swelling on the right-hand side of her neck. She reports it as being present for several years, slowly getting larger. There are no associated symptoms of hoarse voice or swallowing difficulties. There is no family history of thyroid disease

On examination, there is an uneven goitre but no bruit.
Her thyroid blood tests are normal.
Given the history and examination findings, what is the most likely underlying cause?

Answer 3

Thyroid cyst

Question 4

A 70-year-old woman attends her local endocrine clinic. She has had a 4-week history of progressive neck swelling which is now causing discomfort. She has a past history of Hashimoto’s thyroiditis. A thyroid uptake scan performed shows little uptake. You suspect thyroid cancer

Which of the following thyroid cancer subtypes is most likely?

Answer 4

Thyroid Lymphoma

Question 5

What are all the different types of thyroid cancers?

Answer 5

1. Papillary Thyroid Cancer
2. Follicular Thyroid Cancer
3. Medullary Thyroid Cancer
4. Anaplastic Thyroid Cancer
5. Thyroid Lymphoma

Question 6

What percentage of thyroid cancers is papillary thyroid cancer (PTC)?

Answer 6

Around 70% of all thyroid cancers

Question 7

Which age group is most commonly affected by papillary thyroid cancer?

Answer 7

30-40 years of age

Question 8

What is the general prognosis for small papillary thyroid cancers?

Answer 8

Excellant

Question 9

What are the common sites for metastasis of papillary thyroid cancer?

Answer 9

Bone and lung

Question 10

What is the key feature that can help you remember papillary thyroid cancer’s popularity?

Answer 10

“Papillary = Popular”, since it is the most common type of thyroid cancer

Question 11

What regions have a higher incidence of follicular thyroid cancer?

Answer 11

Areas with low iodine and women are at higher risk

Question 12

At what age does follicular thyroid cancer typically present?

Answer 12

30-60 years of age

Question 13

What is the typical pattern of metastasis for follicular thyroid cancer?

Answer 13

Lung and bone

Question 14

What percentage of thyroid cancers are medullary thyroid cancer (MTC)?

Answer 14

around 5%

Question 15

From which cells does medullary thyroid cancer originate?

Answer 15

Calcitonin-producing C-cells

Question 16

What symptoms are commonly seen with increased calcitonin levels in medullary thyroid cancer?

Answer 16

Hypocalcaemia and diarrhoea

Question 17

What genetic syndromes are associated with medullary thyroid cancer?

Answer 17

1. Multiple Endocrine Neoplasia (MEN) types 2A and 2B

Question 18

What is the typical pattern of metastasis for medullary thyroid cancer?

Answer 18

Lymph nodes

Question 19

How does the prognosis of medullary thyroid cancer compare to papillary and follicular cancer?

Answer 19

Worse prognosis than papillary and follicular thyroid cancers

Question 20

What is the most distinguishing characteristic of anaplastic thyroid cancer?

Answer 20

Aggressive nature with rapidly growing masses

Question 21

At what age is anaplastic thyroid cancer most commonly present?

Answer 21

60-70 years of age - elderly age-old women

Question 22

What is the prognosis for patients with anaplastic thyroid cancer?

Answer 22

Extremely poor, with a median survival rate of 8 months

Question 23

What type of lymphoma is most commonly associated with thyroid cancer?

Answer 23

Non-Hodgkin’s lymphoma

Question 24

Which thyroid condition is strongly associated with thyroid lymphoma?

Answer 24

Hashimoto’s thyroiditis

Question 25

At what age does thyroid lymphoma most commonly present?

Answer 25

50-80 years old

Question 26

What is the standard management for papillary and follicular thyroid cancers?

Answer 26

Total thyroidectomy followed by radioiodine (I-131) therapy

Question 27

What is the treatment for anaplastic thyroid cancer?

Answer 27

Surgical resection where possible, palliation through isthmus-ectomy and radiotherapy, but chemotherapy is largely ineffective

Question 28

Order of most to least prevalent

Answer 28

1. Papillary 2. Follicular 3. Medullary 4. Anaplastic (worst prognostic) 5. Lymphomas

Question 29

A 23-year-old female presents to her GP as her parents have noticed that her neck looks bigger than normal. She has no other problems and has no medical conditions. On examination, the doctor can palpate a thyroid mass that moves on swallowing but not on tongue protrusion. The GP suspects thyroid cancer and refers the patient via the two-week wait system. Upon further investigation, the patient is found to have the most common type of thyroid cancer. What is the most likely complication of this type of malignancy?

Answer 29

Spread to cervical lymph nodes

Question 30

A 51-year-old female presented to her GP with a nodule on the thyroid region of her neck. She has a past medical history of Cushing's disease and small mucosal neuromas. She was referred to the ENT surgeons who performed a biopsy and unfortunately diagnosed her with thyroid cancer. On her blood tests, she was noted to have a raised calcitonin level. From the information provided above, what type of thyroid cancer is this lady most likely suffering from?

Answer 30

Medullary

Question 31

A 46-year-old female presents to the emergency department after a syncopal episode. She has recently had thyroid surgery for a follicular carcinoma of her thyroid. On examination, she is noted to have paresthesia periorally. In her ECG, the waveform timings recorded are as follows: 'Ventricular rate: 70 bpm PR interval: 161 ms QRS duration: 94 ms Corrected QT interval: 530 ms' What electrolyte disturbance is the most likely cause for the abnormality in ECG timing? and why?

Answer 31

Hypocalcaemia = damage to parathyroid glands can result in hypocalcaemia = prolonged QT

Question 32

A 34-year-old female presents with a thyroid nodule. She has a family history of thyroid disease and both her sisters have undergone total thyroidectomies. Her past medical history includes hypertension which has been difficult to manage What does she have?

Answer 32

Medullary carcinoma = inherited in an autosomal dominant fashion

Question 33

A 52-year-old woman presents with a neck swelling. Her GP reports that her TSH value is low at 0.01 mu/l. A scintigraphy demonstrates a hot nodule What does she have?

Answer 33

Toxic adenoma = This lady has thyrotoxicosis (low TSH) and a hot solitary nodule indicating a toxic adenoma. Thyroid cancer rarely causes thyrotoxicosis or hot nodules

Question 33

An 18-year-old female presents with 3 nodules in the right lobe of the thyroid. Clinically she is euthyroid and there is associated cervical lymphadenopathy. She has no family history of thyroid disease What does she have?

Answer 33

Papillary carcinoma

Question 34

Which type of thyroid cancer is most commonly associated with Hashimoto's thyroiditis?

Answer 34

Papillary thyroid carcinoma

Question 35

A 63-year-old woman presents to her GP with a neck lump that has been growing rapidly for 3 weeks. She reports that she is now having difficulty swallowing and breathing. On examination, she has a large, hard mass in the left anterior aspect of the neck which moves up on swallowing but not on tongue protrusion. There is also associated cervical lymphadenopathy. What is the most likely diagnosis?

Answer 35

Anaplastic thyroid cancer = sounds aggressive

Question 36

A 53-year-old woman undergoes a total thyroidectomy for treatment-resistant graves disease. She is otherwise fit and well. 7 hours after returning to the ward she complains of tingling in her fingertips bilaterally and around her mouth What is the most appropriate management for the likely diagnosis?

Answer 36

IV calcium chloride

Question 37

A 32 year old female attends clinic complaining that she has recently noticed a swelling on the left side of her neck. She is otherwise fit and healthy. She has no significant family history. On examination the lump is solid and moves up on swallowing. If you were considering a cancer diagnosis, what is the most likely diagnosis?

Answer 37

Papillary thyroid cancer = cause it said MOSTLY so therefore pick most common type