What is Endocrinology - Should radioiodine be administered to all thyroid cancer patients?7/31/2022 What is Endocrinology - Should radioiodine be administered to all thyroid cancer patients?
No. Patients with distant metastases, tumours with obvious extrathyroidal extension, and tumours greater than 4.0 cm are recommended for radioiodine therapy. For unifocal tumours less than 1.0 cm, radioiodine therapy is not advised because there is no documented survival benefit or recurrence risk reduction. Patient-specific selection is suggested when deciding whether to employ radioiodine therapy for thyroid cancers of medium size.
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What is Endocrinology - What function does radioactive iodine play in the treatment of thyroid cancer?
After a thyroidectomy, radioiodine can be used to remove any remaining thyroid tissue and is sometimes used as adjuvant therapy to treat nearby lymph nodes or distant metastases. What is Endocrinology - . What factors into the initial surgical procedure's scope?
The final surgery for thyroid cancer should be the first one. The degree of lymph node metastases in the anterior lateral cervical lymph node chains can be determined by preoperative neck ultrasonography (US). Due to its ability to distinguish malignant lymph node characteristics beyond their size, ultrasound (US) is superior than computed tomography (CT) and magnetic resonance imaging (MRI). A near-total thyroidectomy with lymph node excision is the preferred surgery for thyroid cancer that has already spread to lymph nodes and is more than 1 cm in size. A hemithyroidectomy might be sufficient if the main tumour is less than 1 cm. It is debatable if prophylactic central neck lymph node removal is necessary because there aren't any research showing that it improves survival (prophylactic because central neck lymph nodes cannot be seen with an intact thyroid in place). What is Endocrinology - How is thyroid cancer primarily treated?
The main course of treatment is surgical resection. The surgeon's experience is the best indicator of a successful procedure (cancer removal and avoidance of problems). Practices that perform many thyroidectomies regularly produce great results with low complication rates. What is Endocrinology - How frequently do metastases happen?
Adults may experience localised lymph node metastases as frequently as 30% to 60% of the time, although distant metastases are far less common, occurring in only 2% to 4% of individuals. The manifestation of paediatric thyroid carcinoma is more severe. In 60 to 80 percent of these patients, there are local lymph node metastases, and in 10 to 20 percent of patients, there are distant metastases. What is Endocrinology - How do follicular thyroid cancer (FTC) and papillary thyroid cancer (PTC) often spread?
Local and regional lymph nodes are often where PTC spreads. The lungs, with basilar miliary dissemination, are the most typical site of distant metastases outside of the neck. FTC typically has a high risk of bone metastases and hematogenous dissemination. Any type of aggressive thyroid cancer has the potential to directly invade or extend into the fascia, muscle, and extrathyroidal soft tissue. What is Endocrinology - How are thyroid cancer diagnoses and prognoses affected by molecular markers?
The use of molecular markers that can be detected in thyroid biopsy aspirates has improved practitioners' capacity to identify malignancy in thyroid nodules with uncertain FNA cytology (average malignancy risk ,25 percent ). There are two commercial tests that estimate the likelihood of developing cancer using various techniques. The Veracyte, Inc.-developed Afirma test uses microarray analysis on a gene set with a high negative predictive value (NPV) of 93% and a 40%–50% positive predictive value (PPV) for suspicious nodules. With the use of this test, it is possible to predict benign lesions and prevent needless diagnostic surgery. The miRInform test by Asuragen, Inc. examines thyroid nodule aspirates for particular RNA fusion transcripts (RET/PTC1, RET/PTC3, and PAX8/PPARg) and DNA mutation markers (KRAS, HRAS, NRAS, and BRAF mutations) that are specific for thyroid cancer. Although benign follicular adenomas can also harbour RAS mutations, thyroid carcinoma is the disease for which they have a PPV of about 85%. The remaining markers in this panel are all functionally 100% predicative of cancer. However, because thyroid tumours may have genetic mutations that are missed by this test, their sensitivity is rather low. Compared to other mutations discovered in differentiated thyroid cancer (DTC), BRAF is present in between 30 and 60 percent of papillary thyroid cancer (PTCs) and is associated with worse overall prognosis, lymph node metastases, radioiodine resistance, and more local invasion. What is Endocrinology -Between Papillary Thyroid Carcinoma (PTC) and Follicular Thyroid Carcinoma (FTC), which is simpler to diagnose using thyroid fine-needle aspiration (FNA) data?
PTC possesses unique nuclear characteristics that enable cytopathology diagnosis with a positive predictive value (PPV) greater than 95%, such as larger, overlapping nuclei with nuclear grooves, and intranuclear pseudoinclusions. On the other hand, FTC is functionally defined as the invasion of follicular cells that mainly appear normal via a tumour capsule. Pure FTC is challenging to detect based on thyroid FNA because this cannot be determined on a cytology aspirate. What is Endocrinology - What are the various Differentiated Thyroid Cancer (DTC) formats?7/31/2022 What is Endocrinology - What are the various Differentiated Thyroid Cancer (DTC) formats?
About 80% of thyroid cancer cases are Papillary thyroid cancer ( PTC), the most prevalent type of DTC. The follicular variant of PTC (FVPTC) and more uncommonly aggressive subtypes of PTC, such as the tall cell variant, the sclerosing variant, and other poorly differentiated forms of PTC, are all classified as PTC. Follicular Thyroid Cancer (FTC,) the second most prevalent type of DTC, accounting for 10% to 15% of thyroid cancer cases globally, while this percentage may be lower in regions with abundant iodine. Finally, in comparison to other types of DTC, pure Hürthle cell carcinomas have invasive follicular cells that exhibit a characteristic oxyphilic alteration and may be highly radioiodine resistant. . What is Endocrinology - What are the thyroid cancer risk factors?
In the absence of an inherited genetic condition like multiple endocrine neoplasia type 2 (MEN2), family history and exposure to ionising radiation, particularly when young, are the main risk factors (, 15 years old). In the years following the Chernobyl nuclear accident, studies revealed a dose-related thyroid cancer exposure risk that was 5- to 20-fold higher than in children who had not been exposed. An additional risk factor could have been a relative iodine shortage. |
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