Info
🌱 來自: Huppert’s Notes
Head & Neck Malignancies🚧 施工中
Head & Neck Malignancies
Thyroid cancer
• Diagnosis: Thyroid ultrasound and biopsy
• Risk factors: Older age, M>F, head/neck radiation, MEN2A/B (medullary thyroid cancer)
• Types of thyroid cancer:
- Papillary: 85%. Diagnosis: More aggressive if BRAF-mutated. Treatment: Thyroid lobectomy or total thyroidectomy if >3cm. Adjuvant: TSH suppression therapy, radioiodine therapy for larger tumors, BRAF inhibition if indicated (metastatic disease).
- Follicular: 12%. Malignant follicular cells invade through the fibrous capsule. Diagnosis: RAS mutation in 40% → more aggressive cancers. Treatment: Total thyroidectomy, post-operative iodine ablation.
- Medullary: 1–2%. Malignant proliferation of parafollicular C cells. Elevated calcitonin → deposits as amyloid and stains with congo red. Diagnosis: Hypocalcemia, sometimes ↑calcitonin and CEA. Perform genetic testing for RET mutations and MEN2 syndrome. Treatment: Total thyroidectomy.
- Anaplastic: 1%. Mortality nearly 100%; 90% of patients have invasion of local structures at time of diagnosis (e.g., larynx, trachea, esophagus), which may cause dysphagia, respiratory compromise. Treatment: Surgical resection if possible. If locally advanced inoperable disease, can give concurrent chemotherapy/radiation therapy. BRAF/MEK inhibition if BRAF V600E mutation present.