Thyroid Cancer Diagnosis And Management

THYROID CANCER : Diagnosis and Management Ida Marie Tabangay Lim,MD, FPCS,FPSGS,FPAHNSI, Fellow UICC

In cid en ce: (2005 Philippine Cancer Facts and Estimates ) 

9th most common for both sexes combined (3.3%), 15th leading site in men ( 1.5%) and 6th among females (5%)



In 2005, estimated 3,521 new cases, 755 in males and 2,766 in females.



There will be 1,012 deaths, 245 in males and 767 in females.

Estim at es for new cas es and dea ths for thy roi d canc er in 200 2 (USA)

Shah, 2003

Age an d S ex d istr ibut ion: ( 2005 Philippine Cancer Facts and Estimates )  Most

common cancer of women at ages 15- 24

 Incidence

among female residents in the Philippines is among the highest observed worldwide

Age an d S ex d istr ibut ion ( USA )

Shah, 2003

Histo lo gic dis trib utio n: n Well differentiated type

Papillary

80 % Follicular cancer 5 – 10 % Medullary cancer 5–9%

Anaplastic type 1–2%

Progression of thyroid cancer from differentiated to anaplastic cancer :

Diagnosis:

History

Exposure to ionizing radiation

( dental x-rays) Family history Presence of difficulty swallowing, breathing, voice changes

Risk s tra tific atio n fo r ma lig nanc y in a thy ro id nodu le :

Prog nostic in dic es utiliz ed in th yroid c anc er ma nagem ent Memorial Mayo Hospital Clinic, 1987

Mayo Clinic, 1993

Lahey Clinic

Karolinska Institute

GAMES AGES

MACIS

AMES

DAMES

Grade Age Metastases Extension Size

Distant Metastasis Age Completeness of Resection Invasion Size

Age Metastases Extension Size

DNA Age Metastases Extension Size

Age Grade Extension Size

Risk G ro up C ateg orie s acco rd in g to Pro gno stic Facto rs

Struc tu ra l a ss essme nt of a th yro id n odule:

Physical Examination Complete head and neck examination Inspection, palpation of thyroid gland- note its size, mobility, consistency, fixation Laryngoscopy to document mobility of the cords Palpate for cervical lymph nodes

Physical examination of the thyroid

From behind

From in front

Diag nosis :

Bio psy

Fine needle aspiration Cytology : - hard mass - mass associated with neck nodes suspicious for malignancy

FNAC FNA B e n ig n F o llo w u p 1 year R epeat FN A

S y m p to m s

L o b e c to m y

A t y p ic a l o r S u s p ic io u s

M a lig n a n t

L o b e c to m y

T h y r o id e c t o m y

Functio nal as sessme nt o f a th yro id n odule:

Algo rith m fo r wo rk u p o f a th yro id m as s : ( MSKC C )

TREATMENT GOALS Well differentiated cancer  Cure Anaplastic cancer  Diagnosis and airway managemnt

Treatment options

Surgery : Thyroidectomy Conservative Thyroidectomy vs Total thyroidectomy

Factors affecting choice of treatment

Management

Neck dissection: Prophylactic neck dissection not recommended  If node positive, the most conservative neck dissection is warranted 

Post-op Management  





Thyroid hormone for replacement as well as suppression I 131 whole body scan to detect residual normal thyroid tissue and/ or metastatic disease I 131 for ablation of residual normal thyroid tissue and/ or metastatic disease Follow- up physical exam, serum thyroglobulin levels, I 131 whole body scans to detect recurrent disease

Thank You