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Y4: Endocrine surgery > Thyroid cancer > Flashcards

Thyroid cancer Flashcards

1
Q

What are the main types of thyroid cancer?

A
  • Papillary
  • Follicular
  • Medullary
  • Anaplastic
  • Lymphoma
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2
Q

Thyroid anatomy

A
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3
Q

Describe Papillary carcinoma of the thyroid?

A
  • Most common thyroid cancer
  • Young women
  • Metastasises through lymphatics
  • Papillary projections and pale empty nuclei
  • ‘Orphan annie eye’ and psammoma bodies
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4
Q

Describe Follicular carcinoma of the thyroid?

A
  • Second most common thyroid cancer
  • Encapsulated lesions with microscopic capsular invasion
    • No invasion = follicular adenoma
  • Haematogenous spread to bones and lungs
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5
Q

What are Hurthle cell tumours?

A
  • Follicular carcinoma variant
  • Oxyphil cells predominate
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6
Q

Describe Medullary carcinomas of the thyroid?

A
  • Parafollicular C cells (derived from neural crest cells)
  • Raised calcitonin
  • Associated with MEN2 syndromes
  • Spreads through lymphatic and medullary routes
  • Very poor prognosis in nodal disease
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7
Q

Describe Anaplastic thyroid cancer?

A
  • Very aggressive, poor prognosis
  • Elderly women
  • Local invasion
  • Chemotherapy ineffective
  • Palliation with isthmusectomy and radiotherapy
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8
Q

Describe lymphoma of the thyroid?

A
  • Associated with Hashimoto’s thyroiditis
  • Marked compressive and B-cell symptoms
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9
Q

What is pictured here?

A

Papillary carcinoma of the thyroid

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10
Q

What is pictured here?

A

Follicular carcinoma of the thyroid

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11
Q

What is pictured here?

A

Medullary carcinoma of the thyroid

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12
Q

What is pictured here?

A

Anaplastic cancer of the thyroid

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13
Q

Name some risk factors for thyroid cancer?

A
  • Female gender
  • Family history (including MEN2)
  • Radiation exposure in childhood
  • Full body radiotherapy for bone marrow transplant
  • Hashimoto’s disease
    • Predisposes to lymphoma subtype
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14
Q

What are the common clinical features of thyroid cancer?

A
  • Palpable lump
  • Multiple lumps
  • Found incidentally on imaging of the neck
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15
Q

What are the red flag clinical features for thyroid cancer?

A
  • Rapid growth
  • Pain
  • Cough, hoarse voice, stridor
  • Multiple enlarged cervical lymph nodes
  • Tethering of the lump to surrounding structures
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16
Q

Name some differentials for thyroid cancer?

A
  • Benign thyroid adenoma or cyst
  • Toxic multi-nodular goitre
    • Toxic refers to excess thyroid hormones
  • Non-toxic multi-nodular goitre
  • Thyroglossal duct cyst
    • Will move superiorly as patient sticks out their tongue
17
Q

Describe the investigations into a suspected thyroid cancer?

A
  • TFTs
  • Serum calcitonin may be useful for diagnosis and monitoring of medullary carcinoma
  • Thyroid US scan
  • Fine needle aspiration cytology (FNAC)
18
Q

What are the suspcious features that may be noticed when performing a thyroid ultrasound?

A
  • Irregular margins
  • Microcalcifications
  • Hypoechogenicity
19
Q

How is thyroid cancer staged?

A
  • TNM staging
20
Q

Describe the management of paillary and follicular thyroid cancer?

A
  • Total thyroidectomy
  • Radioiodine to kill residual cells
  • Yearly thyroglobulin to detect recurrent disease
21
Q

Name some complications of thyroid surgery?

A
  • Bleeding immediately after op => Haematoma under skin
  • Hypocalcaemia
  • Vocal cord paralysis
22
Q

Describe the prognosis of the different thyroid cancers?

A
  • Papillary: 90% 10 yr survival
  • Follicular: 85% 10 yr survival
  • Medullary: 90% 10 yr survival
  • Anaplastic: 20% 1 year survival
23
Q

A patient is experiencing voice hoarseness several days post-operatively after the thyroidectomy for follicular thyroid cancer. What is the most likely reason for this?

A

RLN damage during surgery

Y4: Endocrine surgery (9 decks)

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