Flashcards in Thyroid cancer Deck (37):
What is the effect of thyroid adenomas?
usually non functional
can secrete T3/T4 (leads to thyrotoxicosis)
What is the macroscopic appearance of a thyroid adenoma?
discreet solitary mass
encapsulated by collagen cuff
neoplastic thyroid follicles (follicular adenoma)
What is the mutation causing follicular adenomas?
Mutation in TSHR signalling pathway
What can follicular adenoma be mistaken for?
What is the most common differentiated thyroid cancer?
How do papillary carcinomas present?
may often be calcified
What mutation causes papillary carcinoma?
MAP kinase pathway activation
What is the prognosis with papillary carcinoma?
95% 10 year survival
good because it's differentiated
What conditions are associated with papillary carcinoma?
What is the mode of metasteses in papillary carcinoma
Where does papillary carcinoma metastasise to?
bones, lungs, liver, brain
What is the second most common differentiated thyroid cancer?
What is the presentation of a follicular carcinoma?
What is the mode of mets in follicular carcinoma?
need vascular or capsular invasion
Where does follicular carcinoma metasts to?
bone, liver, lungs
(nb, blood brain barrier?)
What is the prognosis for follicular carcinoma?
depends on level of invasion
minimal invasion the 90% survival at 10 years
What is the etiology in Medullary thyroid carcinoma?
multiple endocrine neoplasia (MEN) (young)
What is the mutation in MTC?
c cell mutation
What is the presentation of MTC?
sporadic: solitary nodule
familial: bilateral/multicentric (c cells)
What is the histolgical appearance of MTC?
What are the local symptoms of MTC?
What are the paraneoplastic signs of MTC?
What is MTC associated with?
How common are MTCs? What grade are they?
What is the etiology of anaplastic tumours?
PMHx differentiated tumour
Why are anaplastic tumours aggressive?
Why is survival poor with anaplastic tumours?
Invades neck structures
What factors increase the likelihood of a thyroid tumour being malignant?
Vocal cord palsy
Nodule increasing in size
Hx neck radiation
What investigations do you do in a suspected thyroid tumour?
US guided FNA
laryngoscopy if vocal nerve palsy
excision and biopsy lymph node
What test(s) is NOT done in suspected thyroid tumour?
NO isotope scan
How do you assess cytology and what sample is needed?
What is the grading of Thy1-Thy5?
Thy3-atypical, suspected benign
Thy4-atyplical, suspected malignancy
What grade are follicular lesions and why?
difficult to assess
What are the surgical options for thyroid cancer?
lobectomy and isthmusectomy
When is lobectomy and isthmusectomy appropriate?
minimally invasive follicular carcinoma
low risk AMES
When is (sub)total thyroidectomy appropriate?
DTC and nodes
DTC and distant mets
DTC with extrathyroidal spread
High risk AMES