Thyroid cancer Flashcards Preview

Endocrinology > Thyroid cancer > Flashcards

Flashcards in Thyroid cancer Deck (37):
1

What is the effect of thyroid adenomas?

usually non functional
can secrete T3/T4 (leads to thyrotoxicosis)

2

What is the macroscopic appearance of a thyroid adenoma?

discreet solitary mass
encapsulated by collagen cuff
neoplastic thyroid follicles (follicular adenoma)

3

What is the mutation causing follicular adenomas?

Mutation in TSHR signalling pathway

4

What can follicular adenoma be mistaken for?

follicular carcinoma

5

What is the most common differentiated thyroid cancer?

papillary carcinoma

6

How do papillary carcinomas present?

Solitary nodule
maybe multifocal
usually cystic
may often be calcified

7

What mutation causes papillary carcinoma?

MAP kinase pathway activation

8

What is the prognosis with papillary carcinoma?

95% 10 year survival
good because it's differentiated

9

What conditions are associated with papillary carcinoma?

Hashimoto's thyroiditis

10

What is the mode of metasteses in papillary carcinoma

lymphatic
haematogenous

11

Where does papillary carcinoma metastasise to?

bones, lungs, liver, brain

12

What is the second most common differentiated thyroid cancer?

follicular carcinoma

13

What is the presentation of a follicular carcinoma?

single nodule
painless
slow growing
non functional

14

What is the mode of mets in follicular carcinoma?

Haematogenous
need vascular or capsular invasion

15

Where does follicular carcinoma metasts to?

bone, liver, lungs
(nb, blood brain barrier?)

16

What is the prognosis for follicular carcinoma?

depends on level of invasion
minimal invasion the 90% survival at 10 years

17

What is the etiology in Medullary thyroid carcinoma?

sporadic (40s+50s)
multiple endocrine neoplasia (MEN) (young)
Familial (40s+50s)

18

What is the mutation in MTC?

c cell mutation
secretes calcitionin

19

What is the presentation of MTC?

sporadic: solitary nodule
familial: bilateral/multicentric (c cells)

20

What is the histolgical appearance of MTC?

spindle cell
nest arrangement
trabeculae/follicles

21

What are the local symptoms of MTC?

dysphagia
hoarseness
airway obstruction

22

What are the paraneoplastic signs of MTC?

diarrhoea
Cushings signs

23

What is MTC associated with?

amyloid deposition

24

How common are MTCs? What grade are they?

Rare
High grade

25

What is the etiology of anaplastic tumours?

older patients
PMHx differentiated tumour

26

Why are anaplastic tumours aggressive?

undifferetiated

27

Why is survival poor with anaplastic tumours?

Rapid growth
Invades neck structures

28

What factors increase the likelihood of a thyroid tumour being malignant?

Male
New nodule
50 years
Vocal cord palsy
Nodule increasing in size
lesion >4cm
Hx neck radiation

29

What investigations do you do in a suspected thyroid tumour?

US guided FNA
laryngoscopy if vocal nerve palsy
excision and biopsy lymph node

30

What test(s) is NOT done in suspected thyroid tumour?

NO isotope scan
(NO CT/MRI?)

31

How do you assess cytology and what sample is needed?

Thy1-Thy5
FNA

32

What is the grading of Thy1-Thy5?

Thy1-insufficient sample
Thy2-benign
Thy3-atypical, suspected benign
Thy4-atyplical, suspected malignancy
Thy5-malignant

33

What grade are follicular lesions and why?

All Thy3
difficult to assess
no capsule

34

What are the surgical options for thyroid cancer?

lobectomy and isthmusectomy
subtotal thyroidectomy
total thyroidectomy

35

When is lobectomy and isthmusectomy appropriate?

papillary microcarcinoma
<1cm
minimally invasive follicular carcinoma
low risk AMES

36

When is (sub)total thyroidectomy appropriate?

DTC and nodes
DTC and distant mets
Bilateral/multifocal DTC
DTC with extrathyroidal spread
High risk AMES

37

When should lymph nodes be removed?

Showing signs of macroscopic disease
use judgement