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Thyroid Cancer -- Papillary Papillary Carcinoma – 80% of thyroid cancers –Follicular variant of papillary has same behavior –Average age 30 -40 –Women.

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Presentation on theme: "Thyroid Cancer -- Papillary Papillary Carcinoma – 80% of thyroid cancers –Follicular variant of papillary has same behavior –Average age 30 -40 –Women."— Presentation transcript:

1 Thyroid Cancer -- Papillary Papillary Carcinoma – 80% of thyroid cancers –Follicular variant of papillary has same behavior –Average age –Women twice as frequent as men –Most common thyroid malignancy in children –Most common after low dose radiation

2 Thyroid Cancer -- Papillary Papillary Carcinoma –Psammoma bodies, intranuclear cytoplasmic inclusions (Orphan Annie nuclei) –Poor prognosis, aggressive, radioiodine resistant: Tall cell, insular, columnar, clear cell variants –Multicentric –Intrathyroidal lymphatic spread –Cervical Lymph node spread

3 Thyroid Cancer -- Papillary Papillary Carcinoma –88% 10 year survival without treatment –98% 10 year survival with thyroidectomy / RAI –95% 20 year survival with thyroidectomy / RAI –But, 35% 5 year survival for radioresistant variants (tall cell, insular, columnar) or extensive radioresistant differentiated tumors

4 Thyroid Cancer -- Papillary Papillary Carcinoma – Lower risk Men age , Women age Tumor < 1 cm cm Unilateral thyroidectomy and isthmusectomy –Recurrence risk 7% –50% mortality in years if recurrence Berry picking of gross lymph nodes –LNs present in 30% of all papillary CAs –LNs present in % if age <15

5 Thyroid Cancer -- Papillary Papillary Carcinoma – Higher risk Age Aggressive variants Size > 1.5 cm or extends beyond capsule of thyroid Cervical LNs or distant mets –20% pulmonary mets if age < 15 Radiation history Total thyroidectomy, LN berry picking –Children often require mod. neck dissections

6 Thyroid Cancer -- Papillary Papillary Carcinoma – Post-thyroidectomy follow-up Thyroglobulin RAI (I-131) –Not useful in radioresistant variants –20% of all papillary CAs do not trap RAI –Many patients over 60 have radioresistant CAs –Not useful if normal thyroid tissue remains –Initial scan 6 weeks after thyroidectomy

7 Thyroid Cancer -- Papillary Papillary Carcinoma – RAI identified LNs or residual thyroid Resect if palpable Often implies good prognosis if enlarging in post-op period due to increased post-op TSH High dose ablative I-131 if no palpable disease but suspect residual tumour other than: –Ligament of Berry Can be used repeatedly, and can ablate pulmonary mets, if used early

8 Thyroid Cancer -- Papillary Therapeutic radioactive I-131 – 2-3 days in hospital –Start levothyroxine 2-3 days after treatment –F/U scan in 1 year –Treat and repeat each year until gone

9 Thyroid Cancer -- Follicular Follicular CA –10% of thyroid CAs (increased with goiter) Hurthle cell variant is 2% of thyroid CAs –Hematogenous spread early –Locoregional / lymph node spread late 5% of follicular CAs have LN spread –Average age 50 –Women:Men 3:1 –Generally radiosensitive

10 Thyroid Cancer -- Follicular Follicular CA –Low risk: Age < 40 Low grade encapsulated (microinvasion) Negative bone scan FNA follicular cells Ipsilateral thyroidectomy/isthmusectomy –Frozen section to check if extension through capsule, then total thyroidectomy –Total thyroidectomy if > 4 cm (80% malignancy)

11 Thyroid Cancer -- Follicular Follicular CA –Low risk: Tc-99 bone scan following lobectomy –low recurrence rate if negative and small tumor with no capsule macroinvasion –does not need total thyroidectomy Followup 1 year RAI scan 6 week post-op RAI scan after total thyroidectomy

12 Thyroid Cancer -- Follicular Follicular CA –High risk: Age > 50 Macroinvasion, size > 4 cm Distant mets or regional LNs Thyroidectomy 6 week F/U I-131 scan then I-131 ablation as indicated

13 Thyroid Cancer -- Follicular Follicular CA –70% 10 year survival without treatment –85-90% 10 year survival with thyroidectomy / RAI –70% 20 year survival with thyrodiectomy / RAI

14 Thyroid Cancer -- Hurthle –Hurthle cell = aggressive variant of follicular Radioresistant (does not take up RAI) LN spread as well as hematogenous to bone / lung Produces thyroglobulin FNA = Hurthle cell --> lobectomy –If age > 50 or macroinvasion or > 4 cm or LNs or mets then total thyroidectomy –If central LNs, resect them –If lateral LNs, then mod. rad. neck dissection –RAI, radiation, chemo not useful for mets

15 Thyroid Cancer -- Medullary Medullary CA –7% of thyroid tumors –Sporadic cases are % Usually solitary nodule Average age > 30 –Hereditary case are % Bilateral, multicentric MEN IIa -- pheochromocytomas, parathyroids MEN IIb -- pheochromocytoma, neurofibromas –more aggressive medullary CA –starts around age 2


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