.What is ENT -- The role of neck dissection in patients with well-differentiated thyroid carcinoma.2/27/2023 .What is ENT -- The role of neck dissection in patients with well-differentiated thyroid carcinoma.
1. Unlike follicular thyroid carcinoma, which spreads hematogenously, papillary and medullary thyroid tumours frequently expand to regional lymph nodes. Prior to surgery, it is important to perform a thorough examination of the central compartment (level VI) and the lateral neck (levels II–V). Dissecting the neck beyond the central compartment for cosmetic reasons is controversial. In cases when the cancer has advanced to the side of the neck but there is no visible illness in the central part of the neck on imaging, a total thyroidectomy should be performed alongside an ipsilateral central neck dissection. Thyroid cancer surgery can often maintain level I (the submandibular gland) since it is rarely affected by locoregional metastases.
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What is ENT - What options do people with advanced papillary or follicular thyroid cancer have for treatment?
Surgical procedures include a tracheotomy (TT) and a dissection of the neck if necessary. Even while 131I isn't typically successful in curing patients with distant metastases, it can sometimes help. If a circumscribed lesion does not respond to RAI, then external beam radiation may be an option. When there is no 131I uptake by the tumour, resection of symptomatic or otherwise locally confined metastases may be warranted. It is important to have an in-depth discussion with the patient before removing structures (such the larynx, pharynx, or trachea) that are essential to their daily functioning. • Tyrosine kinase inhibitors and other forms of treatment should be investigated for patients with unresectable illness who have not responded to 131I. What is ENT - In what ways are papillary and follicular thyroid cancers treated once they have reached stage III?
• TT with lymph node dissection to eliminate infection. T3 malignancies may be candidates for preventative central neck dissection. • Ablation with 131I is commonly administered after TT. What is ENT - How are papillary and follicular thyroid tumours treated in their early stages?2/27/2023 What is ENT - How are papillary and follicular thyroid tumours treated in their early stages?
It is common practise to do a lobectomy on patients with isolated T1 lesions. According to the guidelines, lobectomy or total thyroidectomy can be utilised to treat T2 lesions, depending on pathological features, contralateral thyroid disease, and patient concerns. In order to permit radioactive iodine (RAI) treatment, a total thyroidectomy is required whenever macroscopic nodal illness is present. Total thyroidectomy has several benefits, including the potential for adjuvant radioactive iodine (RAI) ablation, enhanced specificity in thyroglobulin testing for cancer surveillance, and the ability to perform whole-body nuclear medicine scanning. There are drawbacks, such as the requirement for permanent thyroid replacement and the possibility of greater surgical risk. What is ENT - Explain the distinction between a total thyroidectomy (TT), a hemithyroidectomy (lobectomy), a near-total thyroidectomy (NT), and a sub-total thyroidectomy (ST).
Thyroidectomy (TT) entails the elimination of all outwardly discernible thyroid tissue. Hemithyroidectomy involves the removal of the entire left or right thyroid, including the isthmus. To lessen the risk of complications, a surgeon may choose to leave a tiny quantity of thyroid tissue in the area of the parathyroid glands or the recurrent laryngeal nerve during an NT. Large amounts of thyroid tissue are typically left behind after a subtotal thyroidectomy. Thyroid cancer patients SHOULD NOT have a partial thyroidectomy. What is ENT - What are the clinical prognostic indicators for thyroid cancer?
• AMES: Age; Metastasis; Extent and Size of primary tumor • Low risk: Age less than 40 (M) or 50 (F); tumor less than 4 centimeters and within thyroid gland • High risk: Age over 41 (M) or 51 (F); size >5 centimeters; extrathyroidal extension • MACIS: Metastasis; Age; Completeness of resection; Invasion; Size of tumor • High risk: Age over 40; incomplete tumor resection; local invasion beyond thyroid (recurrent laryngeal nerve, trachea, esophagus, strap muscles) or angioinvasion; size >4 centimeters What is ENT - What is the staging for well-differentiated thyroid cancers?
Staging for Papillary and Follicular Thyroid Cancer Papillary or follicular thyroid tumors <45 years old Stage I: Any T, any N, M0 Stage II: Any T, Any N, M1 Papillary or follicular thyroid tumors >45 years old Stage I: T1N0M0 Stage II: T2N0M0 Stage III: T1–2 N1a M0 or T3 N0–1a M0 Stage IVA: T1–3 N1b M0 or T4a any N M0 Stage IVB: T4b, any N, M0 Stage IVC: Any T, any N, M1 What is ENT - When referring to well-differentiated thyroid carcinoma, what TNM stage should be used?
TNM Staging for Well-Differentiated Thyroid Carcinoma T0: No evidence of primary tumor T1: T1a: Tumor <1 cm, without extrathyroidal extension T1b: Tumor <1 cm but <2 cm in greatest dimension, without extrathyroidal extension T2: Tumor >2 cm but <4 cm in greatest dimension, without extrathyroidal extension T3: Tumor >4 cm in greatest dimension limited to the thyroid or any size tumor with minimal extrathyroidal extension (e.g., extension into sternothyroid muscle or perithyroidal soft tissues.) T4: T4a: Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve T4b: Tumor of any size invading prevertebral fascia or encasing carotid artery or mediastinal vessels N0: No metastatic nodes N1: N1a: Metastases to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes) N1b: Metastases to unilateral, bilateral, or contralateral cervical (Levels I–V) or retropharyngeal or superior mediastinal lymph nodes (Level VII) M0: No distant metastases M1: Distant metastases .What is ENT - 10. What is the differential diagnosis of thyroid cancers?
• Papillary carcinoma: 70%–80% • Follicular carcinoma: 15%–20% • Hurthle cell carcinoma: 3%–5% • Medullary carcinoma: 3%–10% • Anaplastic carcinoma: less than 2% • Insular or poorly differentiated carcinoma: rare • Other: lymphoma, squamous cell carcinoma, metastases from other sites (renal cell carcinoma, melanoma, breast cancer) What is ENT - What is the recommended follow-up for benign thyroid nodules?
Most authors recommend a follow-up ultrasound for suspicious nodules every 6 months, but this varies per study. The need for repeat FNA due to significant modifications is common. It is NOT advised to use exogenous thyroxine for suppression. |
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