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PATHOPHYSIOLOGY OF THYROID CANCER

MODIFIABLE NON-MODIFIABLE

RADIATION DAMAGE AND FAILURE OF REPAIR DNA INHERITED MUTATION;GENETIC

LOW DIETARY IODINE FEMALE

AGE
MUTATION IN GENOME
HORMONAL CHANGES

ALTERATION IN GENES
INACTIVATION OF TUMOR THAT REGULATE
ACTIVATION OF GROWTH SUPRESSOR GENES APOPTOSIS
PROMOTING ONCOGENES

DECREASED APOPTOSIS

UNREGULATED CELL PROLIFERATION

COLONIAL EXPANSION

TUMOR PROGRESSION

MALIGNANT NEOPLASM

DIFFERENTIATED THYROID CARCINOMAS MEDULLARY THYROID ANAPLASTIC THYROID


CARCINOMAS CARCINOMAS

PAPILLARY CARCINOMAS FOLLICULAR HURTHLE CELL


CARCINOMAS CARCINOMAS
THYROID CANCER  Fine-needle aspiration biopsy (FNAB)
Is a disease in which the cells of the thyroid  Neck ultrasonography
gland become abnormal, grow uncontrollably
 Thyroid radioiodine imaging
and form a mass of cells called a tumor.
 Neck computed tomography scanning
Complication
Signs and symptoms
 Dysphagia
 Painless
 Stridor
 Palpable
 Hormone alteration
 Solitary thyroid nodule
 Distant metastases
 Hard and fixed nodules
Prevention
 Changes to your voice
 Adult and children with and inherited
Causes
gene mutation that increases the risk of
 Inherited gene mutation medullary thyroid cancer are often
advised to have thyroid surgery
 Exposure to radiation in the neck area
(prophylactic thyroidectomy).
 Prolonged secretion of
 To the people who are near in nuclear
thyroid-stimulating hormone (TSH)
power plants may be eligible to receive a
Risk factor medication (potassium iodide)
 Female sex
 Exposure to high levels of radiation Treatment
(childhood)
Surgery
 Certain inherited genetic syndromes
 Removing all or most of the
Diagnosis thyroid (thyroidectomy)
 History taking  Removing lympnodes in the neck
 Physical examination  Removing a portion of the thyroid
 Laboratory evaluation (Thyroidlobectomy)
Serum thyroid-stimulating hormone Risk for thyroid surgery
concentration, serum calcitonin
 Bleeding
/pentagastrin-stimulated calcitonin level
and polymerase chain reaction (PRC)  Infection
 Indirect laryngoscopy
 Damage can also occur to your
parathyroid glands, which can
lead to low calcium levels
 Damage to nerves connected to
your vocal cord, which can cause
vocal cord paralysis, horseness,
soft voice or difficulty breathing.
Thyroid hormone therapy
 After thyroidectomy, thyroid
hormone medication
levothyroxine for life.
Radioactive iodine
 To destroy any remaining healthy
thyroid tissue,after thyroidectomy
External radiation therapy
 May be an option if cancer
continues to grow after radioactive
iodine treatment
Chemotherapy
 Is not commonly used in the treatment of
thyroid cancer but it may benefit some
people who don’t respond to other
therapies.
 Combined with radiation theraphy
Drug theraphy
 Cabozantinib(cometriq)
 Sorafenib(nexavar)
 Vandetanib(caprelsa)
Types of thyroid cancer aggressive and less differentiated than
papillary or follicular cancers. These cancers
Papillary carcinomas are slow-growing, are more likely to spread to lymph nodes and
differentiated cancers that develop from other organs, compared with the more
follicular cells and can develop in one or both differentiated thyroid cancers. They also
lobes of the thyroid gland. This type of frequently release high levels calcitonin and
cancer may spread to nearby lymph nodes in carcinoembryonic antigen (CEA), which can
the neck, but it is generally treatable with a be detected by blood tests.
good prognosis. Under the microscope, the
nuclei of papillary carcinomas cells contain Anaplastic carcinoma is the most
very few proteins and small amount of DNA. undifferentiated type of thyroid cancer,
meaning that it looks the least like normal
Follicular carcinoma is the second most cells of the thyroid gland. As a result, it is a
common type of thyroid cancer, and accounts very aggressive form of cancer that quickly
for approximately one out of 10 cases. It is spreads to other parts of the neck and body.
found more frequently in countries with an
inadequate dietary intake of iodine. Follicular Stages for thyroid cancer
carcinoma is also a differentiated form of
thyroid cancer. In most cases, it is associated Stage I (stage 1 thyroid cancer): The tumor is
with a good prognosis, although it is 2 cm or smaller (less than an inch wide), and
somewhat more aggressive than papillary has not grown outside the thyroid. It has not
cancer. Follicular carcinomas do not usually spread to nearby lymph nodes or distant sites.
spread to nearby lymph nodes, but they are Stage II (stage 2 thyroid cancer): The cancer
more likely than papillary cancers to spread meets one of the following criteria:
to other organs, like the lungs or the bones.
The diameter of the primary tumor ranges
Hürthle cell carcinoma, also known as from 2 to 4 cm. There are no cancer cells in
oxyphil cell carcinoma, is a subtype of regional lymph nodes or distant sites in the
follicular carcinoma, and can often cause body.
immune cell to attack it causing inflammation.
Follicular cells in thyroid become adapt to The primary tumor is larger than four cm in
cellular stress like inflammation by becoming diameter or has started to grow outside of the
hurthle cells. they do so by increase the thyroid gland. No cancer was found in the
production of mitochondria which fills up lymph nodes or other parts of the body
(medullary thyroid cancer only).
their cytoplasm and gives a granular
appearance and stains pink. Stage III (stage 3 thyroid cancer): The cancer
meets one of the following criteria:
Medullary thyroid carcinoma develops
from C cells in the thyroid gland, and is more
The primary tumor is larger than 4 cm, or has may not have been found in regional lymph
grown outside the thyroid, but has not spread nodes, but have not reached distant sites.
to nearby lymph nodes or beyond
(differentiated cancers only). Stage IVC: The cancer cells have spread
beyond the thyroid gland to more distant
The tumor can be any size or be growing parts of the body.
outside the thyroid, and has spread to lymph
nodes in the neck but no farther. Nursing considerations

Stage IV (stage 4 thyroid cancer): This is the  Before surgery, tell the patients to expect
most advanced stage of thyroid cancer, is horseness ( but not voice loss) lasting
further subdivided depending on where the several days after surgery
cancer has spread:  After sugery, provide appropriate post
operative care:
Stage IVA: Cancers at this stage have grown  Keep patient in semi-fowler’s position
beyond the thyroid gland and may have after he regains consciousness make sure
spread into nearby tissue, or they may have his head is neither hyperextended nor
spread to lymph nodes in the neck and upper flexed, to avoid pressure on the suture
chest, but not to distant sites. line.
 Monitor vital sign’s, and then check
Stage IVB: The primary tumor has grown the patient’s dressing neck and back for
into the spine or into nearby large blood bleeding; loosen the dressing and call the
vessels. In this thyroid cancer stage, the physician immidiately if the patient
disease may or may not have spread to lymph complains that the dressings feels tight.
nodes, but has not reached distant sites.  Keep a tracheostomy set and oxygen
equipment handy in case of respiratory
Stage IVC: The thyroid cancer cells have
obstruction
metastasized, or spread to distant sites.
 Check serum calcium levels every 12
Stage IV anaplastic thyroid cancer (stage 4 hrs because hypocalcemia may develop if
anaplastic thyroid cancer): the parathyroid have been removed.
Anaplastic/undifferentiated thyroid cancers  Monitor and observe for potential
are much more aggressive than the other complication such as hemorrhage,
subtypes and are all considered stage IV: hematoma formation, edema of the glottis
and injury to recurrent laryngeal nerve.
Stage IVA: The primary tumor is contained  Teach the patient and family about the
within the thyroid gland, although it may or possible signs and symptoms of possible
may not have spread to nearby lymph nodes. complication and those should be
It has not spread to distant organs. reported.
 Explained to the patient and family
Stage IVB: The tumor has spread outside of the need for rest, relaxation, and nutrition.
the thyroid gland, and cancer cells may or

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