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Thyroid Cancers (Treatment Plans (Papillary and follicular carcinomas
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Thyroid Cancers
Treatment Plans
Papillary and follicular carcinomas
- Total thyroidectomy
- Abiative radioactive iodine
Anaplastic carcinomas and lymphomas
- DO NOT respond to radioactive iodine
- External radiotherapy provides brief respite - mainly palliative
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Medullary carcinoma
- Thyroidectomy and lymph node removal
Thyroid LOVES iodine so will readily take up radioactive iodine which in turn will locally irradiate and destroy cancer - providing very little radiation damage to other surrounding structures
Pathophysiology
Types of carcinoma
Anaplastic
- Very undifferentiated and arise from thyroid epithelium
- Aggressive, local spread but poor prognosis
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Follicular
- Middle age, spread to lung/bone, usually good prognosis
- Well differentiated, arise from thyroid epithelium
Medullary Cell
- Arise from calcitonin C cells of thyroid gland
Papillary
- Most common, well differentiated
- Young people, local spread and good prognosis
- Arise from thyroid epithelium
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Carcinomas derived from thyroid epithelium may be:
- Differentiated - papillary or follicular
- Undifferentiated - anaplastic
Clinical Presentation
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Occasionally they present with cervical lymphadenopathy or with lung, cerebral, hepatic or bone metastases
If thyroid gland increases in size, becomes hard and is irregular in shape - think carcinoma
Patients may complain of dysphagia or hoarseness of voice due to tumour compression on surrounding structures
Investigations
Blood test - to check for TFTs (TSH, T4, T3):
- To check if hyperthyroid or hypothyroid - needs to be treated before carcinoma surgery
Ultrasound of thyroid
- Can differentiate between benign or malignant
Fine needle aspiration cytology biopsy
- To distinguish between benign or malignant nodules
Epidemiology
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Not common, but are responsible for 400 deaths annually in the UK
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