Thyroid Cancer.pptx

Dr Kaushal Yadav
MS- Surgery (PGIMS, Rohtak)
MCh- Surgical Oncology (TMH, Mumbai)
Clinical Lead & Senior Consultant
Narayana Superspeciality Hospital, Gurugram
Clinic: Arogyam Care, Sec- 51, Gurugram
www.surgonco.com
THYROID CANCER
1

RISK FACTORS
 Iodine-deficient area : increased risk of goiter and follicular cancer and
anaplastic cancer
 Iodine-sufficient areas: increased risk of autoimmune thyroid disease and
papillary thyroid cancer
 Radiation Exposure
 Family History
 Inherited Cancer Syndromes
 Obesity
DR KAUSHAL YADAV, MS, MCH, WWW.SURGONCO.COM, 8860218789, AROGYAMCARE123@GMAIL.COM

TYPES OF THYROID CANCER
 Differentiated Thyroid Carcinoma
 Papillary Carcinoma Thyroid – most common -80%, more common < 40
 Follicular Carcinoma Thyroid – 10%, more common in older
 Medullary Carcinoma Thyroid
 Anaplastic Carcinoma Thyroid
 Lymphoma

Type Age Lymph Node Metastasis Tumor
Markers
RAI response 10 yr Survival
PTC Usually <40-
50yrs
50%, Lateral
Aberrant
Thyroid
3-5% Thyroglobuli
n
Responsive >95%
Lung mets-
50%
FTC 40-60yrs <10% 10-15% Thyroglobuli
n
Older less
likely
<40yrs- 95%
>40yrs -80%
Hurthel Cell 60-75yrs 18-25% Thyroglobuli
n
Less avid 73%
MTC 50-80% 5-10% Calcitonin,
CEA
- 81%
Anaplastic 40% 50% 1 yr: <20%

CLINICAL FEATURES
 Painless Thyroid Mass-
 10-50% of solitary thyroid nodules
 FTC & MNG coexists in 10%
 Hoarseness of voice- RLN palsy
 Diarrhoea & Flushing- MTC
 Breathing Difficulty
 Dysphagia
 Lateral Aberrant thyroid
 Risk of malignancy in Cyst 2-9%

INVESTIGATIONS: BLOOD
 Thyroid Function Test
 Thyroglobulin $ Anti Thyroglobulin Antibodies
 S. Calcitonin/ S. CEA
 MEN Syndrome in MTC:
 Plasma/ Urinary metanephrine/ normetanephrine
 PTH, Calcium
 RET oncogene

INVESTIGATIONS: FNAC
Bathesda Description Rate of Management
1 Non Diagnostic/ Unsatisfactory 1-4% Repeat Malignancy
2 Benign 0-3% Close Followup
3 Atypia/ Follicular Lesion 5-15% Repeat FNAC/ Lobectomy
4 Follicular Neoplasm/ Suspicious 15-30% Lobectomy
5 Suspicious for Malignancy 60-75% Lobectomy/ Total
Thyroidectomy
6 Malignancy 97-99% Total Thyroidectomy

ULTRASOUND: ATA SONOGRAPHIC & MALIGNANCY RISK
 High risk: Microcalcification, taller than wider, hypoecogenecity, irregular
margins, solid, intraextrnodular vascularity, extrathyroidal extension
USG Characteristic Risk of MAlignancy Consider FNAC
Highly Suspicious >70-90% ≥ 1cm
Intermediate Suspicion 10-20% ≥ 1cm
Low Suspicion 5-10% ≥1.5 cm
Very Low Suspicion < 3% ≥ 2cm
Benign <1% -
ATA Sonographic characterization of thyroid nodule & risk of malignancy

Thyroid Nodule
S. TSH
Low
Radioisotope
Scan
Hot
RAI/ Surgery
Cold
High/Normal
Ultrasound FNAC
No
Monitor
Yes
FNAC
Benign
Monitor
Suspicious
Surgery
Highly
Suspicious/
Malignant
Surgery

DIFFERENTIATED THYROID CA: PTC/ FTC
 Lobectomy
 Total Thyroidectomy
Low Risk High Risk
<40 >40
Female Male
Intrathyroidal Extrathyroidal
No Mets Mtastasis +
<2cm >2cm
Well Differentiated Poorly Differentiated/
Variants

WELL DIFF: ,1CM, T1A , N0
 <1cm, no lymph nodes: Ipsilateral Lobectomy
 1-4cm, no ETE, No L. nodes: Lobectomy/ Total Thyroidectomy
 >4am, ETE, No Mets: Total Thyroidectomy +

Beahrs' triangle:
recurrent laryngeal nerve,
inferior thyroid artery
common carotid artery.

Joll’s Triangle:
Sternothyroid
Superior Pole Thyroid
Neck Midline

Identification of
parathyroid gland

Double Recurrent
Laryngeal Nerve

1-4CM, T1B, T2, NO ETE, N0
 Ipsilateral Lobectomy/ Total Thyroidectomy
 Prophylactic Ipsilateral Central compartment Evaluation/ Exploration and
Clearance in case of N+

T3, N0/N1
 Total Thyroidectomy
 N0: Ipsilateral prophylactic central compartment clearance
 Station VI L. Node+ve: Ipsilateral Central compartment Clearance
 Station II-IV L Node+ve: Ipsilateral Central compartment Clearance + Lateral
compartment Clearance

RAI TREATMENT
Low Risk Intermediate Risk High Risk
No Mets Microscopic parathyroid tissue Macroscopic tumor Invasion
R0 R+
No ETE Multigocal Follicular - extensive
No aggressive biology Aggressive biology Highly raied Tg after Surgery
No Iodine uptake outside bed RAI perithyroid M1
N0 N1 N1>3cm

MEDULLARY CARCINOMA THYROID
 Total Thyroidectomy + Bilateral Central Compartment Clearance + Lateral
neck Dissection

ANAPLASTIC THYROID CARCINOMA
 Highly Aggressive
 Mostly Palliative
 Chemotherapy
 Radiotherapy
 Targetted Therapy

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