Thyroid Cancer Guidelines

Card Set Information

Author:
esmond
ID:
284065
Filename:
Thyroid Cancer Guidelines
Updated:
2015-06-29 11:19:30
Tags:
TThyroid Cancer Guidelines
Folders:

Description:
Thyroid Cancer Guidelines
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user esmond on FreezingBlue Flashcards. What would you like to do?


  1. Risk factors
    • • neck irradiation in childhood;
    • • endemic goitre;
    • • Hashimoto’s thyroiditis (risk of lymphoma);
    • • family or personal history of thyroid adenoma;
    • • Cowden’s syndrome (macrocephaly, mild learning difficulties,carpet-pile tongue, with benign or malignant breastdisease);
    • • familial adenomatous polyposis;
    • • familial thyroid cancer;
    • • obesity.
  2. Prognostic factors
    • Age <10 & >40
    • Male 
    • Histology
    • - papillary > follicular(not if take age/extent into account)
    • - papillary tall cell, columnar cell, degree of cellular differentiation,vascular invasion
    • - follicular - widely invasive’ and ‘vascular invasion
    • - Poorly differentiated and oncocytic follicular (Hurthle-cell) carcinomas poor prognosis
    • Tumour extent
  3. Staging
    • Primary tumour
    • TX Primary tumour cannot be assessed
    • T0 No evidence of primary tumour
    • T1 Tumour ≤2 cm in greatest dimension limited to the thyroid
    • T1a Tumour ≤1 cm, limited to the thyroid
    • T1b Tumour >1 cm but ≤2 cm in greatest dimension, limited to thethyroid
    • T2 Tumour >2 cm but ≤4 cm in greatest dimension, limited tothe thyroid
    • T3 Tumour >4 cm in greatest dimension limited to the thyroidor any tumour with minimal extra-thyroidal extension(e.g. extension to sternothyroid muscle or perithyroidsoft tissues)
    • T4a Tumour of any size extending beyond the thyroid capsule toinvade subcutaneous soft tissues, larynx, trachea, oesophagus, orrecurrent laryngeal nerve
    • T4b Tumour invades prevertebral fascia or encases carotid artery ormediastinal vessels

    • All anaplastic carcinomas are considered
    • pT4 tumours
    • T4a Anaplastic carcinoma limited to thyroidp
    • T4b Anaplastic carcinoma extends beyond thyroid capsuleMultifocal tumours (≥2 foci) of all histological types should bedesignated (m), the largest focus determining the classification,e.g. pT2(m)

    • Regional lymph nodes (cervical or upper mediastinal)
    • NX Regional lymph nodes cannot be assessed
    • N0 No regional lymph node metastasis
    • N1 Regional lymph node metastasis
    • N1a Metastases to Level VI (pretracheal, paratracheal, andprelaryngeal/Delphian lymph nodes)
    • N1b Metastases to unilateral, bilateral, or contralateral cervical(Levels I, II, III, IV, or V) or retropharyngeal or superiormediastinal lymph nodes (Level VII)

    • Distant metastases
    • M0 No distant metastasis
    • M1 Distant metastasis

    • Residual tumour
    • RX Cannot assess presence of residual primary tumour
    • R0 No residual primary tumour
    • R1 Microscopic residual primary tumour
    • R2 Macroscopic residual primary tumour
  4. Staging
    • Papillary/follicular thyroid tumours, <45 yrs
    • Stage I: any T, any N, M0
    • Stage II: any T, any N, M1

    • Papillary/follicular thyroid tumours, >45 yrs
    • Stage I: T1N0M0
    • Stage II: T2N0M0 
    • Stage III: T3N0M0 or T1-3 N1aM0
    • Stage IVA: T4a,anyN,M0 or T1-3,N1bM0
    • Stage IVB: T4b anyN,M0
    • Stage IVC: Any T, any N, M1
  5. Staging prognosis papillary/thyroid
    • Stage 10-year relative survival (%)
    • I 98.5
    • II 98.8
    • III 99.0
    • IVA 75.9
    • IVB 62.5
    • IVC 63
  6. Post-operative risk stratification for risk of recurrence of DTC
    • Low-risk patients
    • • No local or distant metastases
    • • All macroscopic tumour has been resected i.e. R0 or R1 resection(pathological definition)
    • • No tumour invasion of loco-regional tissues or structures
    • • The tumour does not have aggressive histology (tall cell, orcolumnar cell PTC, diffuse sclerosing PTC, poorly differentiatedelements), or angioinvasion

    • Intermediate
    • • Microscopic invasion of tumour into the perithyroidal soft tissues(T3) at initial surgery
    • • Cervical lymph node metastases (N1a or N1b)
    • • Tumour with aggressive histology (tall cell, or columnar cell PTC,diffuse sclerosing PTC, poorly differentiated elements) orangioinvasion

    • High-risk patients
    • • Extra-thyroidal invasion
    • • Incomplete macroscopic tumour resection (R2)
    • • Distant metastases (M1)
  7. Dynamic Risk Stratification:
    definitions of response to initial therapy of DTC (9–12 months after total thyroidectomy with R0 resection and subsequent RRA)
    • Excellent response - low risk
    • • Suppressed and stimulated Tg < 1 lg/l
    • • Neck US without evidence of disease
    • • Cross-sectional and/or nuclear medicine imaging negative(if performed)

    • Intermediate response - intermediate risk
    • • Suppressed Tg < 1 lg/l & stimulated Tg ≥1 and <10 lg/l*
    • • Neck US with nonspecific changesor stable sub centimetre lymph nodes
    • • Cross-sectional and/or nuclearmedicine imaging with nonspecificchanges, although not completely normal

    • Incomplete response - high risk
    • Suppressed Tg≥1 lg/l* or stimulated Tg ≥ 10 lg/l*
    • • Rising Tg values
    • • Persistent or newly identified disease on cross-sectionaland/or nuclear medicine imaging
  8. Ultrasound
    • Benign features
    • spongiform or honeycomb appearance (micro-cystic spaces with thin walls, comprising >50% of the nodule)
    • • purely cystic nodule
    • • nodules with a cystic component containing colloid (hyper-echoic foci with a ‘ring-down’ sign)
    • • egg shell type calcification around the periphery of a nodule
    • • iso-echoic or (mildly) hyper-echoic in relation to the surrounding normal thyroid tissue and typically with a surrounding hypo-echoic halo
    • • peripheral vascularity on colour flow or power Doppler

    • Malignant features papillary/medullary
    • a solid hypo-echoic (i.e. hypo-echoic relative to the normal thyroid tissue) nodule, which may contain hyper-echoic foci (i.e. microcalcification)
    • • an irregular margin, intra nodular vascularity and absence of an associated halo
    • • a ‘taller than wide’ shape referring to Anterior/Posterior (AP > Transverse (TR) diameter when imaged in the axial plane. AP diameter >TRdiameter increasing the likelihood of malignancy
    • • an irregular or spiculated margin and a ‘taller than wide’ shape have both been shown to have good Positive Predictive Value for malignantnodules
    • • egg shell type calcification around the periphery of a nodule with a broken calcified rim where there is extension beyond the calcified rim of ahypo-echoic 

    • Malignant features for follicular
    • • typically hyper-echoic and homogenous in echo texture with a well defined halo
    • • hypo-echogenicity and loss of the associated halo -associated with carcinoma
  9. Ultrasound grading
    U1. Normal.

    • U2. Benign:
    • (a) halo, iso-echoic / mildly hyper-echoic
    • (b) cystic change +/- ring down sign (colloid)(c) micro- cystic / spongiform
    • (d & e) peripheral egg shell calcification
    • (f) peripheral vascularity.

    • U3. Indeterminate/Equivocal:
    • (a) homogenous, hyper-echoic (markedly), solid, halo (follicular lesion).
    • (b) ? hypo-echoic, equivocal echogenic foci, cystic change
    • (c) mixed/central vascularity.

    • U4. Suspicious:
    • (a) solid, hypo-echoic (cf thyroid)
    • (b) solid, very hypo-echoic (cf strap muscle)(c) disrupted peripheral calcification, hypo-echoic
    • (d) lobulated outline

    • U5. Malignant
    • (a) solid, hypo-echoic, lobulated / irregular outline,micro-calcification. (? Papillary carcinoma)
    • (b) solid, hypo-echoic, lobulated/irregular outline, globularcalcification (? Medullary carcinoma)
    • (c) intra-nodular vascularity
    • (d) shape (taller >wide) (AP>TR)
    • (e) characteristic associated lymphadenopathy
  10. Thy prognosis
    • Thy5 98–99%
    • Thy 4 68–70%
    • Thy3a 10%
    • Thy 3f 30%
    • Thy 2 <3%
    • Thy 1 4-8%
  11. Thyroid investigations

What would you like to do?

Home > Flashcards > Print Preview