1. Oncology 2016 Mark D. Browning, M.D. ’77 Thyroid & Gastric Cancer 2.29.16

2. Thyroid Cancers

3. WNL, Papillary, Follicular, Medullary & Anaplastic

4. THYROID CANCER…SYMPTOMS NECK PAIN VOICE CHANGES BREATHING PROBLEMS COUGHING PROBLEMS WITH SWALLOWING

5. THYROID CANCER…RISK FACTORS RET GENE ASSOCIATED WITH MEDULLARY THYROID CANCER & MULTIPLE ENDOCRINE NEOPLASIA TYPE 2 FAMILIAL ADENOMATOUS POLYPOSIS & COWDEN DISEASE ARE ASSOCIATED WITH FOLLICULAR & PAPPILARY CANCER FIRST DEGREE RELATIVE RAISES YOUR RISK LOW IODINE DIET..PAPPILARY RADIATION EXPOSURE

6. THYROID CANCER PATHOLOGY Follicular & Parafollicular tumors Follicular are differentiated (papillary, follicular, hurthle) Undifferentiated (anaplastic) Medullary Carcinoma – Associated with increased calcitonin & MEN 2 syndrome RET is a targetable gene

7. THYROID CANCER…DIAGNOSING Solitary Nodule diagnosed by FNA Radionuclide scanning detects “cold” or “hypofunctioning” lesion – “hot” lesions are usually benign & hyperfunctioning adenomas Ultrasound Can detect ¼ to ½ of asymptomatic lesions Calcitonin is elevated in medullary type Serum Thyroglobulin levels used to monitor the disease

8. THYROID CANCER…THERAPY Standard Therapy is Surgery & Thyroid Stimulating Hormone (TSH) Suppression Radioactive iodine ablation therapy: – This is NOT useful in Medullary or Anaplastic because these cells do not take up iodine

9. GASTRIC CANCER Adenocarcinoma…most common Lymphoma Sarcoma Gastrointestinal Stromal Cell Tumor Carcinoid

11. Gastric… Adenocarcinoma 26,000 Diagnosed in USA in 2015 10,000 Died in 2015 Incidence decreasing in Western World 5 Year Survival rates – 65, 35 & 5% for local, regional and metastatic respectively

12. Gastric Cancer Risk Factors >55 years of age…men 2x > women Blacks, Asians, Hispanic more common H. pylori is a risk factor Genetic…Diffuse Gastric Cancer, Lynch Syndrome, & Familial Adenomatous Polyposis High Nitrate & Salt Diet Incidence Decreasing secondary to refrigeration & decreased fungal/bacterial contamination Alcohol, Tobacco & Weight may increase Risk

13. Gastric Cancer…Clinical Presentation Reflux/ Peptic Ulcer Disease Therapy for months prior to diagnosis Weight Loss, anorexia, epigastric pain, fatigue, anemia, nausea & early satiety ALL Gastric Ulcers must be biopsied

14. Gastric Cancer: Unique Clinical Behavior Drop mets to pelvis – Krukenberg Tumors Periumbilical Mass – From Lymph Node mets or growth into the abdominal wall or peritoneal mets Left Supraclavicular Lymph Node (Virchows) Diffuse Seborrheic Keratosis

15. Gastric Caner TX Surgery Radiation Therapy Chemotherapy Herceptin for Heur 2 Neu + Patients