Thyroid cancer

Thyroid 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