This document discusses the different types and management approaches for thyroid cancer. It covers:
1. Thyroid cancers are classified into groups A and B based on differentiation and prognosis. Papillary thyroid cancer is the most common type, while anaplastic is very rare and aggressive.
2. Diagnostic workup involves ultrasound, fine needle aspiration biopsy, and staging tests if cancer is detected. FNAB results are classified from C1 to C6 indicating likelihood of malignancy.
3. Treatment depends on cancer type and stage. For lower risk papillary cancer, surgery may involve hemithyroidectomy followed by histopathology. Higher risk cancers receive more aggressive surgical and adjuvant treatment.
Discusses how to approach a lump found in the breast by triple assessment: clinical assessment (history, breast exam), imaging (mammography, breast ultrasonography), cell/ tissue diagnosis (by fine needle aspiration or core needle biopsy of the mass). Useful for nursing students, midwifery students, nurses, midwives, Medical Students, General Doctors, Gynecologists, Surgeons.
Discusses how to approach a lump found in the breast by triple assessment: clinical assessment (history, breast exam), imaging (mammography, breast ultrasonography), cell/ tissue diagnosis (by fine needle aspiration or core needle biopsy of the mass). Useful for nursing students, midwifery students, nurses, midwives, Medical Students, General Doctors, Gynecologists, Surgeons.
Carcinoma of breast is the second common killer disease in women after carcinoma of cervix in developing countries like India whereas it is the number one killer in western world. It can also run in families associated with BRCA1 & BRCA2 genes. Early diagnosis is almost curative and that is why they are doing mass screening like mammogram to pick up this cancer early.
Carcinoma of breast is the second common killer disease in women after carcinoma of cervix in developing countries like India whereas it is the number one killer in western world. It can also run in families associated with BRCA1 & BRCA2 genes. Early diagnosis is almost curative and that is why they are doing mass screening like mammogram to pick up this cancer early.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Thyroid cancer :
Thyroid cancer classify histo-pathological finding into :
• Group A as well differentiation
and good prognosis.
• Group B as poor differentiation
and poor prognosis.
3. Papillary thyroid cancer
Most common thyroid cancer with prevalence :
• 80% overall incidence.
• More common under age of 40 yrs.
• Female to male 2:1.
• Risk factors :
- Previous radiation to head and neck.
- Family history of thyroid cancer.
Pathology
features
• Multifocality lesions with papillary pattern, un-encapsulated with pale homogenous and cystic
degeneration.
• Spread by lymphatic and usually into cervical lymph node.
• Diagnosed by presence of cellular features in FNAC include :
- Psammomma bodies and orphan annie nucleus (specific for papillary cancer).
- Other features of malignancy include ( nuclear groove, nuclear overlapping, nuclear clearance, nuclear
crowding, nuclear inclusion).
• Prognosis is 98% survival at 10 yrs but need to make sure that the patient
receive appropriate management.
• There is risk for recurrence for patient who done hemi-thryoidectomy as
papillary cancer is multifocal lesions which some of them not visible under US
especially small size lesion. So need to be more aggressive in management to
achieve good prognosis.
Prognosis
4.
5. Follicular thyroid cancer
Less common thyroid cancer with prevalence :
• 10% overall incidence.
• More common in elderly with mean age of 50yrs.
• Female to male 3:1.
• Risk factors :
- Previous radiation to head and neck.
- Family history of thyroid cancer.
- Associated with lack of iodine.
Pathology
features
• Follicular adenoma is unifocal lesion, encapsulated and rarely associated with cystic degeneration.
• Follicular carcinoma If the tumor associated with invasive of vessels and/or capsule.
• Spread by blood stream and most common sites are lung, bone and brain.
• There is no cytological features of cell in follicular malignancy, hence FNAC is not diagnostic for it as
not differentiate between follicular adenoma or carcinoma.
• So required histopathology on paraffin section of resected specimen to see the invasion of vessel or
capsule.
• Prognosis is 92% survival at 10 yrs but need to make sure that the patient
receive appropriate management.
Prognosis
6.
7. Anaplastic thyroid cancer
Very less common thyroid cancer with prevalence :
• Less than 1% overall incidence.
• More common in elderly with mean age of 65yrs.
• Risk factors :
- Previous radiation to head and neck.
- Family history of thyroid cancer.
- Coexisting of differentiated thyroid cancer.
• The patient present with rapidly enlarging neck mass with surrounding compression. Features of
constitutional symptoms and metastatic features also present.
Pathology
features
• undifferentiated tumors of the thyroid follicular epithelium.
• Very rapid spread and growth
• Commonly spread to lung, bone and brain.
• Diagnosed by FNAC by presence of morphologic patterns of anaplastic thyroid cancer include
spindle cell, pleomorphic giant cell, and/or squamoid with Numerous mitotic figures and atypical
mitoses.
• Poor prognosis as rapidly spread with 20-35% at 1 yr. the management
depend on stage of malignancy as mixed of surgical with radiation and
chemotherapy in locally advanced but no effective therapy for metastatic
which consider palliative therapy.
Prognosis
8.
9. Medulla thyroid cancer
Very less common thyroid cancer with prevalence :
• Less than 4% overall incidence.
• typical age of presentation is in the fourth and sixth decades of life
• Risk factors :
- 80% occur as sporadic tumor.
- 20% familial as part of multiple endocrine neoplasia type 2 (MEN2) syndrome.
• The patient present with upper solitary thyroid nodule (located in upper portion as C cell
predominantly located there)with surrounding compression. Features of constitutional symptoms
and metastatic features also present.
• Systemic symptoms due to hormonal secretion of calcitonin.
Pathology
features
• neuroendocrine tumor of the parafollicular or C cells of the thyroid gland
• Rapidly growth and metastatic.
• Commonly spread to liver, lung, bone and brain.
• Diagnosed by mix picture of tumor mass with high basal serum calcitonin and FNAC features of C
cell presence.
• Prognosis depend on stage of tumor with overall prognosis 50% at 10yrs and
20% at 10yrs if detected when clinically palpable. Management include total
thyroidectomy and median lymph node dissection with surrounding tissue.
Then follow the patient by check the level of calcitonin.
Prognosis
10.
11. Lymphoma thyroid cancer
Very less common thyroid cancer with prevalence :
• Less than 1% overall incidence.
• typical age of presentation is in the elderly women.
• Female to male 4:1.
• Risk factors :
- Preexisting chronic autoimmune (Hashimoto's) thyroiditis.
• The patient present with rapidly enlarging goiter with surrounding compression. Features of
constitutional symptoms also present.
• Systemic symptoms due to hormonal secretion of calcitonin.
Pathology
features
• FNAC not enough to diagnose the lymphoma, large bore needle biopsy or excisional biopsy required
for obtain sufficient material for definitive diagnosis by immunohistochemical studies.
• Prognosis depend on stage of tumor. No surgical intervention required for the
patient. Combined radiotherapy and chemotherapy (CHOP) are the
treatment.
Prognosis
14. • 49 yrs old male presented with a thyroid swelling of 9 months duration. It has been
gradually increasing in size and in the last 6 weeks it has been increasing more rapidly.
He has noticed some hoarseness of voice in the past 1 month. There is no family
history of thyroid malignancy. On examination, there is 4X4 cm thyroid nodule in the
right lobe. It is hard in consistency. There are multiple cervical lymph nodes palpable in
the right lateral group (III and IV).
Full history and clinical examination.
Laboratory test as initial diagnosis :
• Thyroid function test.
• Thyroid autoimmune antibodies.
Other test need as baseline for other intervention:
• CBC
• Coagulation profile.
• RFT
• LFT
15.
16. US of thyroid :
Indicated in case of :
• All patient with rapid growth of goiter or physical examination reveal
thyroid asymmetry, focal firm consistency or tenderness.
• Present of goiter with normal TSH and TPO.
• Patient with goiter and positive TPO for Hashimoto’s thyroiditis.
The result of thyroid
US that suspicious for
malignancy
• Positive if :
- Micro-calcification
- Lymph node metastasis and local invasion
- Irregular margin
- Vascularity
- Shape (AP more than transverse diameter)
- Hypoechoic lesion
17. Fine needle aspiration cytology (FNAC) :
By aspirate the selected nodule and then put them in 6 slides to send them
to pathological studies.
The result depend on the presence of cells features including :
• Psammoma bodies and orphan anni cells.
• Features of malignancy include nuclear groove, nuclear overlapping, nuclear
clearance, nuclear crowding, nuclear inclusion.
• Atypical cells
• Hurthle cells
If US thyroid positive
for suspicious features
according to Bethesda
classification, it
classify the FNAC
result into:
18. Risk for
malignancy
FNAC featuresStage
Containing histiocytes with little or no follicular cells or no significant
cytological atypia.
Non-diagnostic
or unsatisfactory
(C 1)
95% benign
5% malignancy
Showed the cytomorphological features of colloid
goiter/adenomatoid goiter, Hashimoto's thyroiditis, thyrotoxicosis, de
Quervain's thyroiditis, or granulomatous thyroiditis
Benign (C 2)
15%
malignancy
showed cytological features of high cellularity, tiny follicular cells
arranged in sheets, clusters or singly, with occasional occurrence of
multinucleated giant cells, and focal occurrence of Hurthle cells.
Atypical
follicular lesion
of undetermined
significance (C3)
25%
malignancy
cytomorphologic features of moderate to high cellularity, scant or
absent colloid, with predominantly microfollicular or trabecular
configuration of follicular cells in repetitive pattern and features of
hurthle cell.
suspicious for
follicular
neoplasm
Or hurthle cell
lesion (C4)
75%
malignancy
cytological features of high cellularity, comprised elongated oblong
cells with occasional plasmacytoid appearance.
Present ≥ 2 of malignancy features include nuclear groove, nuclear
overlapping, nuclear clearance, nuclear crowding, nuclear inclusion.
Suspecious for
malignancy (C5)
95%
malignancy
Present as C5 but with ≥ 4 of malignancy features with psammoma
bodies and orphan anni cells
Papillary thyroid
carcinoma (C6)
19. For staging and metastatic workup :
• CT scan or MRI.
• Chest x-ray.
• Bone survey
• PET scan
• Brain scan
22. Assess the prognosis and
mortality rate for the
patient with different
scoring system
Low risk of mortality :
• Young patient (<40yrs),
small lesion (<1cm), lesion
intra-thyroidal with no local
extension or metastasis.
• MACIS score <4.
High risk of mortality :
• Older patient (>40yrs), large
sized lesion (>1cm)with local
invasion or metastasis.
• MACIS score >4.
23. Management group A thyroid cancer
Depend on multiple factors including the type of cancer, stage and prognostic
scoring system as well as patient factors if candidate for surgical or not. Overall the
surgical approach for thyroid cancer include :
Pre-
operative
assessment
Surgical
approach
Post-
operative
assessment
Post-
operative
surveillance
24. Pre-operative assessment :
Need to order some tests including :
• TFT for thyroid level as the patient need to be euthyroid during the surgery
unless emergency cases.
• Bone profile and VitD to check the Ca level before surgical as baseline and to
prevent hypocalcaemia in post-OP.
• Other assessment related to anesthesia.
25. ManagementStage
No intervention needed but active surveillance might required.(C 1)
As other diagnosis is considered, treatment depend on the diagnosis.Benign (C 2)
Hemi-thyroidectomy then send to histopathology evaluation of that tissue.
If any element of malignancy found on that tissue, remove the other part.
(C3)
Hemi-thyroidectomy then send to histopathology evaluation of that tissue.
If any element of malignancy found on that tissue, remove the other part.
(C4)
• Some doctors preferred to do total thyroidectomy.
• Other depend on the size found during surgery and number of nodules
or foci :
• If > 1cm, do total thyroidectomy followed by Radioiodine therapy
• If < 1cm and multifocal, do total thyroidectomy followed by
Radioiodine therapy
• If < 1cm and unifocal, hemi-thyroidectomy.
Suspecious for
malignancy (C5)
Total thyroidectomy followed by Radioiodine therapyPapillary thyroid
carcinoma (C6)
Surgical approach
depend on the protocol, according to European guidelines:
26. Post-operative assessment :
Look for any signs of early complication within first 24 hrs which include :
• Hemorrhage with signs of swelling and airway compression as stridor or anemia and
treat with :
• oxygen supplement and evacuation of hematoma by release of suture.
• Recurrent laryngeal nerve damage (1-2%) with signs of stridor in case of bilateral injury
and patient need to be intubated.
• Superior laryngeal nerve paresis.
• Hypoparathyroidism which cause hypocalcaemia and treat with Ca supplement and Vit
D
• Tracheal collapse.
• Thyroid crisis.
• Cervical symptomatic damage.
• Wound infection.
Delay complication :
• Hypothyroidism.
• Wound complication as keloid.
• Recurrent hyperthyroidism.
27. Radioiodine treatment :
Radioiodine (The uptake of 131-I) is administered after thyroidectomy in patients with
differentiated thyroid cancer to ablate residual normal thyroid tissue (remnant ablation), to
provide adjuvant therapy of subclinical or clincally apparent of micrometastatic disease.
• Done within 4-6 week after the thyroid surgery for those who are indicated include :
• Metastasis thyroid cancer.
• According to the classification of FNAC ( see page 25).
• Pregnancy and breastfeeding are absolute contra-indication.
• Patient preparation :
• Avoid all iodine containing medication and limit dietary intake of iodine include salt,
milk. Eggs and seafood for at least 1 week.
• In breastfeeding, should be stopped at least 6 to 8 weeks.
• Thyroid hormones should be withdrawn three to four weeks prior to radioiodine
therapy.
• The treated patient should remain ≥1.8 m (6 feet) away from family members,
caregivers, and the general public as much as possible for approximately 24 hours after
treatment.
28. Post-operative surveillance :
Long term follow up to detect any recurrence every 6-12 months with :
• Clinical examination.
• Serum TSH.
• Free thyroxin.
• Measurement of serum thyroglobulin.
• Routine neck US.