this ppt was made as per the need of the students of Bsc, nursing. It can also be useful for Msc nursing students too.

1. THYROID
CARCINOMA
BY- SAMPURNA DAS

2. ANATOMY OF THYROID GLAND
lobus
dexter (rig
ht lobe)
lobus
sinister (le
ft lobe)
Each lobe is 5cm long, 3cm
wide 2 cm thick
• Each lobe is about 5 cm long, 3 cm wide and 2 cm thick.• Each lobe is about 5 cm long, 3 cm wide and 2 cm thick.• Each lobe is about 5 cm long, 3 cm wide and 2 cm thick.• Each lobe is about 5 cm long, 3 cm wide and 2 cm thick.
Lalouette’s
/
pyramidal
lobe
•Lalouette's pyramid.

3. Superior & recurrent laryngeal
nerve
Superior thyroid artery,
inferior thyroid artery,
thyroid ima artery
Lateral deep cervical lymph nodes, pre &
para tracheal lymph nodes
Superior thyroid veins,
inferior thyroid veins,
left brachiocephalic vein

4. PHYSIOLOGY OF THYROID GLAND

6. Follicles
selectively absorb iodine (as iodide ions, I ) from the
blood for production of thyroid hormones, and also
for storage of iodine in thyroglobulin. 25 % of the
body's iodide ions are in the thyroid gland. Inside the
follicles, in a region called the follicular lumen, colloid
serves as a reservoir of materials for thyroid hormone
production and, to a lesser extent, acts as a reservoir
for the hormones themselves. Colloid is rich in a
protein called thyroglobulin.
Thyroid epit
helial cells
(or
"follicular
cells")
The follicles are surrounded by a single layer of thyroid
epithelial cells, which secrete T3 and T4. When the
gland is not secreting T3 and T4 (inactive), the
epithelial cells range from low columnar to cuboidal
cells. When active, the epithelial cells become tall
columnar cells.
Parafollicul
ar cells
Scattered among follicular cells and in spaces between

7. HISTOLOGY OF THYROID GLAND

8. CAUSES OF THYROID
CANCER

9. • Environmental exposure to ionizing radiation
• Thyroiditis and other thyroid
disease
• Genetic causes include Multiple endocrine
neoplasia type 2

10. PATHOPHYSIOLOGY

11. ETIOLOGY
TARGET CELLS
DYSFUNCTION IN DIFFERENTIATION &
PROLIFERATION OF CELLS
CANCER CELL
PROLIFERATION OF CANCEROUS CELL
CANCER CELL INVADE ORGAN & SPREADS IN
ADJACENT ORGANS
DISTANT METASTASIS THROUGH LYMPHATIC &
HEMATOGENOUS ROUTE
IN
IT
IA
TI
O
N
PROM
OTION
PR
OG
RES
SIO
N

12. TNM STAGING

13. T CATEGORIES-
• TX-Primary tumorcannot be assessed
• T0 –No evidence of primary tumor
• T1-Tumoris2cmorsmalleracross,limitedtothethyroid
• T2-Tumor 2 -4 cm across , limited to the thyroid
• T3-Tumorislargerthan4cmorhasbeguntogrowintonear by
tissues outside the thyroid
• T4a-Tumor of any size and has grown extensively beyond
the thyroid gland into nearby tissues of the neck
• T4b-Tumor has grown either back toward the spine or into
nearby large blood vessels

14. N & M CATEGORIES-
• NXRegional (nearby) lymph nodes cannot be assessed
• N0-No spread to nearby lymph nodes
• N1-Spread to nearby lymph nodes
• N1a-Spread to lymph nodes around the thyroid in the
neck (cervical)
• N1b- Spread to lymph nodes in the sides of the neck
(lateral cervical) or the upper chest
• (upper mediastinal)
• MX-Presence of distant metastasis cannot be assessed
• M0No -distant metastasis
• M1-Distant metastasis is present, involving distant
lymph nodes, internal organs, bones, etc.

15. T1 - Tumor is 2 cm or smaller across ,
limited to the thyroid

16. T2-Tumor 2 -4 cm across , limited to
the thyroid

17. T3-Tumor is larger than 4 cm or has
begun to grow into near by tissues
outside the thyroid

18. T4a-Tumor of any size and has grown
extensively beyond the thyroid gland
into nearby tissues of the neck

19. T4b-Tumor has grown either back
toward the spine or into nearby large
blood vessels

20. N1-Spread to nearby lymph nodes

21. M1-Distant metastasis is
present, involving distant
lymph nodes, internal
organs, bones, etc.

22. DIFFERENT TYPES OF
THYROID CANCER

23. TYPE CAUSE CELL OF
ORIGIN
MEDULLARY Caused by mutation in
the RET proto-oncogene
Parafollicular
FOLLICULAR Tumors tend carry either a
RAS mutation or a PAX8-
PPARγ1 fusion,
Follicular
ANAPLASTIC p53 gene mutations Follicular
PAPILLARY RET(rearranged during
transfection)/ PTC (for
papillary thyroid carcinoma)
oncogene
Follicular

24. SIGNS & SYMPTOMS-

25. • Thyroid nodule
• Enlarged lymph node
• Pain in the anterior region of the neck
• Changes in voice due to an involvement of the recurrent
laryngeal nerve.
• Thyroid cancer is usually found in a euthyroid patient, but
symptoms of hyperthyroidism or hypothyroidism may be
associated with a large or metastatic well-differentiated
tumour.
• Thyroid nodules are of particular concern when they are
found in those under the age of 20. The presentation of
benign nodules at this age is less likely, and thus the
potential for malignancy is far greater.
• The flushing and diarrhea observed in carcinoid syndrome is
caused by elevated levels of circulating serotonin.
• flushing, diarrhea, and itching (pruritis) are all caused by
elevated levels of calcitonin.
• Enlarged cervical lymph nodes.

26. DIAGNOSTIC
STUDIES-

27. • A thyroid nodule is found during a physical
examination
• Ultrasound is performed to confirm the
presence of a nodule, and assess the status of
the whole gland.

28. • Measurement of thyroid stimulating
hormone and anti-thyroid antibodies will help
decide if there is a functional thyroid disease.

29. • Measurement of calcitonin is necessary
to exclude the presence of medullary
thyroid cancer

30. • To achieve a definitive diagnosis before
deciding on treatment, a fine needle
aspiration cytology.

31. Detection of any metastases of thyroid cancer can
be performed with a full
body scanning using iodine-131.

32. • CT scan or MRI thyroid scan shows this
growth to be "cold," meaning it does not
absorb a radioactive substance.

33. TREATMENT-

34. SURGICAL
MANAGEMENT

35.  Total thyroidectomy -removal of all
thyroid tissue, with preservation of
the contralateral parathyroid glands.
 Hemithyroidectomy to distinguish
between adenoma & carcinoma

36. • Robotic-assisted thyroidectomy

37. • Minimally invasive thyroidectomy

38. RADIATION
RADIO ACTIVE IODINE
THERAPY

39. CHEMOTHERAPY

40. Carboplatin – Eprubicin Protocol
• CARBOPLATIN – 300mg/msq. (IV) – D1
(over 30 mins.)
• EPIRUBICIN - 75 mg/ msq.
(4 hours after Carboplatin)
[Administration repeat cycle after 4 to 6 weeks]

41. CVD PROTOCOL
• INDICATION: Advanced Medullary
Thyroid Carcinoma
• CYCLOPHOSPHAMIDE – 750mg/m.sq. –
D1
• VINCRISTINE – 1.4mg/m.sq. – D1
• DACARBAZINE – 600mg/m.sq. – D1,D2
• CYCLE- to be repeated every 3-4 weeks
depending on tolerance

42. DACARBAZINE – 5FU
• INDICATION: Advanced Medullary
Thyroid Cancer
• Dacarbazine – 250mg/m.sq.- IV- (5Day
intraveously)
• 5FU- 450mg/m.sq. – (12 hour infusion)
• cycle to be repeated every 4 weeks

43. TARGETED
THERAPY

44. SORAFENIB—
-400 mg- PO –BD- Daily
Indication – metastatic ,
iodine refractory
carcinoma

45. MOTESANIB—
-125mg- PO - Daily
Indication – Progressive
advanced (metastatic ,
radio iodine resistant
differentiated carcinoma

46. NURSING MANAGEMENT

47. • Acute Pain
Related to:
• pressure / swelling of the tumor nodule
• Surgical interruption/manipulation of tissues/muscles
• Postoperative edema
Possible evidenced by:
• The existence of the neck pain may spread to the orbital area.
• Pain scale of 0-10
• Looks withstand pain
• There is pain in swallowing, and difficulty swallowing
• Narrowed focus; guarding behavior; restlessness
• Autonomic responses

48. • Ineffective airway clearance
Related to:
• Tracheal obstruction due to tumor mass pressure
• Laryngeal spasm
• Accumulation of secretions
Possible evidenced by:
• Difficulty breathing
• Difficulty of removing secret
• Complained of shortness of breath
• Above normal respiration

49. • .Impaired verbal Communication
Related to:
• Injury to vocal cords
• Laryngeal nerve damage
• Tissue oedema
Possible evidenced by:
• Talk husky / can not speak

50. • Injury, risk for [tetany]
Related to
• Risk factors may include
• Chemical imbalance: excessive CNS
stimulation

51. • .Knowledge deficient [Learning Need] regarding
condition, prognosis, treatment, self-care, and
discharge needs
Related to
• Lack of exposure/recall, misinterpretation
• Unfamiliarity with information resources
As evidenced by
• Questions; request for information; statement of
misconception
• Inaccurate follow-through of
instructions/development of preventable
complications

53. CAN YOU
ANSWER??

54. ANAPLASTIC
FOLLOCULAR
PAPILLARY
PAILLARY
LATERAL ABERRANT THYROID
RAS mutation
P53 gene
RET proto onco Gene
RET / PTC gene
MATCH THE FOLLOWING
MEDULLARY

55. T1 - Tumor is 2 cm or smaller across ,
limited to the thyroid

56. NAME 2 CHEMOTHERAPY DRUGS USED FOR
TREATMENT OF CHEMOTHERAPY?
NAME 1 DRUG USED AS TARGETED THERAPY?
TELL ANY 2 ETIOLOGY OF THYROID CANCER?

57. M1-Distant metastasis is
present, involving distant
lymph nodes, internal
organs, bones, etc.