Cancer

1. THYROID CANCER
Ratheesh.R
SLMGNC

2. INTRODUCTION
 The thyroid is a gland in the neck. Thyroid cancer is a common
type of cancer. It accounts for 1 to 5% of all cancers cases
worldwide. As medical technology advances, more cases of
thyroid cancer are being diagnosed early. The earlier treatment
begins, the better the chances of a cure. Most cases of thyroid
cancer are curable with treatment.
 It produces thyroid hormones called thyroxine (T4) and tri-
iodothyronine (T3). These hormones are very important and
help control the body’s metabolism (use of energy). The thyroid
gland also produces calcitonin. This helps control the amounts
of calcium and phosphate salts in the body. The level of
calcitonin is raised when medullary thyroid cancer is present.

3. DEFINITION
 It is a abnormal proliferation of cells of thyroid
gland.

4. TYPES
i)Papillary carcinoma - is the most common type of
thyroid cancer, accounting for approximately 80
percent of cases. Papillary carcinomas are slow
growing, differentiated cancers that develop from
follicular cells and can develop in one or both lobes
of the thyroid gland. This type of cancer may
spread to nearby lymph nodes in the neck, but it is
generally treatable with a good prognosis

5. CONT….
ii)Follicular carcinoma - is the second most
common type of thyroid cancer, and accounts for
approximately one out of 10 cases. It is found more
frequently in countries with an inadequate dietary
intake of iodine. Follicular carcinoma is also a
differentiated form of thyroid cancer. In most cases,
it is associated with a good prognosis, although it is
somewhat more aggressive than papillary cancer.
Follicular carcinomas do not usually spread to
nearby lymph nodes, but they are more likely than
papillary cancers to spread to other organs, like the
lungs or the bones.

6. CONT….
iii) Medullary thyroid carcinoma - develops from C
cells in the thyroid gland, and is more aggressive
and less differentiated than papillary or follicular
cancers. Approximately 4 percent of all thyroid
cancers will be of the medullary subtype. These
cancers are more likely to spread to lymph nodes
and other organs, compared with the more
differentiated thyroid cancers. They also frequently
release high levels calcitonin and carcinoembryonic
antigen (CEA), which can be detected by blood
tests.

7. CONT….
iv) Anaplastic carcinoma - is the most
undifferentiated type of thyroid cancer, meaning
that it looks the least like normal cells of the thyroid
gland. As a result, it is a very aggressive form of
cancer that quickly spreads to other parts of the
neck and body. It occurs in approximately 2 percent
of thyroid cancer cases.

8. A CT scan showing anaplastic
cancer of the thyroid
A woman with anaplastic
cancer of the thyroid

9. CAUSES
 Iodine: Iodine-deficient diets may lead to increase
the TSH level and considered goitrogenic
 Thyroiditis: (Hashimoto's Disease) may develop
into a form of cancer called lymphoma.
 External Radiation
 Increased Age
 Nuclear power plant accident
 Food source contaminated with radioactivity
 Radioactive iodine concentrated in the thyroid
gland.

10. CLINICAL FEATURES
 A lump in the neck, sometimes growing quickly
 Swelling in the neck
 Pain in the front of the neck, sometimes going up to
the ears
 Hoarseness or other voice changes that do not go
away
 Trouble swallowing
 Trouble breathing
 A constant cough that is not due to a cold

11. INVESTIGATION
 History Collection
 Physical Examination
 Thyroid scan
 Thyroid function test
 Biopsy with fine needle and large bore needle
 Ultra sound
 MRI and CT scan
 Radio active iodine uptake studies
 Thyroid suppression test.

12. MEDICAL MANAGEMENT
 Thyroid replacement therapy
 Chemotherapy
 Radiation therapy
 Radioactive iodine therapy
 Drug - Thyroxine therapy

13. RADIOIODINE THERAPY:
The Indications:
1.After Surgery to destroy any residual thyroid
cancer cells or residual normal thyroid tissue.
2.To treat thyroid cancer that has spread to the
lymph nodes, lungs or bones.
3.To treat thyroid cancer recurrence after initial
treatment by surgery or previous radioactive
iodine or both.

14. CONT….
Recent American thyroid association guide lines
recommended radioiodine ablation for:
 Pt. with stage III or IV disease
 All Pt. with stage II disease
> 45 yrs
 Selected Pt. with stage I disease those with:
 large tumor ( >1.5 cm )
 multifocality
 residual disease
 nodal metastasis

15. THYROXIN THERAPY :
 Recent meta-analysis supported the efficacy
of TSH suppression in preventing adverse
clinical effect
 High risk pt. are maintained at TSH level
below 0.1 mu/ L
 Low risk pt. TSH level at or below the
normal range (0.1- 0.5 mu/ L)

16. CONT….
The degree of thyroid suppression is
dictated by balancing the risk of
recurrent thyroid cancer and
subclinical thyrotoxicosis particularly
the cardiovascular risks

17. SURGERY
 Thyroidectomy
 Modified neck re-dissection
 More extensive radical neck dissection.
 In the majority of cases surgery is limited to an
open biopsy to exclude lymphoma.

18. COMPLICATION
 When carcinoma is untreated, it becomes fatal.
 Death
 Hemorrhage
 Hematoma formation

19. NURSING DIAGNOSIS
 Acute Pain related to pressure / swelling of the tumor
nodule.
 Ineffective airway clearance related to Tracheal
obstruction due to tumor mass pressure/Laryngeal
spasm/Accumulation of secretions.
 Impaired Verbal Communication related to Injury to
vocal cords Laryngeal nerve damage Tissue edema.
 Anxiety r/t concern about cancer, upcoming surgery.
 Knowledge deficit r/t cancer and its treatment.

20. TREATMENT :
Primary treatment should be EBRT
combined with Chemotherapy
regimen based on histopathological
subtype of lymphoma
Green LD et al, anaplastic thyroid
cancer and 1ry thyroid lymphoma. J
Surg Oncol 2006;94:725