Thyroid cancer

From Cancer Guidelines Wiki


Recommendation Grade
AYAs presenting with symptoms of tracheal compression including stridor due to thyroid swelling require immediate emergency department admission.
D
Recommendation Grade
AYAs presenting with a thyroid swelling and one or more of the following should be urgently referred to a specialist:
  • A solitary nodule increasing in size
  • A history of neck irradiation
  • A family history of an endocrine tumour
  • Unexplained hoarseness or voice changes
  • Cervical lymphadenopathy


D
Recommendation Grade
AYAs presenting with a thyroid swelling without stridor or any of the features indicated above should be referred by GPs for thyroid function tests. Patients with hyper- or hypothyroidism and an associated goitre are very unlikely to have thyroid cancer and could be referred to an endocrinologist. Those with goitre and normal thyroid function tests should be referred to an endocrinologist.
D
Recommendation Grade
In AYAs presenting with symptoms and/or signs suggestive of thyroid cancer, a referral for an ultrasound investigation may be made, but this should not delay referral to a specialist. Referral for isotope scanning is likely to result in unnecessary delay and is not recommended.
D

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Overview

Symptoms and signs

Thyroid cancer often causes no symptoms.[1] The most common sign is a hard, irregular mass in the neck near the Adam’s apple; cervical lymphadenopathy may be present.[2][3] Symptoms may include hoarseness or voice changes, cough or difficulty in swallowing.[2][1]

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Clinical assessment

Patients with symptoms of tracheal compression including stridor due to thyroid swelling require immediate emergency department admission.

Adolescents and young adults (AYAs) presenting with thyroid swelling along with symptoms and/or signs of cancer, history of neck irradiation or family history of an endocrine tumour should be urgently referred to a specialist.

AYAs presenting with a thyroid swelling without stridor or any of the features indicated above should be referred by general practitioners (GPs) for thyroid function tests (TSH, T3, Free T4).

Other investigations such as ultrasound may be valuable for assessing patients with thyroid cancer,[4] but this should not delay referral to a specialist. Referral for isotope scanning is likely to result in unnecessary delay and is not recommended. FNAC may be a useful preoperative diagnostic tool for thyroid cancer,[5][6] but the patient should be referred to a specialist first.

Patients with hyper- or hypothyroidism and an associated goitre are very unlikely to have thyroid cancer and could be referred to an endocrinologist. Those with goitre and normal thyroid function tests should be referred to an endocrinologist.

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Risk factors

Exposure to ionising radiation is an important risk factor for thyroid cancer;[7] this may be through treatment therapies for conditions such as cancer, acne, tinea or enlarged thymus or environmental sources such as radiation fallout.[1] Thyroid cancer has also been linked to genetic disorders like familial adenomatous polyposis (FAP) and benign thyroid disease.[1]

However, thyroid cancer can occur in AYAs without any of these risk factors.

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References

  1. 1.0 1.1 1.2 1.3 Adolescent and Young Adult Working Party of the Statewide Cancer Clinical Network. South Australian Adolescent and Young Adult Cancer Care Pathway: Optimising outcomes for all adolescent and young adult South Australians with a cancer diagnosis. Adelaide: South Australia Department of Health; 2010.
  2. 2.0 2.1 Bleyer A. CAUTION! Consider cancer: common symptoms and signs for early detection of cancer in young adults. Semin Oncol 2009 Jun;36(3):207-12 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19460578].
  3. National Collaborating Centre for Primary Care. Referral Guidelines for Suspected Cancer. Clinical guideline 27. London: National Institute for Health and Clinical Excellence; 2005.
  4. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 2011 Mar;121(3):487-91 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21344423].
  5. Bagga PK, Mahajan NC. Fine needle aspiration cytology of thyroid swellings: how useful and accurate is it? Indian J Cancer 2014 Oct 31;47(4):437-42 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21131759].
  6. Bargren AE, Meyer-Rochow GY, Sywak MS, Delbridge LW, Chen H, Sidhu SB. Diagnostic utility of fine-needle aspiration cytology in pediatric differentiated thyroid cancer. World J Surg 2010 Jun;34(6):1254-60 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20091309].
  7. Kleinerman RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 2006 Sep;36 Suppl 2:121-5 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16862418].

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