Thyroid_Cancer - Thyroid Carcinoma Vic V. Vernenkar, D.O....

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Thyroid Carcinoma Vic V. Vernenkar, D.O. St. Barnabas Hospital Department of Surgery
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Introduction Infrequent cancer -1% of all cancers Benign diseases common 1200 pts die annually Requires multidisciplinary approach
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Anatomy
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Frequency 17,000 cases diagnosed annually. Women 3 times more than men. Peak incidence 30-40s. Papillary, follicular, medullary, anaplastic, lymphoma, and sarcoma. Papillary 80%, follicular 10%, medullary 5- 10%, anaplastic 1-2%.
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Etiology/Risk Factors Arise from the two cell types in the gland. Follicular cells make papillary, follicular, and anaplastic. C-cells produce medullary. Radiation exposure (papillary). Populations with low dietary iodine have a higher proportion of follicular and anaplastic cancers.
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History Painless, palpable solitary nodule. Nodules are present in 4-7% of population. Most are benign 5% are malignant Age at presentation (>60 and <30) Sex (males) Rapid growth
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History Malignant nodules usually painless Sudden onset pain usually benign. Hoarseness suggests malignancy, nerve involvement. Dysphagia Heat intolerance, palpitations suggest autonomously functioning nodules. Family history (medullary).
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Physical Exam Thorough HEENT exam includes: Thyroid gland Soft tissues of neck Solid, soft, mobile, or fixed? Tenderness? Laryngoscopy if hoarse preop!
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The Goal…. . Differentiate malignant from benign. Determine which patients require intervention. Who can be monitored? Avoid unnecessary surgery .
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Fine Needle Aspiration First intervention in evaluation of a nodule. Inexpensive, easy, few complications. Need a good cytopathologist. Four types of results; Benign, malignant,indeterminate, non-diagnostic . 69% benign, 4% malignant, 10% indeterminate, 17% non-diagnostic. Sensitivity 83%, specificity 92% False positive 2.9%, negative 5.2%
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FNA If non-diagnostic, repeat If malignant go to OR If benign, stop and follow If indeterminate or suspicious OR OK, the path says it’s a “Follicular neoplasm.” FNA can diagnose papillary and medullary cancers Complications of FNA
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Thyroid_Cancer - Thyroid Carcinoma Vic V. Vernenkar, D.O....

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