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
Papillary carcinomas are slow-growing,
differentiated cancers that develop from
follicular cells and can develop in one or both
lobes of the thyroid gland. This type of
cancer may spread to nearby lymph nodes in
the neck, but it is generally treatable with a
good prognosis. Under the microscope, the
nuclei of papillary carcinomas cells contain
very few proteins and small amount of DNA.
Follicular carcinoma is the second most
common type of thyroid cancer, and accounts
for approximately one out of 10 cases. It is
found more frequently in countries with an
inadequate dietary intake of iodine. Follicular
carcinoma is also a differentiated form of
thyroid cancer. In most cases, it is associated
with a good prognosis, although it is
somewhat more aggressive than papillary
cancer. Follicular carcinomas do not usually
spread to nearby lymph nodes, but they are
more likely than papillary cancers to spread
to other organs, like the lungs or the bones.
Hürthle cell carcinoma, also known as
oxyphil cell carcinoma, is a subtype of
follicular carcinoma, and can often cause
immune cell to attack it causing inflammation.
Follicular cells in thyroid become adapt to
cellular stress like inflammation by becoming
hurthle cells. they do so by increase the
production of mitochondria which fills up
their cytoplasm and gives a granular
appearance and stains pink.
Medullary thyroid carcinoma develops
from C cells in the thyroid gland, and is more
aggressive and less differentiated than
papillary or follicular cancers. These cancers
are more likely to spread to lymph nodes and
other organs, compared with the more
differentiated thyroid cancers. They also
frequently release high levels calcitonin and
carcinoembryonic antigen (CEA), which can
be detected by blood tests.
Anaplastic carcinoma is the most
undifferentiated type of thyroid cancer,
meaning that it looks the least like normal
cells of the thyroid gland. As a result, it is a
very aggressive form of cancer that quickly
spreads to other parts of the neck and body.
Stages for thyroid cancer
Stage I (stage 1 thyroid cancer): The tumor is
2 cm or smaller (less than an inch wide), and
has not grown outside the thyroid. It has not
spread to nearby lymph nodes or distant sites.
Stage II (stage 2 thyroid cancer): The cancer
meets one of the following criteria:
The diameter of the primary tumor ranges
from 2 to 4 cm. There are no cancer cells in
regional lymph nodes or distant sites in the
body.
The primary tumor is larger than four cm in
diameter or has started to grow outside of the
thyroid gland. No cancer was found in the
lymph nodes or other parts of the body
(medullary thyroid cancer only).
Stage III (stage 3 thyroid cancer): The cancer
meets one of the following criteria:
The primary tumor is larger than 4 cm, or has
grown outside the thyroid, but has not spread
to nearby lymph nodes or beyond
(differentiated cancers only).
The tumor can be any size or be growing
outside the thyroid, and has spread to lymph
nodes in the neck but no farther.
Stage IV (stage 4 thyroid cancer): This is the
most advanced stage of thyroid cancer, is
further subdivided depending on where the
cancer has spread:
Stage IVA: Cancers at this stage have grown
beyond the thyroid gland and may have
spread into nearby tissue, or they may have
spread to lymph nodes in the neck and upper
chest, but not to distant sites.
Stage IVB: The primary tumor has grown
into the spine or into nearby large blood
vessels. In this thyroid cancer stage, the
disease may or may not have spread to lymph
nodes, but has not reached distant sites.
Stage IVC: The thyroid cancer cells have
metastasized, or spread to distant sites.
Stage IV anaplastic thyroid cancer (stage 4
anaplastic thyroid cancer):
Anaplastic/undifferentiated thyroid cancers
are much more aggressive than the other
subtypes and are all considered stage IV:
Stage IVA: The primary tumor is contained
within the thyroid gland, although it may or
may not have spread to nearby lymph nodes.
It has not spread to distant organs.
Stage IVB: The tumor has spread outside of
the thyroid gland, and cancer cells may or
may not have been found in regional lymph
nodes, but have not reached distant sites.
Stage IVC: The cancer cells have spread
beyond the thyroid gland to more distant
parts of the body.
Nursing considerations
 Before surgery, tell the patients to expect
horseness ( but not voice loss) lasting
several days after surgery
 After sugery, provide appropriate post
operative care:
 Keep patient in semi-fowler’s position
after he regains consciousness make sure
his head is neither hyperextended nor
flexed, to avoid pressure on the suture
line.
 Monitor vital sign’s, and then check
the patient’s dressing neck and back for
bleeding; loosen the dressing and call the
physician immidiately if the patient
complains that the dressings feels tight.
 Keep a tracheostomy set and oxygen
equipment handy in case of respiratory
obstruction
 Check serum calcium levels every 12
hrs because hypocalcemia may develop if
the parathyroid have been removed.
 Monitor and observe for potential
complication such as hemorrhage,
hematoma formation, edema of the glottis
and injury to recurrent laryngeal nerve.
 Teach the patient and family about the
possible signs and symptoms of possible
complication and those should be
reported.
 Explained to the patient and family
the need for rest, relaxation, and nutrition.