Endocrine tumors and systems
what level is thyroid cariledege is at?
c4
what is the clinical presentation of thyroid cancer?
palpable neck mass, lesions are suspicious if fixed hard or cause laryngeal nerve paralysis (hoarseness), pain, dysphagia, dyspena, stridor
well differentiated thyroid cancer?
papillary and fillicular
what is the most common thyroid cancer?
papillary and mixed paplillary
Papillary and mixed papillary spread?
papillary-follicular metastasize to regional nodes - 50-70% have cervical lymph nodes at time of diagnosis
lymaphatic drainage is to the __________ nodes
paraaortic
medulla tumors AKA
phenochromcytomas
Where is the pituitary gland located?
sella turcica of the sphenoid bone
what age is most favorable for adrenal tumors?
youth
the pituitary gland is topographically 2.5 cm anterior and superior to the what?
EAM
how do papillary and mixed papillary follocilar respond best?
EBRT
what is done injunction with I131?
EBRT
what is included in the EBRT field when treating thyroid cancer?
Field includes entire thyroid gland, neck and superior mediastinum
chrioid cartilage is at what level?
c6
nonfunctioning pituitary tumors
chromophobe adenomas - tend to be larger than functioning tumors
adrenal gland tumors occur where?
cortex outer portion or medulla inner portion
Hypothyroidism
cretinisim and myxedema
Surgery for microadenoma is usually _____________
curative
how does Anaplastic spread
displays local invasion of structures such as trachea, skin, and regional nodes
What are the prognostic indicators of thyriod cancer?
extend of disease at the time of diagnosis, grade, age and gender.
how are pituitary tumors classified?
functioning or nonfunctioning related to hormone production
prognostic indicators of thyroid cancer?
grade, age,gender
how does Follicular tend to spread?
hematogenously to bone, brain, lung, liver - lymphatic spread is rare
clinical presentation of pituitary tumors?
hormone effects over or under production
what does the adrenal cortex produce?
hormones (cartisol, estrogen and androgen)
graves disease might be caused by
hyperthyroiddism
What is the pituitary gland attached to?
hypothalamus by the infundibulum
what hormones does the thyriod produce?
including thyroxine (T4) and triodothyronin (T3
What is the pituitary gland?
is the master gland - hormonal production under the influence of hypothalamus, which stimulates and inhibits various bodily functions to maintain homeostasis
how are the left and right lobe of the thyriod connected?
isthmus
right and left thyroid lobes are connected by?
isthmus
what is surrounded by the thyroid
jugular veins and carotid arteries, part of the esophagus, the larynx
What is close to the thyriod?
larynx, trachea, esophagus, carotids, jugular vein, vagus nerve
when do we usually find adrenal tumors?
late stages
where are adrenal gland tumors usually found?
left gland
another name for pituitary?
master gland and hypothesis
Size classification
microadenoma (less than 1 cm) and macroadenoma (greater than 1 cm)
what is the posterior lobe called?
neurohypophysis
what images do we use to diagnose thryroid cancer?
nuclear medicine pet ultrasound CT and MRI
what is close to the pituitary gland?
optic nerve
presenting symptom of adrenal cortex tumors?
pain
Pathology for thyroid cacner
papillary and mixed papillary, follicular, medullary, anaplastic
proton therapy is used for what tumors?
pituitary
what regulates the thyroid by the use of TSH and other hormones?
pituitary and hypothalamus
up to 30% of all intracranial malignancies are what?
pituitary tumors
What is all included in the endocrine system?
pituitary, thyriod, adrenal glands, parathyriods, islets of langerhams in pancres
most common symptom of pituitary tumor?
pressure effect- headache
how does thyriod cancer occur?
radiation exposure from Nagasaki, Hiroshima, and Chernobyl and from those treated with radiation for benign diseases - long latent period
thyroid tumors are usually treated by?
radiation i131 and surgery
are anaplastics used for radiosensitive or radioresistant tumors?
radioresistant
when do pituitary tumors occur?
rarely before puberty, usually middle aged to older ages
What does the endocrine system do?
responsible for complex glandular organs responsible for complex metabolic functions
what does the neurohypophysis secrete?
secretes oxytocin and ADH
what is the best pedictor of prognosis for pituitary tumors
size
Prognosis Indicators of adrenal glands
stage at time of diagnosis
where are the adrenal glands?
superior pole of kidneys
modality that increase survival for adrenal gland tumors?
surgery
what is the only modality that increases survival rates for adrenal glad tumors?
surgery and complete resection
anaplastic thyroid cancer is?
the worst prognosis
treatment of thyroid cancer?
thryroid hormonal therapy, surgery, radioactive I131 ablation, EBRT
what makes up the 2% of all cancers
thyriod cancer
what lab tests are used to detect thyroid cancer?
thyriodglobulin and calcitonin levels?
most common cancer of endocrine system
thyroid
what is responsible for regulating the metabolism?
thyroid
what hormones are critical for carbs and protein metabolism?
thyroid hormones
True or false: do we biopsy for thyroid cancer
true
True or false: young people have increased risk for thyriod cancer if they were treaded for HD using mantle field
true
men and women are equally effected by adrenal glands?
true
true or false: functional disorders occur when the hormone production are disrupted
true
what are some symptoms of pituitary tumors?
visual disturbances, headache
is microadenomas usually curative for pituitary glands?
yes
characteristics of EBRT field for pituitary tumor
¡Immobilization devices to tuck chin ¡3-pt setup ¡Small fields 5x5 or so ¡High energy beams ¡Ant with opposed laterals or vertex field ¡4500 cGy
when would EBRT be a good idea?
÷Inoperable lesion ÷Patient physically unfit for surgery ÷Incomplete removal after surgery ÷Superior vena cava syndrome ÷Skeletal mets ÷Residual disease involving trachea, larynx, or esophagus
Pathology of the Pituitary Gland tumors
Sinusoidal, papillary, or diffuse
detection of pituitary tumors
Symptoms from hypo- or hypersecreting of hormones leads to diagnosis of functioning tumor - appropriate lab tests ordered CT and MRI
what foes the adrenal medulla process produce?
epinephrine/ adrenalin
How large is the pituitary gland?
1.3 cm
what percent of tumors are malignant when talking about adrenal glands?
10%
proton therapy for pituitary
Accurate dose delivery within mm of target because of Bragg Peak effect - spares the optic nerve
how many lobes does the pituitary gland have?
2
How many adrenal glands tumors are there a year?
300-400 very rare
median age for adrenal glands
50 years
what is the dose and fractions for EBRT when treating thyroid cancer?
6500cGy in 7 weeks
rt alone for pituitary tumors has what survival rate?
85% at 5 and 10 years
what 7 horomones are produced by the pituitary gland?
Adenohypophysis forms glandular portions and secretes 7 hormones - GH, PRL, TSH, FSH, LH, MSH, ACTH - released by chemical secretions from the hypothalamus
worst thyroid cancer?
Anaplastic
hyperthyroidism
Graves disease, goiter
steriotactic radiosurgery
High energy photon beam with multiple ports of entry convergent on target Can be done with linac, gamma knife, or cyberknife
what radioactive atoms are used for thyriod cancer?
I131 or I125
why would we use radioactive atoms?
Inoperable primary ÷Thyroid capsular invasion ÷Done after partial surgery ÷Postoperative residual or recurrent disease ÷Cervical or mediastinal node mets ÷Distant mets
thyriod cancer
Most common of the endocrine malignancies
treatment goal for pituitary tumors
Primary goal is to normalize hormone function or relieve pressure effects Secondary goal is to prevent recurrence
functioning pituitary tumors
Prolactin-secreting tumors most common, then GH, TSH, and ACTH secreting tumors
what is thyroid hormonal therapy?
Thyroid hormone suppression therapy is routinely used for differentiated thyroid cancers. Differentiated thyroid cancers grow under stimulation of TSH. Lowering TSH levels should decrease tumor activity. Effectiveness remains unknown.
surgery for thyroid cancer
Thyroidectomy or lobectomy with radical neck dissection for unfavorable pathology
What is important about grade when dealing with thryiod cancer?
Well differentiated thyroid carcinoma (papillary and follicular) have better prognosis than do those with undifferentiated carcinoma (anaplastic)
what do we use to avoid exposure to mouth, waire around palpable tumor?
aquaplast mask
pituitary tumors are usually benign or malignant?
benign
how does Medullary spreads?
blood or lymph