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Cancer

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cancer tiroida

cancer tiroida

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Cancer Cancer Presentation Transcript

  • TUMORILE MALIGNE ALE GLANDEI TIROIDE
  • Epidemiologia si patogenia cancerului tiroidian
    • Cancerul tiroidian este cel mai frecvent cancer endocrin.
    • Factorii recunoscuti in oncogeneza cancerului tiroidian sunt:
        • Iradierea Factori de crestere tiroidiana:
        • Virusi oncogeni - TSH, EGF
        • Factori de risc familiali - IGF1, IGF2
        • Factori genetici si de mediu
        • Deficitul de iod poate fi asociat cu o crestere a incidentei
  • Tumorile maligne tiroidiene
    • Tumori epiteliale maligne:
    • - Carcinomul papilar
    • - Carcinomul folicular
    • - Carcinomul cu celule plate - Hürthle
    • - Carcinomul medular
    • - Carcinomul nediferentiat anaplazic
  • Tumorile maligne tiroidiene
    • Tumori maligne neepiteliale:
      • Fibrosarcom
      • Alte tumori neepiteliale
    • Alte tumori maligne:
      • Carcinosarcom
      • Limfom malign
      • Hemangioepiteliom
      • Teratom malign
    • Tumori secundare
    • Tumori neclasificabile
    • Transformari tumorale
  • Clasificarea TNM
    • T – tumora:
        • To = tumora nepalpabila
        • T1 = tumora < 1 cm
        • T2 = tumora < 4 cm
        • T3 = tumora > 4 cm nedepasind caspula tiroidiana
        • T4 = tumora depasind capsula tiroidiana
  • Clasificarea TNM
    • N – adenopatia:
        • No = fara adenopatie
        • N1 = adenopatie mobila homolaterala
        • N2 = adenopatie mobila bilaterala
        • N3 = adenopatie fixa
    • M – metastaze
        • Mo = fara metastaze
        • M1 = cu metastaze
  • Clasificarea TNM
    • Carcinomul medular:
        • Stadiu I – T1 No Mo
        • Stadiu II – T2-T4 No Mo
        • Stadiu III – orice T, N1 Mo
        • Stadiu IV – orice T, orice N, M1
    • Carcinomul nediferentiat:
        • Toate cazurile sunt stadiu IV
  • ANATOMO - PATOLOGIE CARCINOMUL PAPILAR MICROSCOPIC
  • ANATOMO - PATOLOGIE CARCINOMUL FOLICULAR MICROSCOPIC
  • ANATOMO - PATOLOGIE CARCINOMUL MEDULAR HISTOLOGIC
  • ANATOMO - PATOLOGIE CARCINOMUL ANAPLAZIC
  • Diagnosticul clinic
    • Nodul tiroidian
    • Evolutie scurta
    • Adenopatie cervicala
    • Invazia in organele vecine:
        • Nervul laringeu inferior (recurent)
        • Traheea
        • Esofag
  • Diagnosticul paraclinic
    • TSH, TT4, TT3, FT4, FT3
    • Anticorpi antitiroidieni
    • Tiroglobulina serica
    • Calcitonina plasmatica
    • Antigenul carcinoembrionar
  • Scintigrafia tiroidiana
    • Nodul solitar nefunctional
  • Ecografia tiroidiana
    • Adenom tiroidian
  • Tomografia computerizata
    • Tiroida normala
  • Tomografia computerizata
    • Degenerare chistica a unui adenom tiroidian drept
  • Rezonanta magnetica nucleara
    • Tiroida normala
  • Rezonanta magnetica nucleara
    • Adenom in lobul tiroidian drept
  • Alte investigatii
    • Punctia tiroidiana cu ac subtire
    • Examen ORL
    • Radiografia cervicala
  • Forme clinice
    • Acute = evolutie rapida
    • Schiroase = la varstnici
    • Latente = evolutie indelungata
    • Aberante = pe tiroide ectopice (sd. mediastinal)
  • Diagnosticul diferential
    • Alte hipertrofii tiroidiene nodulare
    • Tiroidita Riedel
    • Tiroidita Hashimoto
    • Tiroidita subacuta (De Quervain)
    • Alte afectiuni generale cu adenopatie cervicala
  • Tratament
    • Chirurgical
    • Hormonoterapie
    • Iodoterapie, Radioterapie
    • Chimioterapie
  • Tratament chirurgical
    • Lobectomie totala homolaterala + lobectomie subtotala controlaterala
    • Tiroidectomie aproape totala
    • Tiroidectomie totala
    • Tiroidectomie totala + disectia radicala a gatului
  • Tratament chirurgical Tiroidectomie totala
  • Tratament chirurgical Tiroidectomie totala
    • Disectia radicala a gatului
    Tratament chirurgical
  • Tratament chirurgical
    • Disectia radicala a gatului
  • Curba supravietuirii in cazul carcinomului papilar si a persoanelor normale
  • Curba supravietuirii in cazul carcinomului folicular si a persoanelor normale
  • Curba supravietuirii in cazul carcinomului medular si a persoanelor normale
  • Curba supravietuirii in cazul carcinomului anaplazic
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