Thyroid Cancer (Papillary, Follicular, Medullary & Anaplastic) | Symptoms, Diagnosis, Treatment
Summary
TLDRThis 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
- ๐ Thyroid cancer originates from the thyroid gland, an endocrine gland in the neck, which produces hormones that regulate metabolism.
- ๐ There are four main types of thyroid cancer: papillary, follicular, medullary (MTC), and anaplastic, with papillary being the most common.
- ๐ฉโโ๏ธ 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.
- ๐งฌ Specific genetic mutations are associated with different types of thyroid cancer, such as BRAF V600E for papillary and RET for medullary thyroid carcinoma.
- โข๏ธ Radiation exposure is a significant risk factor for thyroid cancer, especially for papillary carcinoma.
- ๐ 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.
- ๐ฉบ Diagnosis of thyroid cancer involves a physical examination, blood tests for thyroid hormones and calcitonin, and imaging studies like ultrasonography.
- ๐ Fine needle aspiration biopsy is a critical diagnostic tool for thyroid cancer, and genetic testing can identify specific mutations associated with cancer.
- ๐ฅ Treatment options for thyroid cancer include surgical excision, radioiodine ablation, hormone suppression therapy, and in some cases, chemotherapy and radiation therapy.
- ๐ 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
๐ 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.
๐ 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.
๐จ 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.
๐ฅ 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.
๐ 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.
Mindmap
Keywords
๐กThyroid Cancer
๐กEndocrine Gland
๐กPapillary Carcinoma
๐กFollicular Carcinoma
๐กMedullary Thyroid Carcinoma (MTC)
๐กAnaplastic Carcinoma
๐กThyroid Nodule
๐กFine Needle Aspiration Biopsy
๐กTumor Node Metastasis (TNM) Classification
๐กRadioiodine Ablation
๐กThyroid Hormone Suppression Therapy
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
subscribe for more lessons like this one
thanks so much for watching and hope to
see you next time
Browse More Related Video
Cancer: Pathophysiology, Risk Factors, Signs/Symptoms and more - Medical Surgical | @LevelUpRN
Laryngeal Cancer: Silent Struggles and Hopeful Treatments
Colorectal carcinoma - causes, symptoms, diagnosis, treatment, pathology
Tumor Classification: Tissue Type, Grading & Staging - Medical-Surgical (Immune) | @LevelUpRN
Total thyroidectomy and thyroid lobectomy | UCLA Endocrine Center
Prostrate Cancer, Causes, Signs and Symptoms, DIagnosis and Treatment.
5.0 / 5 (0 votes)