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Thyroid Cancer

Thyroid Cancer. Objectives. The learner will be able to: Identify four different histologic types of thyroid cancer. Identify potential late and long-term side effects unique to this patient population. Incidence and Mortality.

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Thyroid Cancer

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  1. Thyroid Cancer

  2. Objectives The learner will be able to: • Identify four different histologic types of thyroid cancer. • Identify potential late and long-term side effects unique to this patient population.

  3. Incidence and Mortality • ACS estimates 62,980 new cases in 2014 and an estimated 1,890 deaths • Most rapidly increasing cancer in US • Occurs 23x more often in women • Two of every 3 persons diagnosed are <55 years of age • Overall five-year relative survival rate is 97.2%.

  4. Risk Factors • Exposure to high levels of radiation • Low dietary intake of iodine • Having a first-degree relative such as a parent, sibling, or child with a differentiated thyroid cancer has been shown to increase the risk of developing papillary and follicular thyroid cancers.

  5. Diagnosis • Diagnosis is primarily achieved with: • Physical assessment data • Laboratory data • Imaging • Biopsy

  6. Types of Thyroid Cancer Papillary Carcinoma • 80% of thyroid cancers, typically slow growing • Can spread to lymph nodes in neck; when diagnosed early can be successfully cured

  7. Types of Thyroid Cancer Follicular Carcinoma • 10% of all thyroid cancers • Tends not to spread to lymph nodes • Prognosis favorable, though not as good as papillary

  8. Types of Thyroid Cancer Medullary Thyroid Carcinoma (MTC) • 4% of thyroid cancers; develops from the C cells • Produces abnormally elevated levels of calcitonin • May spread to lymph nodes in the neck, lungs, or liver • MTC does not absorb radioactive iodine; poor prognosis • Familial MTC is genetic and may occur in multiple generations and may be linked to other cancers (RET gene)

  9. Types of Thyroid Cancer Anaplastic Carcinoma • 2% of thyroid cancers • Known as undifferentiated carcinoma • Occurs in older individuals, is fast growing, and invades surrounding structures • Poor prognosis, few treatment options

  10. Treatment Modalities • Surgery: Lobectomy versus total thyroidectomy in conjunction with removal of lymph nodes (papillary, follicular, MTC) • Radioactive iodine (papillary, follicular) • External beam radiation therapy • Chemotherapy (anaplastic and more advanced stages of thyroid cancer

  11. Potential Late and Long-Term Side Effects • Voice changes if nerves to the vocal cords are stretched/damaged during surgery • Hypocalcemia upon removal of parathyroid glands; may require patient to take temporary or permanent calcium and vitamin D replacement • Hypothyroidism • Secondary head and neck malignancy

  12. References American Cancer Society. (2014). Laryngeal and hypopharyngeal cancer. Retrieved from http://www.cancer.org American Cancer Society. (2014). Oral cavity and oropharyngeal cancer. Retrieved from http://www.cancer.org American Thyroid Association. (2006). Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Retrieved from: http://www.thyroid.org/professionals/publications/documents/Guidelinesthy2012.pdf National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines in Oncology: Head and neck cancers [v.1.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf

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