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甲狀腺癌報(bào)告

Thyroidcancerreport甲狀腺癌報(bào)告Operationextent:

primarysiteTodifferentiatedthyroidcancer1.onelobeinvovled:lobectomy+isthmusectomy2.twolobesinvovled:preservesmallpartofinferiororsuperiorpart甲狀腺癌報(bào)告Postoperativemanagementofdifferentiatedthyroidcancer:1.131Iablationandthyroidhormonesuppretion2.externalradiationforresidualdisease3.Detectingthyroglobulinand131Iforfollowup甲狀腺癌報(bào)告Prophylacticthyroidectomyinmultileendocrineneoplasia:Retproto-oncogene,locatedonchromosome10q11.2,Mutationatexon10.11,codon634mutationforMEN2AFMTC,Prophylacticthyroidectomyattheageof4-6yearsMutationatexon16,codon918mutationforMEN2B,Prophylacticthyroidectomybytheageofoneyear甲狀腺癌報(bào)告TreatmentprincipleofMTC:1.clinicalllyevidentMTC:totalthyroidectomyprimarytumor>1CMandcentralnodespositive,ipsilateralneckdissection2.ProphylacticcontralateralneckdissectionWhenprimarytumorisbilateralandthereisextensivelymphadenopathyandMEN2B甲狀腺癌報(bào)告3.postoperativeradiationforresidualdisease4.ProphylacticthyroidectomyforhereditalMTC5.elevatedbasalorstimulatedplasmacalcitoninLevelandintrathyroidalnoduleonultrasoundatotalthyroidectomyandcentralneckdissectionshouldbedone

甲狀腺癌報(bào)告6.persistentorrecurrentMTCshouldhaveacompletethyroidectomyandbilateralcentralandnekdissection7.bonemetastasisshouldberesectedifpossible,RTforunresectedone8.localizedpulmonarymetastasisshouldberesected甲狀腺癌報(bào)告Ttreatmentprincipleofanaplasticcancer

eradicationbycompletesurgicalresectionFollowedbyconcurrentdoxorubicin-basedChemotherapyandRT甲狀腺癌報(bào)告FollicularvariantofPTC

theclinicalbehaviorissimilartopurePTC,andcompletelydifferentfromFTC甲狀腺癌報(bào)告Bonemetastasisofdifferentiatedthyroidcancer

localizedone:surgery+131IorRTmultipleones:131I甲狀腺癌報(bào)告Treatmentofbrainmatastasesfromthyroidcancer1.solitaryone:surgery,radiosurgerywhenhighriskforsurgery2.multiplelesions:wholebrainradiation3.radioactiveiodinetherapywhenthelesionscantakeiodine,cerebraledema甲狀腺癌報(bào)告INDICATIONfortotalthyroidectomy:1.cancerinvolvingtwolobes2.distalmetastasisandneed131Itherapy3.LNMintwosides甲狀腺癌報(bào)告Treatmentoflaryngotrachealinvasionbywelldifferentiatedthyroidcancer:Localshaving-off,partiallaryngotrachealresectionwithSCMmyoperiostealflap,sleevetrachealresection,completelaryngectomyNakedclearancecanhavegoodresult,RTforresidualone甲狀腺癌報(bào)告Follow–up:differentiatedthyroidcancer：

thyroglobulin+131I,thyroglobulin+131I（-）In-octreotide，

FDG-PET（Tsh)甲狀腺癌報(bào)告EitherbasalTglevelishighorTgAbincreases,131IisneededTgmesurementshouldbeafterthyroxineWithdrawlorrhTshstimulationrhTshissuggestedforpatientswhodonotrespondtohormonewithdrawlorcannottoleratehypothyroidismTg>2mg/Lissufficientsensitive甲狀腺癌報(bào)告TgmRNA

inbloodismoresensitivemakerformetastaticdiseasethanTgAndisunaffectedbyanti-TgantibodiesNoneedforthyroidwithdrawlandTshstimulation甲狀腺癌報(bào)告SentinelLNinthyroidcancer:MoresensitivityandspectivityLNMareofdebatableprognosticvalueSLNappearslessthanpromissingResidualLNMisassociatedwithlocalrecurrencewhereasdistantmetastasisiscorrelaredwithpoorersurvivalrates甲狀腺癌報(bào)告ThyroidneoplasmafterradiationduringchildhoodoradolecenceIncidence:33%,1/3oftheselesionsaremalignentDose-responserelationwaslinearuntilthehighestdose(>1000cGY)Interval:6-30yearsThemajorityinanonaggressivefashion甲狀腺癌報(bào)告DedifferentiationofdifferentiatedcancerThosewithmetastasis,1/3arededifferentiaedSomemakers:1.P53:promtepatientsintolowergradeofDedifferentiation2.p16INK4A

:hypermethylationofpromotorregionisafrequentandanearlyeventduringthyroidcarcinogenesisandisassociatedwithtumorprogressionanddedifferetiation甲狀腺癌報(bào)告3.CyclinG2:acyclinnegativelydregulatingcellcycleprogessionlackofCyclinG2malignanttransformationofPTC4.KAL1:ametastasissuppressorgene,ralatedtotheprogressionofPTC5.COX2:up-regulationmaycontributepredominantlyintheearlyphaseofPTCprogression甲狀腺癌報(bào)告6.IL-4,IL-10:increaseBcl-2Bcl-xllevelspromoteprogressionandresistancetochemotherapy,newtheraputictargetsforthetreatmentofthyroidcancer

甲狀腺癌報(bào)告Othermarkers:1.CD44v6:inherencemolecularParticipateininfiltrationandmetastasispoorprognosis2.VEGF-C:promoteproliferationofLymphatic,highexpressionindicateshighLNM,genetherapy甲狀腺癌報(bào)告3.CD10:amembrane-boundzincmetalloproteinaseCD10wasnotdetectedinnormalthyroidtissue,benignlesionsandpurePTCHighexpressioninFTCandFollicularvariantofPTC4.Id-1:memberofIdhelix-loop-helixproteinsKeyregulatorsofcellgrowthanddifferentiationOverexpressedinPTC,甲狀腺癌報(bào)告5.Gadd45:Gadd45fammilyproteinshavebeenimplicatedinavarietyofgrowth-regulatorymechanism.significantlylowerleverinanaplastincanceradenovirus-mediatedreexpressionofGadd45gammasignificantlyinhibitedprolificationofanaplastincancercells-------genetherapy甲狀腺癌報(bào)告6.AdhTERTtk:hTERT:humantelomerasereversetranscriptaseToobtainrestrictedexpressionofasuicidegeneOnlyintumorGCVgenetherapyforanaplastincancer甲狀腺癌報(bào)告7.Ras-Raf-MEK-MAPKpathway:thepathwaytransmitsamitogenicsignaltothenucleus,andactivationofthepathwayisthoughttoPromoteuncontrolledcelldivision甲狀腺癌報(bào)告8.HS90(heatshockprotein):playsacriticalroleintumorcellgrowthandsurvivalGeldanamycin:aspecificinhibitor,9.p70S6KandAkt:arekinasesdowns

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