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THYROID CANCER - PAPILLARY CARCINOMA

  BY: DR.FARIS MOHSIN AL-ABEEDI
Papillary carcinoma is a relatively
common well-differentiated thyroid
cancer. Papillary/follicular carcinoma
must be considered a variant of
papillary thyroid carcinoma (mixed
form). Despite its well-differentiated
characteristics, papillary carcinoma
may be overtly or minimally invasive.
In fact, these tumors may spread
easily to other organs. Papillary
tumors have a propensity to invade
lymphatics but are less likely to
invade blood vessels. Papillary
carcinoma appears as an irregular
solid or cystic mass in a normal
CHARACTERISTICS OF PAPILLARY THYROID
CANCER
*Peak onset ages are 30 to 50 years old.

*Papillary thyroid cancer is more common in females than in males
by a 3:1 ratio.

*The prognosis directly related to tumor size. (Less than 1.5 cm
[1/2 inch] is a good prognosis.)

*This cancer accounts for 85% of thyroid cancers due to radiation
exposure.

*In more than 50% of cases, it spreads to lymph nodes of the neck.

*Distant spread (to lungs or bones) is uncommon.
The overall cure rate is very high (near 100% for small lesions in
young patients).
CAUSES
About 80% of all thyroid cancers diagnosed in the United States are
papillary carcinoma type. It is more common in women than in
men. It may occur in childhood, but is most often seen in adults
around the
age of 45.

The cause of this cancer is unknown. A genetic defect may be
involved.

Radiation increases the risk of developing thyroid cancer. Exposure
may occur from:

*High-dose external radiation treatments to the neck, especially
during childhood, used to treat childhood cancer or some benign
childhood conditions.

*Radiation due to atomic bomb testing in the Marshall Islands and the
1986 Chernobyl nuclear disaster in the Ukraine, mostly in children.

*Radiation given through a vein (through an IV) during medical tests
and treatments does not increase the risk of developing thyroid
EXAMS AND TESTS

If you have a lump on your thyroid, your doctor
will order blood tests and possibly
an ultrasound of the thyroid gland, CT scan
If the ultrasound shows that the lump is bigger
than 1.0 centimeter, a special biopsy called
a fine needle aspiration (FNA) will be performed.
This test helps determines if the lump is
cancerous.
Thyroid function tests are usually normal in
patients with thyroid cancer.
Thyroid cancer /  papillary carcinoma (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)
Thyroid cancer /  papillary carcinoma (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)
This CT scan shows a thyroid cancer tumor in the
throat, encircling, narrowing, and displacing the
windpipe (trachea).
SYMPTOMS

Thyroid cancer usually begins as a small
lump (nodule) in the thyroid gland, which
is located at the center part of the front of
the neck.
While some small lumps may be
cancer, most thyroid nodules are
harmless and are not cancerous.
Most of the time, there are no other
symptoms.
Micrograph of papillary thyroid carcinoma demonstrating
prominentpapillae with fibrovascular cores. H&E stain.
Micrograph showing that the papillae in papillary thyroid
carcinoma are composed of cuboidal cells. H&E stain.
Micrograph (high power view) showing nuclear changes in
papillary thyroid carcinoma (PTC), which include groove
formation, optical clearing, eosinophilic inclusions and
Treatment
 There are three types of thyroid cancer treatment:
 *Surgery
 *Radioactive iodine
 *Medication

 Surgery is done to remove as much of the cancer as possible. The bigger
 the lump, the more of the thyroid gland must be removed. Frequently, the
 entire gland is taken out.
 After the surgery, most patients should receive radioactive iodine, which is
 usually taken by mouth. This substance kills any remaining thyroid tissue. It
 also helps make medical images more clear, so doctors can see if there is
 any additional cancer.

 If surgery is not an option, external radiation therapy can be useful.
 After surgery or radioactive iodine, the patient will need to take medication
 called levothyroxine sodium for the rest of their life. This replaces the
 hormone that the thyroid would normally make
Other follow-up


Most patients who had thyroid cancer need
to a blood test every 6 - 12 months to
check thyroid levels. Other follow-up tests
that may done after treatment for thyroid
cancer include:
Ultrasound of the thyroid done in the first
year
An imaging test called a radioactive iodine
(PROGNOSIS)

The survival rate for papillary thyroid cancer is
excellent. More than 95% of adults with such cancer
survive at least 10 years.
 The prognosis is better for patients younger than 40
and for those with smaller tumors.

The following factors may decrease the survival rate:
*Age over 45
*Cancer has spread to distant parts of the body
*Cancer has spread to soft tissue
*Large tumor
DIFFERENTIAL DIAGNOSIS

De Quervain Thyroiditis
Goiter
Goiter, Nontoxic
Goiter, Toxic Nodular
Graves Disease
Hurthle Cell Carcinoma
Thyroid Lymphoma
Thyroid Nodule
Thyroid, Anaplastic Carcinoma
Thyroid, Follicular Carcinoma
Thyroid, Medullary Carcinoma

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Thyroid cancer / papillary carcinoma (Doctor Faris Alabeedi MSc, MMedSc, PgDip, BDS.)

  • 1. THYROID CANCER - PAPILLARY CARCINOMA BY: DR.FARIS MOHSIN AL-ABEEDI
  • 2. Papillary carcinoma is a relatively common well-differentiated thyroid cancer. Papillary/follicular carcinoma must be considered a variant of papillary thyroid carcinoma (mixed form). Despite its well-differentiated characteristics, papillary carcinoma may be overtly or minimally invasive. In fact, these tumors may spread easily to other organs. Papillary tumors have a propensity to invade lymphatics but are less likely to invade blood vessels. Papillary carcinoma appears as an irregular solid or cystic mass in a normal
  • 3. CHARACTERISTICS OF PAPILLARY THYROID CANCER *Peak onset ages are 30 to 50 years old. *Papillary thyroid cancer is more common in females than in males by a 3:1 ratio. *The prognosis directly related to tumor size. (Less than 1.5 cm [1/2 inch] is a good prognosis.) *This cancer accounts for 85% of thyroid cancers due to radiation exposure. *In more than 50% of cases, it spreads to lymph nodes of the neck. *Distant spread (to lungs or bones) is uncommon. The overall cure rate is very high (near 100% for small lesions in young patients).
  • 4. CAUSES About 80% of all thyroid cancers diagnosed in the United States are papillary carcinoma type. It is more common in women than in men. It may occur in childhood, but is most often seen in adults around the age of 45. The cause of this cancer is unknown. A genetic defect may be involved. Radiation increases the risk of developing thyroid cancer. Exposure may occur from: *High-dose external radiation treatments to the neck, especially during childhood, used to treat childhood cancer or some benign childhood conditions. *Radiation due to atomic bomb testing in the Marshall Islands and the 1986 Chernobyl nuclear disaster in the Ukraine, mostly in children. *Radiation given through a vein (through an IV) during medical tests and treatments does not increase the risk of developing thyroid
  • 5. EXAMS AND TESTS If you have a lump on your thyroid, your doctor will order blood tests and possibly an ultrasound of the thyroid gland, CT scan If the ultrasound shows that the lump is bigger than 1.0 centimeter, a special biopsy called a fine needle aspiration (FNA) will be performed. This test helps determines if the lump is cancerous. Thyroid function tests are usually normal in patients with thyroid cancer.
  • 8. This CT scan shows a thyroid cancer tumor in the throat, encircling, narrowing, and displacing the windpipe (trachea).
  • 9. SYMPTOMS Thyroid cancer usually begins as a small lump (nodule) in the thyroid gland, which is located at the center part of the front of the neck. While some small lumps may be cancer, most thyroid nodules are harmless and are not cancerous. Most of the time, there are no other symptoms.
  • 10. Micrograph of papillary thyroid carcinoma demonstrating prominentpapillae with fibrovascular cores. H&E stain.
  • 11. Micrograph showing that the papillae in papillary thyroid carcinoma are composed of cuboidal cells. H&E stain.
  • 12. Micrograph (high power view) showing nuclear changes in papillary thyroid carcinoma (PTC), which include groove formation, optical clearing, eosinophilic inclusions and
  • 13. Treatment There are three types of thyroid cancer treatment: *Surgery *Radioactive iodine *Medication Surgery is done to remove as much of the cancer as possible. The bigger the lump, the more of the thyroid gland must be removed. Frequently, the entire gland is taken out. After the surgery, most patients should receive radioactive iodine, which is usually taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images more clear, so doctors can see if there is any additional cancer. If surgery is not an option, external radiation therapy can be useful. After surgery or radioactive iodine, the patient will need to take medication called levothyroxine sodium for the rest of their life. This replaces the hormone that the thyroid would normally make
  • 14. Other follow-up Most patients who had thyroid cancer need to a blood test every 6 - 12 months to check thyroid levels. Other follow-up tests that may done after treatment for thyroid cancer include: Ultrasound of the thyroid done in the first year An imaging test called a radioactive iodine
  • 15. (PROGNOSIS) The survival rate for papillary thyroid cancer is excellent. More than 95% of adults with such cancer survive at least 10 years. The prognosis is better for patients younger than 40 and for those with smaller tumors. The following factors may decrease the survival rate: *Age over 45 *Cancer has spread to distant parts of the body *Cancer has spread to soft tissue *Large tumor
  • 16. DIFFERENTIAL DIAGNOSIS De Quervain Thyroiditis Goiter Goiter, Nontoxic Goiter, Toxic Nodular Graves Disease Hurthle Cell Carcinoma Thyroid Lymphoma Thyroid Nodule Thyroid, Anaplastic Carcinoma Thyroid, Follicular Carcinoma Thyroid, Medullary Carcinoma