Thyroid Cancer (Papillary, Follicular, Medullary & Anaplastic) | Symptoms, Diagnosis, Treatment

Summary

This lesson delves into thyroid cancer, detailing its four main types: papillary, follicular, medullary, and anaplastic. It explores the hormonal functions of the thyroid gland, risk factors like radiation exposure and genetic conditions, and the varying ages of onset. The presentation covers symptoms, diagnosis methods including fine needle aspiration biopsy, and staging according to the AJCC TNM system. Treatment options range from surgery and radioiodine ablation to chemotherapy, with a focus on individualized approaches based on cancer type.

Takeaways

• 🌟 Thyroid cancer originates from the thyroid gland, an endocrine gland in the neck, which produces hormones that regulate metabolism.
• 🔍 There are four main types of thyroid cancer: papillary, follicular, medullary (MTC), and anaplastic, with papillary being the most common.
• 👩‍⚕️ Thyroid cancer is more prevalent in females, with a 3:1 female-to-male ratio, and typically appears in the third and fourth decades of life.
• 🧬 Specific genetic mutations are associated with different types of thyroid cancer, such as BRAF V600E for papillary and RET for medullary thyroid carcinoma.
• ☢️ Radiation exposure is a significant risk factor for thyroid cancer, especially for papillary carcinoma.
• 🔎 A thyroid nodule is the most common sign of thyroid cancer, but many nodules are benign; characteristics like painless, hard, and fixed nodules suggest cancer.
• 🩺 Diagnosis of thyroid cancer involves a physical examination, blood tests for thyroid hormones and calcitonin, and imaging studies like ultrasonography.
• 💉 Fine needle aspiration biopsy is a critical diagnostic tool for thyroid cancer, and genetic testing can identify specific mutations associated with cancer.
• 🏥 Treatment options for thyroid cancer include surgical excision, radioiodine ablation, hormone suppression therapy, and in some cases, chemotherapy and radiation therapy.
• 📊 Cancer staging for thyroid cancer follows the TNM classification system, with anaplastic carcinoma automatically classified as stage four due to its aggressive nature.

Q & A

What is the primary function of the thyroid gland?

The thyroid gland is responsible for making thyroid hormones like T3 (triiodothyronine) and T4 (thyroxine), which are responsible for movement, mentation, and metabolism.

How common is thyroid cancer in relation to all cancers?

Thyroid cancer accounts for approximately one percent of all cancers.

What is the ratio of thyroid cancer incidence between females and males?

There is a higher incidence of thyroid cancer in females versus males, with females outnumbering males three to one.

What are the four main types of thyroid cancer?

The four main types of thyroid cancer are papillary carcinoma, follicular carcinoma, medullary thyroid carcinoma (MTC), and anaplastic carcinoma.

Which is the most common type of thyroid cancer?

Papillary carcinoma is the most common type of thyroid cancer, accounting for about 80% of all cases.

What are the two less common types of thyroid cancer mentioned in the script?

The two less common types of thyroid cancer are primary thyroid lymphoma and primary thyroid sarcoma.

What is the significance of the BRAF V600E mutation in thyroid cancer?

The BRAF V600E mutation is the most common type of mutation that can cause or increase the risk of papillary carcinoma.

What are the risk factors for developing thyroid cancer?

Risk factors for thyroid cancer include radiation exposure, family history, genetic conditions like MEN2A and MEN2B, being female, and age, with certain types of thyroid cancer peaking in the third and fourth decades of life and others like anaplastic carcinoma occurring in older patients.

What is the most important sign of thyroid cancer?

The most important sign of thyroid cancer is a thyroid nodule, which is a growth off of the thyroid gland that may be felt or seen protruding from the neck.

How is thyroid cancer diagnosed?

Thyroid cancer is diagnosed through a combination of head and neck examination, blood work, fine needle aspiration biopsy of the nodule, and sometimes imaging studies like thyroid ultrasonography, CT, or MRI.

What is the staging system used for most types of thyroid cancer?

The staging system used for papillary, follicular, and anaplastic thyroid carcinoma is from the American Joint Committee on Cancer (AJCC) and uses the TNM classification system, which considers the size and extent of the primary tumor (T), the presence and extent of lymph node involvement (N), and the presence of distant metastasis (M).

What are the treatment options for papillary and follicular thyroid cancer?

Treatment options for papillary and follicular thyroid cancer include surgical excision, which may be subtotal or total thyrectomy, radioiodine ablation, thyroid hormone suppression therapy, and in advanced or refractory cases, chemotherapy and radiation therapy.

Outlines

00:00

🌟 Introduction to Thyroid Cancer

This paragraph introduces the topic of thyroid cancer, explaining that it originates from the thyroid gland located in the anterior neck. It discusses the gland's role in producing hormones T3 and T4, which regulate metabolism. The paragraph outlines four main types of thyroid cancer: papillary, follicular, medullary (MTC), and anaplastic. It also mentions two less common types: primary thyroid lymphoma and primary thyroid sarcoma. The script notes that thyroid cancer is more prevalent in females and tends to peak in the third and fourth decades of life. The lesson promises to delve into the details of each type, including pathophysiology, signs, symptoms, diagnosis, staging, and treatment.

05:00

🔎 Detailed Types and Mutations in Thyroid Cancer

This section delves deeper into the four main types of thyroid cancer, emphasizing papillary carcinoma as the most common, constituting 80% of cases. Follicular carcinoma follows, accounting for about 10%, with a specific subtype, Hurthle cell carcinoma, affecting mainly women in their 50s. Medullary thyroid carcinoma (MTC), linked to MEN2A and MEN2B genetic conditions, makes up 5-10% of cases. Anaplastic carcinoma, affecting older patients, accounts for 1-2%. The paragraph also discusses the cellular origins of these cancers, with follicular cells leading to papillary, follicular, and anaplastic carcinomas, and C-cells leading to MTC. It mentions specific mutations associated with each type, such as BRAF V600E for papillary, RAS for follicular, and RET for MTC.

10:01

🚨 Risk Factors and Signs of Thyroid Cancer

The paragraph outlines the risk factors for thyroid cancer, highlighting radiation exposure as a significant risk, especially for papillary carcinoma. It also notes the importance of family history and genetic conditions like MEN2A and MEN2B. Being female and age are identified as other risk factors. The signs and symptoms section focuses on the thyroid nodule as the most important sign, describing its characteristics such as painless, solitary, hard, and fixed. It warns of red flags like rapid growth, solitary nodules in patients above 60 or below 30, male patients, and nodular texture, suggesting a higher likelihood of cancer.

15:02

🏥 Diagnosis and Staging of Thyroid Cancer

This part of the script explains the diagnostic process for thyroid cancer, starting with a head and neck examination and the significance of thyroid nodules. It mentions the use of indirect laryngoscopy and blood work, including thyroid hormones and calcitonin levels, which are particularly high in medullary thyroid carcinoma. Fine needle aspiration biopsy is highlighted as a crucial diagnostic tool. The paragraph also covers cancer staging using the TNM classification from the American Joint Committee on Cancer (AJCC), explaining the T (tumor), N (node), and M (metastasis) categories and how they determine the stage of cancer, from stage 1 to stage 4.

20:03

🛑 Treatment Options for Thyroid Cancer

The final paragraph discusses treatment approaches for different types of thyroid cancer. It emphasizes surgical excision as a primary treatment, with potential complications like nerve damage and hypoparathyroidism. For papillary and follicular carcinomas, radioiodine ablation and thyroid hormone suppression therapy may be used. For medullary thyroid carcinoma, a total thyroidectomy with lymph node dissection is recommended, along with genetic testing for MEN conditions. Anaplastic carcinoma may require a more aggressive approach, including a thyroidectomy, tracheotomy, and possibly kinase inhibitors, radiation, and chemotherapy. The paragraph concludes by inviting viewers to explore more lessons on cancer and to subscribe for further information.

Keywords

💡Thyroid Cancer

Thyroid cancer is a malignant growth that originates in the thyroid gland, an endocrine gland located in the front of the neck. It is responsible for producing hormones that regulate metabolism. In the script, thyroid cancer is the central theme, with discussions on its types, causes, symptoms, diagnosis, and treatment.

💡Endocrine Gland

An endocrine gland is a type of gland that secretes hormones directly into the bloodstream. The thyroid gland, as mentioned in the script, is an example of an endocrine gland, responsible for producing hormones like T3 and T4 that regulate metabolism.

💡Papillary Carcinoma

Papillary carcinoma is identified in the script as the most common type of thyroid cancer, accounting for 80% of all cases. It is characterized by specific genetic mutations and is often associated with a better prognosis due to its slower growth rate.

💡Follicular Carcinoma

Follicular carcinoma is the second most common type of thyroid cancer, making up approximately 10% of cases. The script specifies a subtype known as Hurthle cell carcinoma, which is more common in women in their 50s.

💡Medullary Thyroid Carcinoma (MTC)

MTC is a less common type of thyroid cancer, accounting for 5-10% of cases, and is associated with genetic conditions like MEN2A and MEN2B. The script explains that MTC arises from C cells of the thyroid gland and can be identified by elevated calcitonin levels.

💡Anaplastic Carcinoma

Anaplastic carcinoma is a rare and aggressive form of thyroid cancer, representing 1-2% of cases, as noted in the script. It typically occurs in older patients and is characterized by rapid growth and a poor prognosis.

💡Thyroid Nodule

A thyroid nodule, as described in the script, is a growth on the thyroid gland and is a potential sign of thyroid cancer. However, many nodules are benign. The characteristics of a nodule, such as being painless, solitary, hard, and fixed, are important in assessing the risk of cancer.

💡Fine Needle Aspiration Biopsy

Fine needle aspiration biopsy is a diagnostic procedure mentioned in the script where a sample of cells is taken from a thyroid nodule using a thin needle. This helps in determining whether the nodule is cancerous.

💡Tumor Node Metastasis (TNM) Classification

The TNM classification is a system used to stage cancer, including thyroid cancer, as discussed in the script. It considers the size and extent of the primary tumor (T), the presence and extent of spread to lymph nodes (N), and the presence of distant metastasis (M).

💡Radioiodine Ablation

Radioiodine ablation is a treatment method for certain types of thyroid cancer, as mentioned in the script. It involves the use of radioactive iodine to destroy thyroid cancer cells, particularly effective in papillary and follicular carcinomas.

💡Thyroid Hormone Suppression Therapy

Thyroid hormone suppression therapy is a treatment approach discussed in the script where synthetic thyroid hormone is given to reduce the production of thyroid-stimulating hormone (TSH), thereby inhibiting the growth of thyroid cancer cells.

Highlights

Thyroid cancer is a cancer of the thyroid gland, which is an endocrine gland located in the anterior of the neck.

The thyroid gland is responsible for making thyroid hormones T3 and T4, which are crucial for metabolism.

There are four main types of thyroid cancer: papillary, follicular, medullary thyroid carcinoma (MTC), and anaplastic.

Papillary carcinoma is the most common type of thyroid cancer, accounting for 80% of all cases.

Follicular carcinoma accounts for approximately 10% of all cases, with a subtype known as Hurthle cell carcinoma.

Medullary thyroid carcinoma (MTC) accounts for 5-10% of all cases and is associated with MEN2A and MEN2B genetic conditions.

Anaplastic carcinoma accounts for 1-2% of all cases and occurs mainly in older patients, typically in their 60s and 70s.

Follicular cells are responsible for papillary, follicular, and anaplastic carcinomas, while C cells are responsible for MTC.

Papillary carcinoma is often associated with the BRAF V600E mutation.

Follicular carcinoma can be associated with RAS mutations and PAx-8/P-PAR gamma translocations.

Anaplastic carcinoma commonly features P53 mutations.

Medullary thyroid carcinoma is associated with RET mutations, which are responsible for MEN2A and MEN2B conditions.

Radiation exposure is a significant risk factor for thyroid cancer, especially papillary carcinoma.

Family history and genetic conditions like MEN2A and MEN2B increase the risk of certain types of thyroid cancer.

Females have a higher incidence of thyroid cancer, with a ratio of three to one compared to males.

The most common sign of thyroid cancer is a thyroid nodule, which is often painless.

Rapid growth of a thyroid nodule, especially in solitary nodules in patients above 60 or below 30, is a red flag for cancer.

Diagnosis of thyroid cancer involves a fine needle aspiration biopsy of the nodule and sometimes a lobectomy.

Thyroid cancer is staged using the TNM classification system from the American Joint Committee on Cancer (AJCC).

Treatment for thyroid cancer includes surgical excision, radioiodine ablation, and thyroid hormone suppression therapy.

For medullary thyroid carcinoma, a total thyroidectomy with lymphatic dissection of the neck is often performed.

Anaplastic thyroid carcinoma may require a total or subtotal thyroidectomy, targeted radiation, and chemotherapy.

Transcripts

hi everyone this lesson is on thyroid

cancer in this lesson we're going to

talk about the types of thyroid cancer

some of the pathophysiology behind why

thyroid cancer occurs we're also going

to talk about the signs and symptoms how

it's diagnosed and staged and how it's

treated so thyroid cancer is a cancer of

the thyroid gland and the thyroid gland

is an endocrine gland located in the

anterior of the neck or the front of the

neck so the thyroid gland is responsible

for making thyroid hormone like t3 or

triodo thyronine and t4 or thyroxine

both of these hormones are responsible

for movement mentation and metabolism

now there are four main types of thyroid

cancer or thyroid carcinoma

and these are

papillary follicular medullary thyroid

carcinoma or mtc and anaplastic we're

going to talk about these four main

types

in more detail as we go through the next

upcoming slides

and although there are four main types

of thyroid cancer there are actually two

other less common types one being

primary thyroid lymphoma and the other

one being primary thyroid sarcoma

now thyroid cancers account for

approximately one percent of all cancers

and there is a higher incidence of

thyroid cancer in females versus males

females outnumber males three to one

with thyroid cancer and certain types of

thyroid cancer have different ages of

onset but on average

the incidence of thyroid cancer peaks in

the third and fourth decades of life

let's get into more specific details on

those four types of thyroid cancer we

talked about before so again the first

one is papillary carcinoma so this is

actually going to be the most common

type of thyroid cancer and papillary

carcinoma accounts for 80 of all cases

so again this is the most common type of

thyroid cancer the second is follicular

carcinoma

so follicular carcinoma accounts for

approximately 10

of all cases of thyroid cancer and it

has a particular subtype we're going to

mention here known as the hertel cell

carcinoma subtype so this hertel cell or

herthal cell carcinoma accounts for

approximately two to three percent of

all cases of thyroid cancer and this

particular subtype occurs most commonly

in women in their 50s

the third type of thyroid cancer is

medullary thyroid carcinoma or mpc this

type accounts for approximately five to

ten percent of all cases

and it is part of the men2a and men2b

conditions so

men stands for multiple endocrine

neoplasia so multiple endocrine

neoplasia men 2a men 2b conditions men2a

and men2b are genetic conditions that

increase the risk of other endocrine

disorders including field chromocytoma

and hyperparathyroidism we're going to

talk a bit more about this when we talk

about risk factors for having thyroid

cancer and the fourth main type of

thyroid cancer is anaplastic carcinoma

so anaplastic carcinoma accounts for one

to two percent of all cases and it

occurs in older patients so patients in

the sixth to seventh decade of life so

60s and 70s that is going to be the age

group where we start to see anaplastic

carcinoma occurring

now getting into more specific

pathophysiology

behind each of those four main types

there are two main cells that are

responsible for these particular types

of cancer so we have follicular cells in

c cells so follicular cells are

responsible for papillary carcinoma

follicular carcinoma and anaplastic

carcinoma whereas cancers of c cells are

responsible for medullary thyroid

carcinoma so again a cancer of

follicular cells is responsible for

papillary carcinoma follicular carcinoma

and a plastic carcinoma and a cancer of

c cells is responsible for medullary

thyroid carcinoma

so if we were to look into each cancer

in more detail there are particular

mutations that are more common with each

type of cancer for instance in papillary

carcinoma a b raf v600e mutation is

going to be the most common type of

mutation that can cause a papillary

carcinoma or increase the risk of having

papillary carcinoma and then another

important mutation can be a ret

papillary thyroid cancer or rhett ptc

translocation

follicular carcinoma some of the more

important mutations that can occur or

increase the risk of having flicular

carcinoma include ras mutations and

pax-8 and p-par gamma translocations

in a plastic carcinoma we can see p53

mutations occurring and ras mutations

occurring so p53 mutations are going to

be the most common mutation found in

patients with anaplastic carcinoma and

then in medullary thyroid carcinoma it's

going to be the ret mutations rep

mutations are going to be responsible

for men2a and mn2b or those multiple

endocrine neoplasia conditions that we

talked about before so now that we know

the four main types of thyroid cancer

and some of the mutations that are

responsible or that are found in those

particular types of cancer let's talk

about the risk factors for getting

thyroid cancer so one of the biggest

risk factors for getting thyroid cancer

is going to be radiation exposure so

radiation exposure is going to increase

risk of all thyroid cancers especially

papillary carcinoma so this is going to

be head and neck radiation exposure or

could be exposure to radiation in the

environment so again radiation exposure

in particular parts of the world where

there have been nuclear meltdowns for

instance in those areas or surrounding

areas patients are at an increased risk

for thyroid cancer and then the other

important point to note about radiation

exposure is if a patient had radiation

therapy for previous cancer especially

if they had radiation therapy when they

were younger so patients who may have

had lymphoma when they were younger and

then they had radiation therapy this

also increases the risk of having

thyroid cancer again especially

papillary carcinoma the second risk

factor is a family history so family

history doesn't account for a large

number of cases of thyroid cancer but it

does account for a smaller percentage of

certain cancers like papillary carcinoma

and medullary thyroid carcinoma when it

comes to that genetic condition we

talked about before men2a and men2b and

this leads us into the third risk factor

being genetic conditions and again

genetic conditions like men2a and men2b

so we can see in this chart here men2a

has three important endocrine disorders

that are associated with each other so

medullary thyroid carcinoma is one of

them but the other ones are

pheochromocytoma and parathyroid

hyperplasia leading to

hyperparathyroidism and then in men2b we

can see

again this medullary thyroid carcinoma

and then we can also see

pheochromocytoma

mucosal neuromas and marfanoid body

habitus so if a patient has a family

history of some of these other endocrine

conditions they're at an increased risk

of medullary thyroid carcinoma and if

they have medullary thyroid carcinoma

they may have some of these other

conditions that have not been detected

yet so something to think about as well

being female is also another risk factor

for having thyroid cancer as you

mentioned before females outnumber males

three to one with thyroid cancers

patients age is also another potential

risk factor we talked about incidents

increasing in the third fourth decade of

life but some other types of cancer like

anaplastic carcinoma occur at higher

levels as the patient gets older in

their 60s to 70s for instance now let's

talk about the signs and symptoms of

thyroid cancer so by far the most

important sign that's going to occur in

thyroid cancer is a thyroid nodule so a

thyroid nodule is going to be a little

growth off of the thyroid gland again

the thyroid gland is in the front of the

neck so patients may actually feel or

see this little lump protruding from

their neck so this is going to be a

potential sign of thyroid cancer however

there are a lot of patients that have

thyroid nodules that actually don't have

thyroid cancer so thyroid nodules are

actually not that uncommon so this is a

potential sign of thyroid cancer but in

most cases a patient will not have

thyroid cancer if they do have a thyroid

nodule there are particular

characteristics of the thyroid nodule

that's going to be important in thyroid

cancer the thyroid nodule itself is

going to be painless so if a patient

will actually touch that lump on their

neck in the area of the thyroid gland

there's not going to be any pain from it

it's going to be painless the patient

may have one thyroid nodule which means

it's a solitary nodule or they could

have many little nodules that they can

feel and it could be hard and fixed hard

meaning that if you're to actually touch

it it's not soft and squishy it's hard

and it could be fixed meaning that it

doesn't move around if you were to try

to push it and move it around it doesn't

really move around it's fixed in place

important point to note with these

thyroid nodules is that if there's a

sudden onset of pain from the thyroid

nodule that is more indicative of a

benign thyroid condition so if there is

sudden onset of pain in the nodule that

increases the chances that that is a

benign thyroid condition like a cyst

that has hemorrhaged for instance so

could be a thyroid cyst that has had a

bleed into it and that can cause pain so

that's going to be an important point to

note and then there are particular red

flags with regards to these thyroid

nodules as well one of them is going to

be a rapid growth of the thyroid nodule

so if the patient sees the lump on their

throat and it starts to grow and get

larger and if it gets larger rapidly

that's a red flag or an ominous sign

that this is likely a cancerous growth

the second red flag is that there's a

solitary nodule in those above 60 and

below 30 so having one nodule in the

extremes of age is another red flag the

third red flag with regards to a thyroid

nodule is that if the patient is male

and the fourth is that if the nodule

itself is nodular nodular meaning that

the lump itself is lumpy and bumpy it's

not a smooth soft lump so if you were to

actually feel that thyroid nodule it's

not going to be soft and smooth it's

going to be lumpy and bumpy so that's

going to be another red flag for a

thyroid nodule as well some other signs

and symptoms of thyroid cancer include

cervical lymph nodes so there could be

cervical lymphadenopathy there can be

swollen tender lymph nodes in the

cervical chain so there can be swollen

tender lymph nodes in the neck there

could be neck swelling as well so the

neck can get larger and larger

especially in anaplastic thyroid

carcinoma so as that anaplastic cancer

grows rapidly and it does grow rapidly

this is a more serious cancer that

thyroid mass starts to grow rapidly and

causes neck swelling and then as thyroid

cancer worsens and that thyroid mass

grows it may start to impinge on other

surrounding structures including the

vocal cords in the recurrent laryngeal

nerve leading to voice hoarseness so a

patient may have a disrupted voice or

lose their voice entirely in some cases

some other clinical features include

dysphagia so dysphagia is difficulty

swallowing so if the thyroid mass starts

to push on the esophagus so the

esophagus is where food passes from the

mouth to the stomach it passes through

the esophagus so if there's something

impinging on to the esophagus there can

be difficulty swallowing dyspnea so

dyspnea is shortness of breath this

could be due to the thyroid mass that is

growing and pushing against the trachea

so that could cause dyspnea as well we

can see this more commonly in anaplastic

thyroid carcinoma horner syndrome is

something else that could occur in

thyroid cancer as well horner syndrome

is a condition involving three signs and

symptoms including meiosis or a

excessively constricted pupil in nasal

coria which is different sized pupils so

if you're to look at this patient here

their pupil on their left and right side

is different sizes so that's a

nisochoria and then ptosis which is a

drooping eyelid so those are three signs

of horner syndrome and horner's energy

can be caused by a variety of things

that essentially compress the

sympathetic chain so that is going to be

important and may occur in some later

stages of thyroid cancer and then

thyroid cancer can also have

constitutional symptoms as well

including weight loss so there can be

significant unintended weight loss

fatigue so patiently very very tired and

patients may also have fever and night

sweats as well let's talk about how

thyroid cancer is diagnosed so it's

important to do a head and neck

examination we talked about thyroid

nodules being something that is going to

be an important sign of thyroid cancer

some other ways of examining the patient

can include indirect laryngoscopy some

blood work can be also important when

assessing if a patient may have thyroid

cancer or not so some blood work

including looking at thyroid hormone so

tsh t3 t4 we can also look at calcitonin

as well

if the patient comes back as

hyperthyroid so they have a low tsh and

their t3 and t4 are elevated this

actually is a sign that it is less

likely that that thyroid nodule is a

malignancy it could actually be an

active nodule so it could be a toxic

adenoma for instance and if a clinician

were to look at calcitonin levels

there's going to be high calcitonin

levels in patients who have medullary

thyroid carcinoma this is again a cancer

involving c cells and c cells make

calcitonin so we're going to see high

levels of calcitonin in medullary

thyroid carcinoma what's going to be

important with diagnosing a thyroid

cancer is a fine needle aspiration

biopsy of the nodule

and then in some cases a lobectomy so

taking one of the lobes of the thyroid

can be important in making the diagnosis

as well and then in some cases there can

be genetic analyses that are performed

if there is a question of whether or not

a patient has medullary thyroid

carcinoma looking at the rat mutation or

looking for the rep mutation can be

important especially if that patient has

a family history some of those other

conditions we talked about before those

men to a and men2b conditions that's

going to be important in looking out for

the right mutation and in some cases and

in some locations if there's a question

of whether or not this patient has

papillary carcinoma looking for a brev

v600e mutation can be something that

could be performed as well

imaging is also going to be very

important so doing a thyroid

ultrasonography is going to be important

especially when doing the fine needle

aspiration biopsy of the nodule and then

a neck abdominal pelvic ct or mri is

going to be important when looking for

metastases or mass extension so

some important areas and we're not going

to talk about this in too much detail

but some of the areas where metastasis

can occur include the cervical lymph

nodes so this can be something that can

be noted in medullary thyroid carcinoma

this can actually be found in about 50

of cases on diagnosis and then within a

plastic carcinoma we can see metastases

in the lungs bones and brain and there

can be other mass extension and

metastases in other types of thyroid

carcinoma including the papillary and

follicular types that we talked about

before when thyroid cancer has been

diagnosed it gets staged and how does it

get staged there's a lot of complexity

with cancer staging in general the

staging we're going to look at here

for thyroid cancer comes from the

american joint committee on cancer or

ajcc

and it's going to be utilizing the tumor

node and metastasis or tmn

classification so the following is going

to be applicable to papillary follicular

and anaplastic medullary thyroid

carcinoma uses a slightly different

staging so we're not going to talk about

that here but for those other three

types papillary follicular and

anaplastic we look at the t

or the tumor so t 0 would be no primary

tumor found t1 tumor less than or equal

to 2 centimeters and limited to the

thyroid it can be split up into one a

and one b we're not going to get into

all the details here t2 is going to be a

tumor of two to four centimeters in size

and again limited to the thyroid t3 is

going to be a tumor greater than four

centimeters limited to the thyroid or

only involving strap muscles so strap

muscles are infrahyoid muscles in the

neck and then t3 is separated into 3a

and 3b and then t4 is any size tumor

with extra thyroidal extension beyond

the strap muscles so once it spreads out

further past the infrahyoid muscles we

get into t4 and then t4 split into 4a

and 4b and you can read these for more

information

and then we look at the n or the node as

part of our classification so n0 would

be no regional lymph node involvement

and n1 would be regional lymph node

involvement and then we look at the m as

part of our tumor node metastasis

classification so m0 would be no distant

metastases found and m1 would be distant

metastases found so all these

definitions are going to be important

when we stage the cancer and the stages

are the following stage 1 is going to be

t1 or t2 with n0 and m0 stage 2 is going

to be t1 to t2

with n1 so there's going to be regional

lymph node involvement in m0 or t3a and

t3b with any n so if the patient has t3a

or t3b and they may still have n0

then they would still be classified as

stage two stage three is going to be t4a

any n and m zero stage

four a so stage four gets split into

four a and four b stage four a is going

to be

t4b any n and m0 and stage 4b is going

to be any t with any n and m1 so when a

patient gets two distant metastases

staged they already have stage 4b and

then anaplastic carcinoma is going to be

slightly different it's always going to

be stage four so as soon as a patient

has anaplastic carcinoma they are

automatically considered to have stage

four carcinoma and they have slightly

different staging for anaplastic

carcinoma 4a is going to be t1 to t3a

n0m0 4b is going to be t1 to t4 any n

and m0 and

stage 4c is going to be t1 to t4 any n

and m1 so again a brief look at staging

if you want more information please look

up other sources on thyroid cancer

staging let's talk about the treatment

for thyroid cancer so treatments are

going to depend on the type of thyroid

cancer we're looking at so we're first

going to look at papillary and

follicular types of thyroid cancer and

how they are treated so surgical

excision is going to be important for

all types of thyroid cancer and it could

be subtotal so removing a lot of the

thyroid but not all of it or it could be

a total thyrectomy so removing all of

the thyroid gland and again surgical

excision is an important treatment

modality for treating all types of

thyroid cancer what i do want to mention

is that there can be complications of

surgery including recurrent laryngeal

nerve injury and hypoparathyroidism so

recurrent laryngeal nerve injuries

located in the neck as well and if

there's any damage to this nerve there

can be issues with talking the patient

may have issues with their voice and

then hypo parathyroidism may also occur

as well this is because there are four

parathyroid glands that are located on

the posterior of the thyroid gland so

when removing the thyroid gland some of

the parathyroid tissue may be removed as

well and this can cause

hypoparathyroidism it's important to

have a very experienced surgeon that

does thyroid surgeries a lot so they

will have less risk of some of these

complications occurring in some cases

radioiodine ablation may be used as well

so this can help to facilitate the extra

treatment of papillary and follicular

cancer and thyroid hormone suppression

therapy may be also used as well in

these particular types of thyroid cancer

in the subtype we talked about before in

the follicular category the herthol or

hurdle cell carcinoma in that particular

subtype a lobectomy ismectomy and a

complete thyroidectomy may be used in

that particular case and then if there

is cases of papillary and follicular

thyroid carcinoma that are refractory or

they're advanced they're not responding

to treatments chemotherapy and radiation

therapy may be used in those particular

instances with regards to medullary

thyroid carcinoma a total thyroidectomy

with lymphatic dissection of the

anterior compartment of the neck is

going to be an important treatment for

this particular type of cancer so like

we said before surgery is one important

treatment modality for thyroid cancer

but in the case of medullary thyroid

carcinoma a lymphatic dissection of the

anterior compartment of the neck is

going to be an important next step along

with the surgery as well in some cases

there can be prophylactic central lymph

node dissection and there may also be

prophylactic thyroidectomy in cases if

the patient has those men2a or men to be

conditioned that we talked about before

and then other blood work looking for

those men related conditions like

feochromocitoma for instance can be

important as well

in some cases systemic chemotherapy

kinase inhibitors so targeting the ret

mutation may be used in refractory cases

and then once the medullary thyroid

carcinoma has been treated calcitonin

fall measurements are going to be

important again calcitonin is produced

by those c cells if there's a cancer of

those c cells we're going to see

increased levels of calcitonin so there

may be a case where the patient has

their medullary thyroid carcinoma

treated their calcitonin levels start to

decrease but then over time with follow

up measurements calcitonin starts to

increase again that could be a sign of a

recurrence of the cancer and then in

some cases some clinicians may use

carcinoma antigen levels or cea levels

this can also be helpful in following up

on medullary thyroid carcinoma as well

and then for anaplastic thyroid

carcinoma a total or subtotal

thyroidectomy can be performed if

permitted so if there is a possibility

of helping to reduce that thyroid mass

that can be helpful especially if

there's any impinging or compression

symptoms so like we said before

anaplastic is going to be a very rapidly

growing aggressive cancer and it can

start to impinge and compress other

surrounding structures including the

esophagus and the airways like the

trachea so this is going to be important

in helping reduce some of those symptoms

a tracheotomy may also be required in

cases of airway collapse as well nb raf

kinase inhibitors can be utilized in

anaplastic thyroid carcinoma we didn't

mention this before but a b raf mutation

can also occur in anaplastic thyroid

carcinoma and it can worsen the

progression of the cancer so this can

also be something that can be utilized

in some cases of anaplastic thyroid

carcinoma targeted radiation and

chemotherapy can also be used post

surgery so after surgery has been

performed targeted radiation

chemotherapy can also be used as well so

if you want to learn more about other

types of cancer please check out my

lessons on those topics and if you

haven't already please like and

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thanks so much for watching and hope to

see you next time