thyroid甲狀腺癌全英文簡版

1、Thyroid CancerShuguang Hospital General Surgery VINCENT RaoTHYROID CANCER 3 what to do with it? TREATMENT 4 HOW BAD IS IT? PROGNOSIS 1 where is it？ ANATOMY 2 why did it happen？ ETIOLOGY 1.Apperance: the largest endocrine glands:butterfly-shaped of two side lobes connected by isthmus .2.Location:belo

2、w the thyroid cartilage,around larynx and trachea。 5 cm long, 3 cm wide and 2 cm thick。top to the middle of thyroid cartilage ,down to the fifth or sixth tracheal ring。 THYROID ANATOMYFrom skin to thyroid：skin superficial fascia（platysma） superficial layer of deep fascia infrahyoid musclesPretrachea

3、l fasciathyroid THYROID ANATOMY 3.Nerves and vessels (both coupled):2 nerves :superior laryngeal nerve + recurrent laryngeal nerve.2 arterys:superior and inferior thyroid arterys3 veins:superior 、middle and inferior thyroid veins.4.Lymphatic drainage: knowing the way how throid cancer cell transfers

4、 is the foundation to lymphadenectomy . THYROID ANATOMYDiagram of cervical lymph node levelsLevel IA : bounded by anterior belly and hyoid bone.Level IB : bounded by the anterior and posterior bellies and the mandible. Level VI (Central compartment lymph nodes):bounded by hyoid bone , the common car

5、otid arteries and the sternum .Although level VI is large in area, the few lymph nodes that it contains are mostly in the paratracheal regions near the thyroid gland.Level VII:superior mediastinum lymph nodes.Diagram of cervical lymph node levelsLevel V： posterior triangle of neckLevel II: bounded b

6、y skull base, stylohyoid muscle, hyoid bone horizontal line and posterior edge of the sternocleidomastoid muscle.Level III :begins at the inferior edge of level II and is bounded by the laryngeal strap muscles anteriorly, by the posterior border of the sternocleidomastoid muscle posteriorly, and by

7、a horizontal plane extending posteriorly from the inferior border of the cricoid cartilage.Level IV :begins at the inferior border of level III and is bounded anteriorly by the strap muscles, posteriorly by the posterior edge of the sternocleidomastoid muscle, and inferiorly by the clavicle.lymph no

8、de metastases of Thyroid cancerStudy shows that :VI is often the first level The second is level III、IVLevel VII、II、V、I is not frequent .THYROID CANCER 3 what to do with it? TREATMENT 4 HOW BAD IS IT? PROGNOSIS 1 where is it？ ANATOMY 2 why did it happen？ ETIOLOGY ETIOLOGYBased on classification :Pap

9、illary thyroid cancer (75% to 85% of cases ) often in young females excellent prognosis. relevant to radiotherapy ,TSH,excessive iodine intake.Follicular thyroid cancer (10% to 20% of cases ) occasionally seen in patients with Cowden syndrome.relevant to iodine deficiency.Medullary thyroid cancer (5

10、%10 to 8% of cases) cancer of the parafollicular cells,relevant to gene.Anaplastic thyroid cancer (Less than 5%10) It is not responsive to treatment and can cause pressure symptoms,could DIE quickly.THYROID CANCER 3 what to do with it? TREATMENT 4 HOW BAD IS IT? PROGNOSIS 1 where is it？ ANATOMY 2 wh

11、y did it happen？ ETIOLOGY DiagnosisTreatmentDIGNOSIS:1.Any throid mass having the following conditions should be considered malignant.General condition ：children(50%) ;male(increased rate); femal (over 60 or under 30). Symptom Sign:painless ;small and hard and fixed solitary nodule;rapid growth(Omin

12、ous sign). Accessory examination：calcification;enlargement of neck lymph nodes.2.Gold standard:pathological examination( fine-needle aspiration biopsy (FNAB).DiagnosisTreatmentTreatmentLet General Surgeons do their jobs.The surgical methods differ from cancer types and lymphatic metastasis .surgical methodType of cancer cellLymphatic metastasisCentral lymph node dissection functional neck dissectionmodified radical neck dissection(MRND)radical neck dissection(RND)Thyroidectomy DiagnosisTreatmentTHYROID CANCER 3 what to do with it? TREATMENT 4 HOW BAD IS IT? PROGNOSIS 1 wh