THYROID CANCER :

Diagnosis and
Management

Ida Marie Tabangay Lim,MD,

FPCS,FPSGS,FPAHNSI,
Fellow UICC
In cid en ce: (2005 Philippine
Cancer Facts and Estimates )
 9th most common for both sexes combined
(3.3%), 15th leading site in men ( 1.5%) and
6th among females (5%)

 In 2005, estimated 3,521 new cases, 755 in

males and 2,766 in females.

 There will be 1,012 deaths, 245 in males and

767 in females.
Estim at es for new cas es and
dea ths for thy roi d canc er in
200 2 (USA)

Shah, 2003
Age an d S ex d istr ibut ion:
( 2005 Philippine Cancer Facts and
Estimates )
 Mostcommon cancer of women at ages
15- 24

 Incidenceamong female residents in the

Philippines is among the highest
observed worldwide
Age an d S ex d istr ibut ion ( USA )

Shah, 2003
Histo lo gic dis trib utio n:
n
Well differentiated
type
Papillary
80 %
Follicular cancer
5 – 10 %
Medullary cancer
5–9%

Anaplastic type
1–2%
Progression of thyroid cancer from
differentiated to anaplastic cancer :
Diagnosis:

History
Exposure to ionizing radiation
( dental x-rays)
Family history
Presence of difficulty swallowing,
breathing, voice changes
Risk s tra tific atio n fo r
ma lig nanc y in a thy ro id
nodu le :
 Prog nostic in dic es utiliz ed
in th yroid c anc er
ma nagem ent
Memorial Mayo Mayo Clinic, Lahey Karolinska
Hospital Clinic, 1993 Clinic Institute
1987
GAMES AGES MACIS AMES DAMES
Grade Age Distant Age DNA
Age Grade Metastasis Metastases Age
Metastases Extension Age Extension Metastases
Extension Size Completeness of Size Extension
Resection
Size Size
Invasion
Size
Risk G ro up C ateg orie s
acco rd in g to Pro gno stic
Facto rs
Struc tu ra l a ss essme nt of a
th yro id n odule:
 Physical Examination

Complete head and neck

examination
Inspection, palpation of
thyroid gland- note its size,
mobility, consistency, fixation
Laryngoscopy to document
mobility of the cords
Palpate for cervical lymph
nodes
Physical examination of the thyroid

From behind From in front

Diag nosis : Bio psy

Fine needle aspiration Cytology :

- hard mass
- mass associated with neck nodes
suspicious for malignancy
 FNAC

FNA

B e n ig n A t y p ic a l o r S u s p ic io u s M a lig n a n t

F o llo w u p S y m p to m s L o b e c to m y T h y r o id e c t o m y
1 year
R epeat FN A

L o b e c to m y
Functio nal as sessme nt o f a
th yro id n odule:
Algo rith m fo r wo rk u p o f a
th yro id m as s : ( MSKC C )
TREATMENT GOALS
Well differentiated cancer
 Cure

Anaplastic cancer
 Diagnosis and airway managemnt
Treatment options

Surgery : Thyroidectomy

Conservative Thyroidectomy vs
Total thyroidectomy
Factors affecting choice of
treatment
Management

Neck dissection:

 Prophylactic neck dissection not

recommended
 If node positive, the most conservative
neck dissection is warranted
Post-op Management
 Thyroid hormone for replacement as well
as suppression
 I 131 whole body scan to detect residual
normal thyroid tissue and/ or metastatic
disease
 I 131 for ablation of residual normal
thyroid tissue and/ or metastatic
disease
 Follow- up physical exam, serum
thyroglobulin levels, I 131 whole body
scans to detect recurrent disease
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