ROJoson PEP Talk: Thyroid Cancer Development - Fundamentals and Generalities - January 2022

1. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the DEVELOPMENT
of THYROID CANCER
as a health disorder
or medical disease.
Cancer Course
–
Fundamentals
and
Generalities in
THYROID
CANCER
Development
January 08, 2022
1400H - 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the DEVELOPMENT
of THYROID CANCER
as a health disorder
or medical disease.
Cancer Course
–
Fundamentals
and
Generalities in
THYROID
CANCER
Development

3. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the DEVELOPMENT
of THYROID CANCER
as a health disorder
or medical disease.
Cancer Course
–
Fundamentals
and
Generalities in
THYROID
CANCER
Development
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

4. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

5. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

6. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the DEVELOPMENT
of THYROID CANCER
as a health disorder
or medical disease.
Cancer Course
–
Fundamentals
and
Generalities in
THYROID
CANCER
Development
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Development of
THYROID Cancer,
which is part of the
Cancer Course.

7. Definition of Terms in Title AND Delimitation of
Coverage of Talk:
Fundamentals – simplest and essential facts and
theories which can serve as a basis or foundation
and support for advanced information
Generalities – general statements of info, not
covering specifics and details
Development of THYROID cancer – appearance;
growth of THYROID cancer
Fundamentals
and
Generalities
in THYROID
CANCER
Development

8. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Contents:
• What is a thyroid cancer?
• How common is thyroid cancer?
• What are the different types of thyroid
cancer?
• What are the possible and theorized causes of
thyroid cancer?
• Can thyroid cancer be prevented?
• Who are at higher risk for developing thyroid
cancer?
• What are the behaviors of thyroid cancers?
• How does thyroid cancer kill a patient?
• Is thyroid cancer curable?

9. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What is a thyroid cancer?

10. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What is a thyroid cancer?
Thyroid cancer is a medical disease when
some of the thyroid cells grow
uncontrollably with a potential to invade
the adjacent body tissues or organs and to
spread to distant tissues or organs.
A thyroid cancer presents as a solid tumor not
liquid tumor.
It is also known as thyroid malignancy or
malignant tumor of the thyroid.
(To differentiate it from benign tumor of the
thyroid which does not invade and spread.)

11. Fundamentals
and
Generalities
in THYROID
CANCER
Development
How common is thyroid cancer?

12. Fundamentals
and
Generalities
in THYROID
CANCER
Development
How common is thyroid cancer?
Thyroid cancer ranks No. 7 in the overall
cancer cases in the Philippines.
More common in females (No. 4) vs than
in males (No. 17).
1% of all cancers.
Most common among endocrine gland
malignancies (hormone producing -
adrenals, pancreas, parathyroid, etc.)
NOTE:
About 90% of all
thyroid nodules
are benign.

13. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the different types of thyroid
cancer?

14. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the different types of thyroid
cancer?
NOT all thyroid cancers are the same.
It is important to know the specific type as
this affects decisions on treatment and
prognosis.

15. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the different types of thyroid
cancer?
The more common types of thyroid
cancers:
• Papillary carcinoma (about 90%)
• Follicular carcinoma (about 10%)
• Anaplastic carcinoma (about 1%)
• Medullary carcinoma (less than 1%)
• Others – lymphoma, squamous cell
carcinoma (less than 1%)
Origins
From follicular
cells
(papillary,
follicular,
anaplastic ca)
From C cells
(medullary ca)

16. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?

17. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Up to now,
most of the time, (90 to 95%)
nobody knows the exact cause of thyroid
cancer developing in a patient as most of
the time, the cause is multifactorial.
In only 5 to 10% are thyroid cancers due to
inherited gene mutation from parents.
90 to 95% are “sporadic.”
Higher incidence of
hereditary as a
cause
MEDULLARY
THYROID
CARCINOMA
But this cancer is
rare in the
Philippines.

18. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
All diseases including thyroid cancers have
underlying, antecedent and immediate causes.
All diseases have predisposing, precipitating and
perpetuating factors.
However, it is difficult to pinpoint the exact cause,
a single cause at that, as oftentimes the cause is
multifactorial.
At best, we can only theorize the possible causes
and factors.

19. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
For a patient with thyroid cancer, an example in
the analysis of theorized causation for the
development of cancer could be as follows:
- genetic predisposition could be an underlying
cause;
- long-term unhealthy lifestyle could be the
antecedent cause or precipitating and
perpetuating factor; and
- gene mutation is the immediate cause.
All diseases have
underlying,
antecedent and
immediate causes.
All diseases have
predisposing,
precipitating and
perpetuating factors.

20. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
All diseases have
underlying,
antecedent and
immediate causes.
All diseases have
predisposing,
precipitating and
perpetuating factors.
For a patient with thyroid cancer, an example in
the analysis of theorized causation for the
development of cancer could be as follows:
- genetic predisposition could be an underlying
cause;
- excessive exposure to radiation could be the
antecedent cause or precipitating and
perpetuating factor; and
- gene mutation is the immediate cause.

21. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
All diseases have
underlying,
antecedent and
immediate causes.
All diseases have
predisposing,
precipitating and
perpetuating factors.
For a patient with thyroid cancer, an example in
the analysis of theorized causation for the
development of cancer could be as follows:
- no genetic predisposition but the
underlying cause may be from chemicals which
now also becomes the antecedent cause or
precipitating and perpetuating factor; and
- gene mutation is the immediate cause.

22. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
At the present stage of knowledge, for the
“sporadic” cases, not the inherited gene
mutations from parents, it seems that the last,
ultimate or proximate cause of cancer is changes
(or mutations) to the DNA within cells – the gene.
Thus, one can say that
thyroid cancer is a
genetic disease—that
is, it is caused by
changes to genes that
control the way our
cells function,
especially how they
grow and divide.

23. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
The three most common theorized ways
by which a gene mutation can instruct a
healthy cell to form cancer are the
following:

24. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
•Allow rapid growth.
A gene mutation (oncogenes) can tell a cell
to grow and divide more rapidly. This
creates many new cells that all have that
same mutation.

25. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
•Fail to stop uncontrolled cell growth.
Normal cells know when to stop growing so that
you have just the right number of each type of
cell.
Cancer cells lose the controls (tumor suppressor
genes) that tell them when to stop growing.
A mutation in a tumor suppressor gene allows
cancer cells to continue growing and
accumulating.

26. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
•Make mistakes when repairing DNA
errors.
DNA repair genes look for errors in a cell’s
DNA and make corrections.
A mutation in a DNA repair gene may
mean that other errors aren’t corrected,
leading cells to become cancerous.

27. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
All diseases have
underlying,
antecedent and
immediate causes.
All diseases have
predisposing,
precipitating and
perpetuating factors.
What causes gene mutations?
What are the underlying and antecedent
and immediate causes?
What are the predisposing, precipitating
and perpetuating factors?

28. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Gene mutations can occur for several
reasons, for instance:

29. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Gene mutations you’re born with.
You may be born with a genetic mutation
that you inherited from your parents.
This type of mutation accounts for a small
percentage of cancers.
[Underlying / Predisposing Cause]

30. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Gene mutations that occur after
birth.
Most gene mutations occur after you’re born and
aren’t inherited.
A number of forces can cause gene mutations,
such as smoking, radiation, viruses, cancer-
causing chemicals (carcinogens), hormones,
chronic inflammation, etc. [Antecedent /
Precipitating / Perpetuating Cause]
Most notorious of the
environment factors
causing gene
mutation:
RADIATION EXPOSURE
Increased risk for
papillary and follicular
thyroid cancers

31. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Radiation history – thyroid cancers:
•Low-dose to moderate-dose x-ray
treatments used before 1950 to treat
children with acne, tonsillitis, and other
head and neck problems.
Most notorious of the
environment factors
causing gene
mutation:
RADIATION EXPOSURE
Increased risk for
papillary and follicular
thyroid cancers

32. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Radiation history – thyroid cancers:
•Radiation therapy for Hodgkin
lymphoma or other forms of lymphoma in
the head and neck.
Most notorious of the
environment factors
causing gene
mutation:
RADIATION EXPOSURE
Increased risk for
papillary and follicular
thyroid cancers

33. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Radiation history – thyroid cancers:
•Exposure to radioactive iodine, also called
I-131 or RAI, especially in childhood.
Most notorious of the
environment factors
causing gene
mutation:
RADIATION EXPOSURE
Increased risk for
papillary and follicular
thyroid cancers

34. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
Radiation history – thyroid cancers:
•Exposure to ionizing radiation, including
radioactive fallout from atomic weapons testing
during the 1950s and 1960s and nuclear power
plant fallout. Examples include the 1986
Chernobyl nuclear power plant accident and the
2011 earthquake that damaged nuclear power
plants in Fukushima, Japan. Another source is
environmental release of I-131 from atomic
weapon production plants.
Most notorious of the
environment factors
causing gene
mutation:
RADIATION EXPOSURE
Increased risk for
papillary and follicular
thyroid cancers

35. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the possible and theorized
causes of thyroid cancer?
The gene mutations you’re born with
and those that you acquire
throughout your life work together to
cause cancer.

36. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Can thyroid cancer be prevented?

37. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Can thyroid cancer be prevented?
YES, but not all – not 100% preventable.
Thyroid cancers develop through multiple
factors such as genetic predisposition and
environmental factors that it is difficult to
identify a sure-shot specific strategy of
prevention.
Except for minimizing RADIATION
EXPOSURE as much as possible.

38. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Can thyroid cancer be prevented?
YES, but not all – not 100% preventable.
There are some things that can increase
the risk of cancer that we can't change.
These include things like damaged DNA
inherited from a parent; family history;
and getting RADIATION because of need
for treatment for another disease.

39. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Can thyroid cancer be prevented?
YES, but not all – not 100% preventable.
Though managing certain controllable risk
factors can lower your chances of
developing thyroid cancer,
But NO guarantee – best effort!

40. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?

41. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?
The exact specific cause of thyroid cancer
developing in a particular patient is
difficult to pinpoint.
For a preventive program against thyroid
cancers, know the risk factors; know the
controllable ones and then, control and
mitigate them.

42. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?
Risk factors if present affect your chances
of getting a thyroid cancer, but having a
risk factor does not mean that you are
guaranteed to get it.

43. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?
Again, to emphasize –
Though managing certain controllable risk
factors can lower your chances of
developing thyroid cancer,
But NO guarantee – best effort!

44. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?
Uncontrollable risk factors:
• Female
• Family history of thyroid cancers
• Inherited thyroid cancer genes from
parents
• Need for radiation for treatment of
another cancer

45. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?
Controllable risk factor: (most common)
• Exposing to excessive radiation
particularly to the neck

46. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Who are at higher risk for developing
thyroid cancer?
Cancer Prevention - Mitigation Tips on
Controllable Risk Factors:
1. Avoid excessive radiation exposure.
2. Be in touch with reliable medical
information on thyroid cancer risk and
prevention.
Can thyroid cancer be prevented?

47. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the behaviors of thyroid
cancers?

48. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the behaviors of thyroid
cancers?
Once a thyroid cancer develops, it has the
potential to grow and invade or infiltrate adjacent
organs or tissues and also the potential to spread
to distant sites in the body.
The rate of growth and spread of the cancer is
dependent primarily on the behavior of the
mutated genes and secondarily on the presence
of promoting factors in the person’s body and in
the environment like cancer-causing chemicals.

49. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the behaviors of thyroid
cancers?
A thyroid cancer that has spread to
another place in the body is called
metastatic cancer.
The process by which cancer cells spread
to other parts of the body is called
metastasis.

50. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the behaviors of thyroid
cancers?
Metastatic cancer has the same name and
the same type of cancer cells as the
original, or primary, cancer.
For example, thyroid cancer that forms a
metastatic tumor in the lung is metastatic
thyroid cancer, not lung cancer.

51. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the behaviors of thyroid
cancers?
Papillary and follicular thyroid cancers
- Usually slow growing
- Prognosis is good
Anaplastic cancers
- Usually fast growing (invasion and
spread)
- Prognosis is very very poor
Behavior of
common types of
thyroid cancers
• Papillary
cancers
• Follicular
cancers
• Anaplastic
cancers

52. Fundamentals
and
Generalities
in THYROID
CANCER
Development
What are the behaviors of thyroid
cancers?
Papillary thyroid cancers usually spread via
the lymph channels
Follicular thyroid cancers usually spread
via the blood channels
Most common sites of metastasis:
• Bone
• Lungs
Behavior of
common types of
thyroid cancers
• Papillary
cancers
• Follicular
cancers
• Anaplastic
cancers

53. Fundamentals
and
Generalities
in THYROID
CANCER
Development
How does a thyroid cancer kill a patient?

54. Fundamentals
and
Generalities
in THYROID
CANCER
Development
How does a thyroid cancer kill a patient?
Thyroid cancer can directly kill a patient
when it
• invades the airway to the point of
asphyxiation
• spreads or metastasizes to essential
organs, like lungs, bones, liver, and/or
brain and stops them from functioning
properly.
Direct causes of
death in thyroid
cancer

55. Fundamentals
and
Generalities
in THYROID
CANCER
Development
How does a thyroid cancer kill a patient?
Thyroid cancer can kill a patient
secondarily (indirectly) through:
• Complications during surgery
• Complications from other forms of
treatment such as chemotherapy
• Infection due to compromised immune
system
• Malnutrition
Indirect or
secondary causes
of death in
thyroid cancers

56. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?

57. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
Before I answer this question, let’s have a
definition of MEDICAL CURE.
The conventional definition of “medical cure”: a
medical condition that’s completely gone and will
never come back.
For example, if you have appendicitis and doctors
remove your appendix, you’ve been cured.
If you have gallbladder stones and doctors
remove your gallbladder with the stones, you’ve
been cured of the problem.

58. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
For thyroid cancers, especially the PAPILLARY and
FOLLICULAR ones, there are patients who after
treatment do not have their cancers coming back
10, 15 years after or even longer.
Strictly speaking, they can be considered
“CURED.”
However, doctors do not want to categorically use
the word “CURE” for them. They use the word
“IN REMISSION.”

59. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable? There are theories on how
gene mutations lead to
cancer development:
- Allowing rapid growth
- Failure to stop
uncontrolled growth
- Makes mistakes when
repairing DNA errors
EXACT MECHANISMS –
NOT DEFINITELY KNOWN
YET!
Thus, the targeted cancer
therapies on the molecular
or gene level are not yet
100% successful.
Why no doctors guarantee cure for cancer (that it
will not come back even after treatment)
There are several reasons for this:
1. Doctors don’t know everything about
thyroid cancer as a disease yet.
The best knowledge so far is that the ultimate or
proximate cause of cancer is changes (or
mutations) to the DNA (genes) within cells; that
cancer is a genetic disease caused by changes
to genes that control the way our cells function,
especially how they grow and divide.

60. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
Why no doctors guarantee cure for cancer (that it
will not come back even after treatment)
There are several reasons for this:
2. The usual cancer treatment modalities
(surgery, chemotherapy, and radiotherapy)
are strictly not treating the primary cause
of the cancer. They just extirpate, kill with
drugs, and burn the cancer. If the primary
cause is still around, there is always the
possibility of recurrence after treatment.

61. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
Why no doctors guarantee cure for cancer (that it
will not come back even after treatment)
There are several reasons for this:
3. No two cancers are the same. Each
individual cancer possesses different biological
characteristics, even cancers of the same type and
same extent. Some are slow growing while some
are fast growing. Usually, the biologic behavior of
the cancer is not known at the time of treatment.
Thus, only time will tell the outcome of
treatment.

62. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
Why no doctors guarantee cure for cancer (that it
will not come back even after treatment)
There are several reasons for this:
4. After treatment, some cancer cells may
remain somewhere in the body (unnoticed
and patients are asymptomatic) for a long
time, even as long as 10 years, but can
eventually grow, divide, invade, spread to
distant areas and become a nuisance. (A
RECURRENCE)
At the time there are
no symptoms of
cancer, doctors use
the word
“REMISSION.” They
do not guarantee
completely no more
cancer.
Some cancer cells may
be present but
unnoticed.

63. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
Complete remission means that tests,
physical exams, and scans show that all
signs of your cancer are gone.
Some doctors also refer to complete
remission as “no evidence of disease
(NED)” or “no evidence of recurrence
(NER)”.
COMPLETE REMISSION DOESN’T MEAN
CURE.

64. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
RECURRENCE
Some cancer cells can remain unnoticed in
the body for years after treatment.
If a cancer returns after it has been in
remission, it’s called a “recurrence.”
A cancer can recur in the same place it was
originally diagnosed, or it can recur in a
different part of the body.

65. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
So, up to now, strictly speaking, there is
NO true “cure” for cancer (NO guarantee it
will not recur).
Physicians do not talk of “cure.” They use
the word “remission” if there are no signs
of recurrence.
But they together with the patients always
hope for a cure especially for those
cancers which are recognized, diagnosed
and treated early and with known track
record of slow growth in behavior.

66. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Is thyroid cancer curable?
To boost the morale of thyroid cancer
patients though, one may say that a
patient is cured already if there is no
recurrence after 10 years or more. (there
is always exception to this, though).
LONG REMISSION is usually seen in
patients diagnosed and treated early.

67. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Contents:
• What is a thyroid cancer?
• How common is thyroid cancer?
• What are the different types of thyroid
cancer?
• What are the possible and theorized causes of
thyroid cancer?
• Can thyroid cancer be prevented?
• Who are at higher risk for developing thyroid
cancer?
• What are the behaviors of thyroid cancers?
• How does thyroid cancer kill a patient?
• Is thyroid cancer curable?
Summary
Conclusion
Take Away

68. Fundamentals
and
Generalities
in THYROID
CANCER
Development
Take Away in
relation to
Patient
Empowerment
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to prevent thyroid cancer and in case it is
not prevented, to gain greater control over
decisions in management.
Be always in touch with reliable medical
information on fundamentals and
generalities in thyroid cancer
development.

69. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the DEVELOPMENT
of THYROID CANCER
as a health disorder
or medical disease.
Cancer Course
–
Fundamentals
and
Generalities in
THYROID
CANCER
Development