Cancer
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Transcript of Cancer
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TUMORILE MALIGNE ALE TUMORILE MALIGNE ALE GLANDEI TIROIDEGLANDEI TIROIDE
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Epidemiologia si patogenia cancerului tiroidian
•Cancerul tiroidian este cel mai frecvent cancer Cancerul tiroidian este cel mai frecvent cancer
endocrin.endocrin.
•Factorii recunoscuti in oncogeneza cancerului Factorii recunoscuti in oncogeneza cancerului
tiroidian sunt:tiroidian sunt:
•Iradierea Factori de crestere tiroidiana:Iradierea Factori de crestere tiroidiana:
•Virusi oncogeni - TSH, EGFVirusi oncogeni - TSH, EGF
•Factori de risc familiali - IGF1, IGF2Factori de risc familiali - IGF1, IGF2
•Factori genetici si de mediuFactori genetici si de mediu
•Deficitul de iod poate fi asociat cu o crestere a incidenteiDeficitul de iod poate fi asociat cu o crestere a incidentei
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Tumorile maligne tiroidieneTumorile maligne tiroidiene
Tumori epiteliale maligne:Tumori epiteliale maligne:
- Carcinomul papilar- Carcinomul papilar
- Carcinomul folicular- Carcinomul folicular
- Carcinomul cu celule plate - Hürthle - Carcinomul cu celule plate - Hürthle
- Carcinomul medular- Carcinomul medular
- Carcinomul nediferentiat anaplazic- Carcinomul nediferentiat anaplazic
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Tumorile maligne tiroidieneTumorile maligne tiroidieneTumori maligne neepiteliale:Tumori maligne neepiteliale:
FibrosarcomFibrosarcom
Alte tumori neepitelialeAlte tumori neepiteliale
Alte tumori maligne:Alte tumori maligne:CarcinosarcomCarcinosarcom
Limfom malignLimfom malign
HemangioepiteliomHemangioepiteliom
Teratom malignTeratom malign
Tumori secundareTumori secundare
Tumori neclasificabileTumori neclasificabile
Transformari tumoraleTransformari tumorale
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Clasificarea TNM
• T – tumora:• To = tumora nepalpabila
• T1 = tumora < 1 cm
• T2 = tumora < 4 cm
• T3 = tumora > 4 cm nedepasind caspula tiroidiana
• T4 = tumora depasind capsula tiroidiana
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Clasificarea TNM
• N – adenopatia:• No = fara adenopatie
• N1 = adenopatie mobila homolaterala
• N2 = adenopatie mobila bilaterala
• N3 = adenopatie fixa
• M – metastaze• Mo = fara metastaze
• M1 = cu metastaze
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Clasificarea TNM
• Carcinomul medular:• Stadiu I – T1 No Mo
• Stadiu II – T2-T4 No Mo
• Stadiu III – orice T, N1 Mo
• Stadiu IV – orice T, orice N, M1
• Carcinomul nediferentiat:• Toate cazurile sunt stadiu IV
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ANATOMO - PATOLOGIEANATOMO - PATOLOGIE
CARCINOMUL PAPILARCARCINOMUL PAPILAR MICROSCOPICMICROSCOPIC
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ANATOMO - PATOLOGIEANATOMO - PATOLOGIE
CARCINOMUL FOLICULARCARCINOMUL FOLICULAR MICROSCOPICMICROSCOPIC
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ANATOMO - PATOLOGIEANATOMO - PATOLOGIE
CARCINOMUL MEDULARCARCINOMUL MEDULAR HISTOLOGICHISTOLOGIC
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ANATOMO - PATOLOGIEANATOMO - PATOLOGIE
CARCINOMUL ANAPLAZICCARCINOMUL ANAPLAZIC
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Diagnosticul clinic
• Nodul tiroidian
• Evolutie scurta
• Adenopatie cervicala
• Invazia in organele vecine:• Nervul laringeu inferior (recurent)
• Traheea
• Esofag
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Diagnosticul paraclinic
• TSH, TT4, TT3, FT4, FT3
• Anticorpi antitiroidieni
• Tiroglobulina serica
• Calcitonina plasmatica
• Antigenul carcinoembrionar
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Scintigrafia tiroidiana
• Nodul solitar Nodul solitar
nefunctionalnefunctional
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Ecografia tiroidiana
• Adenom tiroidianAdenom tiroidian
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Tomografia computerizata
• Tiroida normala
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Tomografia computerizata
• Degenerare chistica a unui adenom tiroidian drept
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Rezonanta magnetica nucleara
• Tiroida normala
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Rezonanta magnetica nucleara
• Adenom in lobul tiroidian drept
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Alte investigatii
• Punctia tiroidiana cu ac subtire
• Examen ORL
• Radiografia cervicala
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Forme clinice
• Acute = evolutie rapida
• Schiroase = la varstnici
• Latente = evolutie indelungata
• Aberante = pe tiroide ectopice (sd. mediastinal)
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Diagnosticul diferential
• Alte hipertrofii tiroidiene nodulare
• Tiroidita Riedel
• Tiroidita Hashimoto
• Tiroidita subacuta (De Quervain)
• Alte afectiuni generale cu adenopatie cervicala
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Tratament
• Chirurgical
• Hormonoterapie
• Iodoterapie, Radioterapie
• Chimioterapie
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Tratament chirurgical
• Lobectomie totala homolaterala +
lobectomie subtotala controlaterala
• Tiroidectomie aproape totala
• Tiroidectomie totala
• Tiroidectomie totala + disectia radicala a
gatului
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Tratament chirurgical Tiroidectomie totala
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Tratament chirurgical Tiroidectomie totala
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Disectia radicala a gatului
Tratament chirurgical
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Tratament chirurgicalDisectia radicala a gatului
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Curba supravietuirii in cazul carcinomului Curba supravietuirii in cazul carcinomului papilar si a persoanelor normalepapilar si a persoanelor normale
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Curba supravietuirii in cazul carcinomului Curba supravietuirii in cazul carcinomului folicular si a persoanelor normalefolicular si a persoanelor normale
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Curba supravietuirii in cazul carcinomului Curba supravietuirii in cazul carcinomului medular si a persoanelor normalemedular si a persoanelor normale
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Curba supravietuirii in cazul carcinomului Curba supravietuirii in cazul carcinomului anaplazicanaplazic
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