甲状腺癌读书报告.pptVIP

Thyroid cancer report Operation extent: primary site To differentiated thyroid cancer 1.one lobe invovled: lobectomy + isthmusectomy 2.two lobes invovled:preserve small part of inferior or superior part Postoperative management of differentiated thyroid cancer: 1.131I ablation and thyroid hormone suppretion 2.external radiation for residual disease 3.Detecting thyroglobulin and 131I for followup Prophylactic thyroidectomy in multile endocrine neoplasia: Ret proto-oncogene ,located on chromosome 10q11.2, Mutation at exon 10.11,codon634 mutation for MEN2A FMTC, Prophylactic thyroidectomy at the age of 4-6 years Mutation at exon 16,codon 918 mutation for MEN2B, Prophylactic thyroidectomy by the age of one year Treatment principle of MTC: 1.clinicallly evident MTC:total thyroidectomy primary tumor 1CM and central nodes positive,ipsilateral neck dissection 2. Prophylactic contralateral neck dissection When primary tumor is bilateral and there is extensive lymphadenopathy and MEN2B 6.persistent or recurrent MTC should have a complete thyroidectomy and bilateral central and nek dissection 7.bone metastasis should be resected if possible,RT for unresected one 8.localized pulmonary metastasis should be resected Ttreatment principle of anaplastic cancer eradication by complete surgical resection Followed by concurrent doxorubicin-based Chemotherapy and RT Follicular variant of PTC the clinical behavior is similar to pure PTC,and completely different from FTC Bone metastasis of differentiated thyroid cancer localized one : surgery + 131I or RT multiple ones : 131I Treatment of brain matastases from thyroid cancer 1.solitary one :surgery,radiosurgery when high risk for surgery 2.multiple lesions: whole brain radiation 3.radioactive iodine therapy when the lesions can take iodine , cerebral edema INDICATION for total thyroidectomy: 1.cancer involving two lobes 2.distal metastasis and need 131I therapy 3.LNM in two si