ROJoson PEP Talk: Thyroid Cancer Management - Part 2 - Fundamentals and Generalities

Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 2
January 29, 2022
1400H - 1500H
Via Zoom

Empowerment
objective - for
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 2

Empowerment
objective - for
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 2
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.

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

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

Empowerment
objective - for
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 2
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
Thyroid Cancer, Part
2. This is part of the
Cancer Course.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Contents:
• Screening for thyroid cancer
• Symptoms that will lead to suspected presence
of thyroid cancer
• Clinical diagnosis of thyroid cancer
• Paraclinical diagnostic procedures for thyroid
cancer
• Treatment for thyroid cancer
• Surveillance of thyroid cancer
• Prognosis of thyroid cancer
• Palliative and hospice care for thyroid cancer
patients
PART 1
PART 2

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
Medical Management – diagnosis and treatment
of thyroid cancer by physicians
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Treatment for thyroid cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
After formulating the pretreatment diagnosis,
including the extent of the thyroid cancer,
first thing to do before considering and comparing
the options of treatment methods or modalities is
to spell out the specific objective or goal of
treatment:
whether curative or palliative.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
The usual goals of cancer treatment include
• eradicating known tumors / cancers entirely,
preventing the recurrence or spread of the
primary cancer, and
• relieving symptoms if all reasonable curative
approaches have been exhausted.
Curative goal
Palliative goal

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
At the time of treatment, a patient may present in
a cancer stage in which the goal is at best
palliative only (relieving symptoms). These are
usually the patients with advanced cancers.
Thus, objective of
treatment is primarily
dependent on the
stage of cancer at the
time of treatment.
Advanced cancers
• Anaplastic
carcinoma
• Advanced papillary
/ follicular /
medullary cancers
Palliative goal

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
For patients presenting with early staged cancers,
resectable or operable cancers, the goal is
curative that is, eradicating the tumors / cancers
entirely and preventing the recurrence or spread
of the primary cancer.
Thus, objective of
treatment is primarily
dependent on the
stage of cancer at the
time of treatment.
Curative goal

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Stage and Staging of Cancers
Stage and staging describe the extent of a cancer.
There are so many ways of staging cancers.
- early stage and advanced stage
- localized, regional and distant
- localized, early locally advanced, late locally
advanced, and metastasized
- TNM Staging describe the size of the cancer
and how far it has grown.
TNM Staging
T = tumor
How large is the primary
tumor?
N = nodes
Has the tumor spread to
the lymph nodes? If so,
where and how many?
M = metastasis
Has the cancer spread to
other parts of the body? If
so, where and how much?

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
TNM Staging for Thyroid Cancers
Based on
• types of thyroid cancer (papillary, follicular,
anaplastic, medullary)
• age of patients (for papillary and follicular
cancers)
• historical track records of the different thyroid
cancers
Common types of
thyroid cancers:
• Papillary
• Follicular
• Anaplastic
• Medullary

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
TNM Staging for 4 groups of patients with thyroid
cancer and NOT uniform for all thyroid cancers
• Papillary and Follicular Thyroid Cancers
younger than 55 years old
• Papillary and Follicular Thyroid Cancers 55
years old and older
• Medullary Thyroid Cancers
• Anaplastic Thyroid Cancers
Different staging systems
Anaplastic – only
Stage IV (no Stage I, II,
and III)
Papillary (≥55yo),
Follicular, and
Medullary – have
Stage I, II, III and IV
Papillary and
Follicular (<55yo) –
only Stage I and II

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
TNM Staging for Anaplastic Thyroid Cancers
Stage IV:
All anaplastic thyroid tumors are classified
as stage IV, regardless of tumor size,
location, or metastasis.
Different staging systems
Anaplastic – only
Stage IV (no Stage I, II,
and III)
Papillary (≥55yo),
Follicular, and
Medullary – have
Stage I, II, III and IV
Papillary and
Follicular (<55yo) –
only Stage I and II

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
TNM Staging for
• Papillary and Follicular Thyroid Cancers
younger than 55 years old
• Papillary and Follicular Thyroid Cancers 55
years old and older
Different staging
systems
Different for those
younger than 55 years
old
and those 55 years old
and older
Younger people have a low likelihood of dying from
differentiated (papillary or follicular) thyroid cancer. The
TNM stage groupings for these cancers take this fact into
account.
So, all people younger than 55 years with these cancers are
stage I if they have no distant spread and stage II if they
have distant spread.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
T1 < 2cm
T2 2-4cm
T3 >4cm
T4 extensive
N – lymph nodes
M - metastasis

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
There are a lot of cancer treatment being
advocated.
Mainstream ones – accepted by and being
promoted by majority of the physician-cancer
specialists – conventional, standard – with well-
documented evidences for effectiveness in
various degrees
Non-mainstream ones – outside the mainstream
ones – alternative – with health claims usually not
meeting evidence-based standards

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
The commonly used non-mainstream or
alternative medicine treatment for cancer are
currently the following:
• Herbs and herbal medicine
• Special diet
• Supplements including vitamins
• Acupuncture
• Lifestyle medicine - healthy eating, physical
activity, and other healthy behaviors without
the use of medicine
Alternative
medicine is defined
loosely as a set of
products, practices,
and theories that are
believed or perceived
by their users to have
the healing effects of
medicine, but whose
effectiveness has not
been established
using scientific
methods.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
The commonly used non-mainstream or
alternative medicine treatment for cancer are
currently the following:
Another categorization of types:
• Natural products
• Mind-body medicine practices (ex. Meditation)
• Manipulative practices (ex. Chiropractic)
• Body-based practices (ex. Massage)
Alternative
medicine is defined
loosely as a set of
products, practices,
and theories that are
believed or perceived
by their users to have
the healing effects of
medicine, but whose
effectiveness has not
been established
using scientific
methods.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Usage of Alternative Medicine
No data in the Philippines
In USA, in two reports (2013 / 2018), 74%, 80%
are using alternative medicine in management of
thyroid cancers
Majority (70%) are using it for symptom relief
rather against the cancer itself. 30% - cancer tx.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783927/
https://news.cancerconnect.com/thyroid-cancer/high-
prevalence-of-cam-use-among-thyroid-cancer-patients
• Prayer
• Multivitamins
• Massage
• Accupuncture
• Chiropractic
• Meditation
• Herbal tea
• Special diets
• Herbal
supplements
• Homeopathy
• Ginger

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Words of caution on ALTERNATIVE MEDICINE for
cancers:
•Delaying surgery, radiation, chemotherapy, or
other traditional treatment by using an
alternative therapy can allow the cancer to grow
and spread to other parts of the body.
•Evidence shows that people who use alternative
therapies in place of standard cancer treatments
have much higher death rates.
After a median of 5
years, patients with
breast or colorectal
cancer were nearly
five times as likely to
die if they had used
an alternative
therapy as their initial
treatment than if they
had received
conventional
treatment. (2017 -NCI)
No studies in thyroid cancers but mostly the same outcome.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
The mainstream modalities of treatment for
thyroid cancer are currently the following:
• Surgery – operation – cutting
• Hormonal therapy – hormone manipulation
• Radiotherapy – Radioactive iodine therapy
radiation - burning
• Chemotherapy – drugs – killing
• Immunotherapy – immune system
manipulation
• Targeted therapy – gene manipulation

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
The mainstream modalities of treatment for
thyroid cancer can be classified into:
Localized therapies - treatment that are directed
to a specific limited area such as the thyroid and
the neck. They include surgery and radiotherapy.
Systemic therapies - drugs that spread throughout
the body to treat thyroid cancer cells wherever
they may be. They include radioactive iodine
therapy, chemotherapy, hormonal therapy,
targeted drugs, and immunotherapy.
Thyroid cancer
treatment may be
single or combined
modalities depending
on the extent and
track records of
effectiveness.
May be
• localized therapy
only
• Systemic therapy
only
• Localized +
systemic therapy

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Thyroid cancer treatment may be single or
combined modalities depending on the extent
and track records of effectiveness.
May use
• localized therapy only (surgery or radiotherapy)
• Systemic therapy only (radioactive iodine
therapy, hormonal therapy, and chemothrapy)
• Localized + systemic therapy

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Any cancer treatment can be used as a primary
treatment, but the most common primary cancer
treatment for thyroid cancer is surgery (especially
those in the operable stage).
Other combinations of treatment are done
depending on the anatomic stage, prognostic
stage and other factors like track records of
effectiveness.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
General guidelines:
Operable thyroid cancer:
• Surgery (thyroidectomy ± neck dissection);
thyroidectomy (subtotal vs total)
• Hormonal therapy – levothyroxine (uses:
replacement / suppressive therapy)
• Radioactive iodine therapy

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
General guidelines:
Operable thyroid cancer:
• Surgery (thyroidectomy ± neck dissection);
thyroidectomy (subtotal vs total)
Surgery = primary
treatment for
thyroid cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
General guidelines:
Additional treatment after operation:
• Hormonal therapy – levothyroxine
• Uses:
• replacement in those with total or near-
total thyroidectomy or those ablated by RAI
• suppressive therapy (to prevent recurrence)

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
General guidelines:
Additional treatment after operation:
• Radioactive iodine therapy
• Uses:
• To ablate remaining thyroid tissues and
thyroid cancers
• To run after metastatic thyroid cancers

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
General guidelines:
Inoperable thyroid cancer: (for palliation)
• Radiation therapy
• Chemotherapy

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Procedures Benefit
(goal of
treatment)
Risk Cost Availability
Option1
Option2
Option3
The physician gives or
lists the various
options of treatment
and then gives data
on the BRCA.
With the data given,
the patient is asked
what s/he prefers.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1 > 3 acceptable 6000 available
Option3 least survival rate acceptable 3000 available
Example of BRCA
comparative analysis
of treatment
procedures
Benefit Risk Cost Avail
Option1 Survival rate same as Option2 More complications
Option2 Survival rate same as Option1 Less complications
Option3 Least survival rate Least complications

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1 > 3 acceptable 6000 available
Option3 least survival rate acceptable 3000 available
Example of BRCA
comparative analysis
of treatment
procedures
Benefit Risk
Option1 Lowest recurrence rate Risk 5+
Option2 Recurrence rate <1 >3 Risk 2+
Option3 Highest recurrence rate Risk 1+

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Surveillance for thyroid cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Surveillance of thyroid cancer
Surveillance after cancer treatment –
MONITORING for
• Recurrence after all the evident cancers are
eradicated (after curative treatment)
• For progression / regression after palliative
treatment (when all the evident cancers are
not / cannot be eradicated totally)
Questions / Issues:
• By whom?
• How long?
• How often?
• What methods?

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Surveillance of thyroid cancer Questions / Issues:
• By whom?
• How long?
• How often?
• What methods?
MONITORING for outcome
BY WHOM?
• Oncologist/s
• Family physician
whom you prefer (competence - expertise,
professionalism, holistic and compassionate care,
cost, availability, convenience, etc.)

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
BY WHOM?
• Oncologist/s (MD with specialty in cancer
management - various types)
• Surgical oncologists (head and neck
surgeons – general surgeons / ENT)
• Medical oncologists (endocrinologists)
• Nuclear medicine specialists
• Radiation oncologists
May choose one or more as
indicated and as preferred
whom you prefer
(competence - expertise,
professionalism, holistic
and compassionate care,
cost, availability,
convenience, etc.)

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
HOW LONG?
• For those with curative treatment goal
• LIFETIME as all cancers have the potential
to recur even after a long period of
remission (even after 10 to 15 years)

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
HOW LONG?
• For those with palliative treatment goal
• Until signs of progression / regression occur
(another round of decision thereafter)
• Until a call / decision for hospice care is
made (no more aggressive anti-cancer
treatment)
• Until the end of life

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
HOW OFTEN?
Two situations:
- Monitoring for immediate results of
treatment
- Monitoring for recurrence of cancer
after curative treatment

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
HOW OFTEN?
- Monitoring for results of treatment
- side-effects / complications of treatment
- response to treatment (hormonal therapy /
radioactive iodine therapy /chemotherapy
/ radiotherapy / etc.)
Duration of
monitoring –
depending on types
and duration of
treatment;
recuperation time;
expected response
time (such as 2-3
months for hormonal
therapy / RAI /
radiation /chemo);
etc.
Frequency – ranging from daily to every month - average of 6 months.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
HOW OFTEN?
• Depends on the type of cancer; treatment
done; usual prognosis; time of treatment (soon
after – long after); mind-set and personality of
patients; etc.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
HOW OFTEN?
General guidelines:
• More often for those with higher risk for recurrence such
as aggressive type of cancer; early post-treatment say 1
to 2 years when recurrence usually appears; and anxious
patients who need frequent psychological support from
physicians.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
WHAT METHODS?
- Symptom-sign directed surveillance
approach
- Regular screening instrumental –
laboratory diagnostic tests directed
surveillance approach

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
WHAT METHODS?
- Symptom-sign directed surveillance
approach
• Patient’s symptoms and physician’s sign
findings will direct instrumental-
laboratory diagnostic tests to be done.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
• By whom?
• How long?
• How often?
• What methods?
WHAT METHODS?
- Regular screening instrumental –
laboratory diagnostic tests directed
surveillance approach
• Battery of screening tests on possible
sites of recurrence are done even in the
absence of symptoms and signs.
Usual tests being
ordered:
• Ultrasound of neck
• Total body RAI scan
• PET Scan

Surveillance after thyroid cancer
treatment
Procedures Benefit
(early
detection)
Option1
Option2
Procedures Benefit
(survival)
Option1
Option2
Procedures Benefit
(quality of
life)
Option1
Option2
Symptom-sign directed
Battery of tests directed
lists the options of
surveillance and then
gives data on the
BRCA.
what s/he prefers.
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer

Surveillance after thyroid cancer
treatment
lists the options of
surveillance and then
gives data on the
BRCA.
what s/he prefers.
Procedures Benefit
(early
detection)
Option1 +
Option2 +++
Procedures Benefit
(survival)
Option1 Same
Option2 Same Pain
Procedures Benefit
(quality of
life)
Option1 Better P
Option2 Poorer False (+) PPPPPP
Symptom-sign directed
Battery of tests directed
√
√
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Prognosis of thyroid cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Prognosis of thryoid cancer
ESTIMATE HOW THE CANCER WILL GO FOR YOU!
• The likely course of the CANCER without
treatment
• If with treatment, whether curative or
palliative, the likely outcome
• Chances of recovery from cancer
• Chances of response to treatment: cure-
remission or recurrence.
• ESTIMATE OF 5- TO 10-YEAR SURVIVAL RATE /
MEDIAN SURVIVAL RATE

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Dependent on:
• Type of cancer
• Stage of cancer
• Inherent biologic behavior of cancer
• With or without co-morbidities (other
illnesses) and gravity of co-morbidities
• Track records of the cancer

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Track records of cancers
 Studies on 5- / 10-year survival rates and
median survival of different cancers
• By stage of cancers
• With and without treatment

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
5- / 10-year survival rate of cancers
The percentage of patients who are alive five
years / 10 years after they were diagnosed with
or started treatment.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Prognosis of thyroid cancer Differential Prognosis
of Thyroid Cancers
• Papillary cancers –
BEST
• Follicular cancers –
• Medullary cancers
–
• Anaplastic cancers -
WORST

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Median survival of cancers
The length of time from either the date of
diagnosis or the start of treatment for a cancer,
that half of the patients diagnosed with the
disease are still alive.
OVERALL MEDIAN
SURVIVAL
---- ? months
Median survival time
with treatment /
without treatment
Median survival time
- based on stage
- based on types of
metastasis

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Median survival of cancers
The length of time from either the date of
diagnosis or the start of treatment for a cancer,
that half of the patients diagnosed with the
disease are still alive.
Median survival data are especially important in
patients with far advanced and incurable
diseases.
Since thyroid
cancers generally
have good
prognosis, especially
papillary and
follicular cancers,
median survival
data are often not
mentioned, just 5-
to 10-yar survival
rates.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Five-year survival rates thyroid cancer types
•Papillary: Close to 100% for localized; around
80% for metastasized.
•Follicular: Close to 100% for localized; around
•Medullary: Close to 100% for localized; around
•Anaplastic: Close to 31% for localized; 4% for
metastasized.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Palliative and hospice care for thyroid
cancer patients

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
cancer patients
There are two terms that one will encounter in
the medical management of cancer patients
which most Filipino laypeople are not familiar
with and which most Filipino physicians do not
acquaint the cancer patients with.
Palliative Care
Hospice Care

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
cancer patients
Palliative and hospice care are being used
in patients with advanced cancer patients
who have little or no prospect of cure and
who are expected to die and for whom the
primary goal is to optimize the quality of
their remaining life on earth.

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
cancer patients
Both palliative care and hospice care
provide COMFORT for advanced cancers
(physical and mental/spiritual).
• Palliative care can begin at diagnosis and at the
same time as treatment. (may consist of anti-
cancer treatment).
• Hospice care begins after treatment of the
cancer is stopped (no anti-cancer treatment
anymore) when it is clear that the person is not
going to survive the cancer.
Advanced Cancers
Palliative Goal
Palliative Care
Hospice Care

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
PART 1
PART 2
Summary
Take Away
Contents:
• Screening for thyroid cancer
• Symptoms that will lead to suspected presence
of thyroid cancer
• Clinical diagnosis of thyroid cancer
• Paraclinical diagnostic procedures for thyroid
cancer
• Treatment for thyroid cancer
• Surveillance of thyroid cancer
• Prognosis of thyroid cancer
• Palliative and hospice care for thyroid cancer
patients

Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
cancer.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management.
Take Away in
relation to
Patient
Empowerment

ROJoson PEP Talk: Thyroid Cancer Management - Part 2 - Fundamentals and Generalities

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ROJoson PEP Talk: Thyroid Cancer Management - Part 2 - Fundamentals and Generalities