[PDF] - E so pha g us Sto ma c h 4/ 2/ 15 Collecting Cancer Data: Larynx PDF Document

SLIDE 1

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 1

Collecting Cancer Data: Larynx & Thyroid

2014-2015 NAACCR We b ina r Se rie s Ma y 7, 2015

Q&A

Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r

c o nte nt thro ug h the Q&A pa ne l. Re minde r:

I

f yo u ha ve pa rtic ipa nts wa tc hing this we b ina r a t yo ur site , ple a se c o lle c t the ir na me s a nd e ma ils.

We will b e distrib uting a Q&A do c ume nt in a b o ut o ne we e k.

T his do c ume nt will fully a nswe r q ue stio ns a ske d during the we b ina r a nd will c o nta in a ny c o rre c tio ns tha t we ma y disc o ve r a fte r the we b inar.

2

F ABUL OUS PRIZE S

3

SLIDE 2

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 2

L ARYNX

4

ANAT OMY

Site
Glo ttis
Sub site
T

rue Vo c a l Co rds

Ante rio r Co mmissure s
Po ste rio r Co mmissure s
Site
Sub g lo ttis
Sub site
No ne

5

Site
Supra g lo ttis
Sub site
Supra hyo id e pig lo ttis
F

a lse Vo c a l Co rds

Ve ntric le s
Arye pig lo ttic fo lds
a ryte no ids

ANAT OMY

6

http:/ / e n.wikipe dia .o rg / wiki/ Pha rynx# / me dia / F ile :I llu01_he a d_ne c k.jpg

SLIDE 3

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 3

Image Source: SEER Training Website

Supra g lo ttis 30-35% Sub g lo ttis 5% Glo ttis 60-65%

L ARYNX

Supra g lo ttis
E

pig lo ttis

Supra hyo id
Infra hyo id
Arye pig lo ttic fo lds
Ve ntric ula r b a nds

(F a lse Vo c a l Co rds)

Ve ntric ula r fo lds
a ryte no ids

8

SQUAMOUS CE L L CARCINOMA

Ne a rly a ll la ryng e a l c a rc ino ma s o f the la rynx a re

e pithe lia l

Prima rily sq ua mo us c e ll c a rc ino ma
Othe r type s o f e pithe lia l c a rc ino ma 's o f the la rynx

inc lude

Ba sa lo id sq ua mo id c a rc ino mas
Spindle -c e ll (i.e ., sa rc o ma to id) c a rc ino mas
Sma ll-c e ll c a rc ino mas
Na so pha ryng e al-type undiffe re ntiate d c a rc ino mas (i.e .,

lympho e pithe lio mas)

Ca rc ino mas o f the mino r sa livary g la nd

9

SLIDE 4

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 4

MUCOSAL ME L ANOMA OF T HE HE AD AND NE CK

Oc c ur in muc o sa l site s o f the he a d a nd ne c k
T

wo thirds o c c ur in na sa l c a vity a nd pa ra na sa l sinuse s

One q ua rte r o c c ur in o ra l c a vity
Re ma inde r o c c ur in o the r site s o f the he a d a nd ne c k
Hig hly Ag g re ssive
Ca nc e rs limite d to the muc o sa a re a ssig ne d T

3 N0 M0 Sta g e I I I

In situ muc o sa l me la no ma ’ s ve ry ra re a nd a re e xc lude d

fro m sta g ing

10

AJCC Sta g ing Ma nua l 7th e ditio n

RE GIONAL L YMPH NODE S T E RMINOL OGY

I

psila te ra l

Sa me side a s tumo r
Co ntra la te ra l
Oppo site side a s the tumo r
Bila te ra l
Sa me side a nd o ppo site

side Prima ry

I llustra tio n c o urte sy o f the Ame ric a n So c ie ty o f Clinic a l Onc o lo g y.

12

Jug ulo dig a stric / L e ve l I I L e ve l VI / Pa ra - la ryng e al

I llustra tio n c o urte sy o f the Ame ric a n So c ie ty o f Clinic a l Onc o lo g y.

SLIDE 5

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 5

13

L e ve l I / sub me nta l o r sub ma ndib ula r L e ve l I I I / Middle De e p Ce rvic a l L e ve l I V/ L

we r De e p

Ce rvic a l

I llustra tio n c o urte sy o f the Ame ric a n So c ie ty o f Clinic a l Onc o lo g y.

14

F a c ia l/ pa ro tid L e ve l VI I / Supe rio r me dia stina l (b e lo w the supra ste rnal no tc h) L e ve l V/ Po ste rio r T ria ng le g ro up

I llustra tio n c o urte sy

f the Ame ric a n

So c ie ty o f Clinic a l Onc o lo g y.

15

Cric o id Ca rtilag e Uppe r Ce rvic a l L

we r

Ce rvic a l

I llustra tio n c o urte sy o f the Ame ric a n So c ie ty o f Clinic a l Onc o lo g y.

SLIDE 6

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 6

16

http:/ / visua lso nline .c a nc e r.g o v/ pre vie w.c fm? ima g e i d=1775&file fo rma t=jpg

ST AGING: L ARYNX

17

L ARYNX: CHAPT E R 5

AJCC Ca nc e r Sta g e

18

SLIDE 7

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 7

AJCC CANCE R ST AGE : L ARYNX

I

CD-O-3 T

po g ra phy Co de s
C10.1

Ante rio r (ling ua l) surfa c e o f e pig lo ttis

C32.0

Glo ttis

C32.1

Supra g lo ttis (la ryng e a l surfa c e )

C32.2

Sub g lo ttis

C32.8

Ove rla pping le sio n o f la rynx

C32.9

L a rynx NOS

I

CD-O-3 Histo lo g y Co de Ra ng e s

8000-8576, 8940-8950, 8980-8981

19

AJCC CANCE R ST AGE : L ARYNX CL ASSIF ICAT ION

Clinic a l sta g ing
E

vide nc e prio r to tre a tme nt

Na so la ryng o sc o py
L

a ryng e a l tumo r b io psy

Ra dio lo g ic no da l sta g ing to supple me nt c linic a l

e xa m

Mic ro la ryng o sc o py

20

AJCC CANCE R ST AGE : L ARYNX CL ASSIF ICAT ION

Pa tho lo g ic sta g ing
E

vide nc e o b ta ine d in c linic a l sta g ing a nd in histo lo g ic study o f surg ic a lly re se c te d spe c ime n

L

ympha de ne c to my de sc riptio n de sc rib e s size , numb e r, a nd po sitio n o f invo lve d no de s a nd pre se nc e o r a b se nc e o f e xtra c a psula r spre a d (E CS)

21

SLIDE 8

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 8

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry

T

X: Prima ry tumo r c a nno t b e a sse sse d

T

0: No e vide nc e o f prima ry tumo r

T

is: Ca rc ino ma in situ

22

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry S upraglo ttis

T

1: L imite d to 1 sub site o f supra g lo ttis with no rma l vo c a l c o rd mo b ility

T

2: I nva de s muc o sa o f mo re tha n 1 a dja c e nt sub site

f supra g lo ttis o r g lo ttis o r re g io n o utside the

supra g lo ttis witho ut fixa tio n o f la rynx

23

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry S upraglo ttis

T

3: L imite d to la rynx with vo c a l c o rd fixa tio n a nd/ o r inva de s a ny o f the fo llo wing : po stc ric o id a re a , pre e pig lo ttic spa c e , pa ra g lo ttic spa c e , a nd/ o r inne r c o rte x o f thyro id c a rtila g e

T

4a : Mo de ra te ly a dva nc e d lo c a l dise a se . I nva de s thro ug h the thyro id c a rtila g e a nd/ o r inva de s tissue s b e yo nd the la rynx

T

4b : Ve ry a dva nc e d lo c a l dise a se . I nva de s pre ve rte b ra l spa c e , e nc a se s c a ro tid a rte ry, o r inva de s me dia stina l struc ture s

24

SLIDE 9

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 9

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry Glo ttis

T

1: L imite d to vo c a l c o rds with no rma l mo b ility

T

1a : L imite d to 1 vo c a l c o rd

T

1b : I nvo lve s b o th vo c a l c o rds

T

2: E xte nds to supra g lo ttis a nd/ o r sub g lo ttis, a nd/ o r with impa ire d vo c a l c o rd mo b ility

25

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry Glo ttis

T

3: L imite d to la rynx with vo c a l c o rd fixa tio n a nd/ o r inva sio n o f pa ra g lo ttic spa c e , a nd/ o r inne r c o rte x o f thyro id c a rtila g e

T

4a : Mo de ra te ly a dva nc e d lo c a l dise a se . I nva de s thro ug h o ute r c o rte x o f thyro id c a rtila g e a nd/ o r inva de s tissue s b e yo nd the la rynx

T

4b : Ve ry a dva nc e d lo c a l dise a se . I nva de s pre ve rte b ra l spa c e , e nc a se s c a ro tid a rte ry, o r inva de s me dia stina l struc ture s

26

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry S ubglo ttis

T

1: L imite d to 1 sub g lo ttis

T

2: E xte nds to vo c a l c o rd(s) with no rma l o r impa ire d mo b ility

T

3: L imite d to la rynx with vo c a l c o rd fixa tio n

27

SLIDE 10

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 10

AJCC CANCE R ST AGE : L ARYNX

T

Ca te g o ry S ubglo ttis

T

4a : Mo de ra te ly a dva nc e d lo c a l dise a se . I nva de s thro ug h c ric o id o r thyro id c a rtila g e a nd/ o r inva de s tissue s b e yo nd the la rynx

T

4b : Ve ry a dva nc e d lo c a l dise a se . I nva de s pre ve rte b ra l spa c e , e nc a se s c a ro tid a rte ry, o r inva de s me dia stina l struc ture s

28

AJCC CANCE R ST AGE : L ARYNX

N Ca te g o ry:
NX: Re g io na l lymph no de s c a nno t b e a sse sse d
N0: No re g io na l lymph no de me ta sta sis
N1: Me ta sta sis in sing le ipsila te ra l lymph no de , 3 c m
r le ss in g re a te st dime nsio n
N2: Me ta sta sis in sing le ipsila te ra l lymph no de , mo re

tha n 3 c m b ut no t mo re tha n 6 c m in g re a te st dime nsio n, o r in multiple ipsila te ra l lymph no de s, no ne mo re tha n 6 c m in g re a te st dime nsio n, o r in b ila te ra l o r c o ntra la te ra l lymph no de s, no ne mo re tha n 6 c m in dime nsio n

29

AJCC CANCE R ST AGE : L ARYNX

N Ca te g o ry:
N2a : Me ta sta sis in sing le ipsila te ra l lymph no de ,

mo re tha n 3 c m b ut no t mo re tha n 6 c m in g re a te st dime nsio n

N2b : Me ta sta sis in multiple ipsila te ra l lymph no de s,

no ne mo re tha n 6 c m in g re a te st dime nsio n

N2c : Me ta sta sis in b ila te ra l o r c o ntra la te ra l lymph

no de s, no ne mo re tha n 6 c m in dime nsio n

N3: Me ta sta sis in a lymph no de , mo re tha n 6 c m in

g re a te st dime nsio n

30

SLIDE 11

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 11

AJCC CANCE R ST AGE : L ARYNX

M Ca te g o ry
M0: No dista nt me ta sta sis
M1: Dista nt me ta sta sis

31

AJCC CANCE R ST AGE : L ARYNX

Group T N M

Sta g e 0 T is N0 M0 Sta g e I T 1 N0 M0 Sta g e I I T 2 N0 M0 Sta g e I I I T 3 T 1 T 2 T 3 N0 N1 N1 N1 M0 M0 M0 M0

32

AJCC CANCE R ST AGE : L ARYNX

Group T N M

Sta g e I VA T 4a T 4a T 1 T 2 T 3 T 4a N0 N1 N2 N2 N2 N2 M0 M0 M0 M0 M0 M0 Sta g e I VB T 4b Any T Any N N3 M0 M0 Sta g e I VC Any T Any N M1

33

SLIDE 12

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 12

POP QUIZ

1/ 8/ 15 Na so la ryng o sc o py with b io psy: Sma ll

tumo r o f le ft vo c a l c o rd, c o nfine d to vo c a l c o rd, sq ua mo us c e ll c a rc ino ma

1/ 14/ 15 CT
f ne c k a nd c he st: No

lympha de no pa thy; lung s within no rma l limits

1/ 28/ 15 He mila ryng e c to my: Sq ua mo us c e ll

c a rc ino ma in situ, rig ht vo c a l c o rd; sq ua mo us c e ll c a rc ino ma , le ft vo c a l c o rd

34

POP QUIZ

Wha t is the AJCC c linic a l sta g e ?
Wha t is the AJCC pa tho lo g ic sta g e ?

35

L ARYNX: GL OT T IS C32.0

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

36

SLIDE 13

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 13

SUMMARY ST AGE 2000: GL OT T IS

0 I

n situ

No ninva sive ; intra e pithe lia l
1 L
c a lize d o nly
Co nfine d to g lo ttis
I

ntrinsic la rynx

L

a ryng e al c o mmissure (s): Ante rio r; po ste rio r

Vo c a l c o rd(s): T

rue c o rd(s), true vo c a l c o rd(s)

I

nva sive tumo r WI T H o r WI T HOUT no rma l vo c a l c o rd mo b ility

One vo c a l c o rd; b o th vo c a l c o rds

37

SUMMARY ST AGE 2000: GL OT T IS

1 L
c a lize d o nly
T

umo r invo lve s a dja c e nt re g io n(s) o f la rynx

Sub g lo ttis; supra g lo ttis [fa lse vo c a l c o rd(s)]
T

umo r limite d to la rynx WI T H vo c a l c o rd fixa tio n

I

nvo lve me nt o f intrinsic musc le (s)

Arye pig lo ttic
Co rnic ulate tub e rc le ; c une fo rm tub e rc le
Aryte no id; c ric o aryte no id; c ric o thyro id; thyro a ryte no id;

thyro e pig lo ttic ; vo c a lis

L
c a lize d NOS

38

SUMMARY ST AGE 2000: GL OT T IS

2 Re g io na l b y dire c t e xte nsio n o nly
E

xte nsio n to :

Ba se o f to ng ue
Hypo pharynx NOS
Po stc ric o id a re a
Pre -e pig lo ttic tissue s
Pyrifo rm sinus (pyrifo rm fo ssa )
Va lle c ula

39

SLIDE 14

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 14

SUMMARY ST AGE 2000: GL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
Ante rio r de e p c e rvic a l (la te ro tra c he a l) (re c urre nt

la ryng e a l)

Pa ra la ryng e al
Pa ra tra c he a l
Pre la ryng e al: De lphian no de
Pre tra c he a l
Ce rvic a l NOS

40

SUMMARY ST AGE 2000: GL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
I

nte rna l jug ula r, NOS:

De e p c e rvic a l, NOS:
L
we r NOS
Jug ulo -o mo hyo id (supra o mo hyo id)
Middle
Uppe r NOS
Jug ulo dig astric (sub dig a stric )

41

SUMMARY ST AGE 2000: GL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
Ma ndib ula r NOS
Sub ma ndib ula r (sub ma xilla ry)
Sub me nta l
Re tro pha ryng e a l
Re g io na l lymph no de (s) NOS

42

SLIDE 15

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 15

SUMMARY ST AGE 2000: GL OT T IS

4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

Co de s 2 + 3
5 Re g io na l NOS

43

SUMMARY ST AGE 2000: GL OT T IS

7 Dista nt site (s)/ lymph no de (s) invo lve d
Dista nt lymph no de (s)
Me dia stinal
Supra c lavic ular (tra nsve rse c e rvic al)
Othe r dista nt lymph no de (s)

44

SUMMARY ST AGE 2000: GL OT T IS

7 Dista nt site (s)/ lymph no de (s) invo lve d
E

xte nsio n to / thro ug h

Ce rvic al (uppe r) e so pha g us; c ric o id c a rtilag e ; e xtrinsic

(stra p) musc le s (o mo hyo id, ste rno hyo id, ste rno thyro id, thyro hyo id); o ro pha rynx; skin; so ft tissue s o f ne c k; thyro id c a rtila g e ; thyro id g la nd; tra c he a

F

urthe r c o ntig uo us e xte nsio n

Me ta sta sis
9 Unkno wn if e xte nsio n o r me ta sta sis

45

SLIDE 16

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 16

L ARYNX: SUPRAGL OT T IS C32.1

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

46

SUMMARY ST AGE 2000: SUPRAGL OT T IS

0 I

n situ

No ninva sive ; intra e pithe lia l
1 L
c a lize d o nly
I

nva sive tumo r with no rma l vo c a l c o rd mo b ility c o nfine d to

Supra g lo ttis (1 sub site ): Arye pig lo ttic fo ld; a ryte no id

c a rtila g e ; c o rnic ulate c a rtilag e ; c une ifo rm c a rtila g e ; e pilarynx NOS; fa lse c o rd(s): ve ntric ular b a nd(s), ve ntric ular c a vity, ve stibular fo ld; infra hyo id e pig lo ttis; la ryng e al c a rtila g e NOS; la ryng e al (po ste rio r) surfa c e o f e pig lo ttis; suprhyo id e pig lo ttis; (inc luding tip, ling ual {a nte rio r} a nd la ryng e al surfa c e s)

47

SUMMARY ST AGE 2000: SUPRAGL OT T IS

1 L
c a lize d o nly
I

mpa ire d vo c a l c o rd mo b ility

T

umo r invo lve s a dja c e nt re g io n(s) o f la rynx

T

umo r invo lve s mo re tha n o ne sub site o f supra g lo ttis WI T HOUT fixa tio n o r NOS

T

umo r limite d to la rynx WI T H vo c a l c o rd fixa tio n

L
c a lize d NOS

48

SLIDE 17

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 17

SUMMARY ST AGE 2000: SUPRAGL OT T IS

2 Re g io na l b y dire c t e xte nsio n o nly
E

xte nsio n to

Ba se o f to ng ue inc luding muc o sa
Cric o id c a rtilag e
Hypo pharynx NOS
Po stc ric o id a re a
Pre -e pig lo ttic tissue s
Pyrifo rm sinus (pyrifo rm fo ssa )
Va lle c ula

49

SUMMARY ST AGE 2000: SUPRAGL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
Ante rio r de e p c e rvic a l (la te ro tra c he a l) (re c urre nt

la ryng e a l)

Pa ra la ryng e al
Pa ra tra c he a l
Pre la ryng e al: De lphian no de
Pre tra c he a l
Ce rvic a l NOS

50

SUMMARY ST AGE 2000: SUPRAGL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
I

nte rna l jug ula r, NOS:

De e p c e rvic a l, NOS:
Middle
Uppe r NOS
Jug ulo dig astric (sub dig a stric )

51

SLIDE 18

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 18

SUMMARY ST AGE 2000: SUPRAGL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
Ma ndib ula r NOS
Sub ma ndib ula r (sub ma xilla ry)
Sub me nta l
Re tro pha ryng e a l
Re g io na l lymph no de (s) NOS

52

SUMMARY ST AGE 2000: SUPRAGL OT T IS

4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

Co de s 2 + 3
5 Re g io na l NOS

53

SUMMARY ST AGE 2000: SUPRAGL OT T IS

7 Dista nt site (s)/ lymph no de (s) invo lve d
Dista nt lymph no de (s)
Me dia stinal
Supra c lavic ular (tra nsve rse c e rvic al)
Othe r dista nt lymph no de (s)

54

SLIDE 19

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 19

SUMMARY ST AGE 2000: SUPRAGL OT T IS

7 Dista nt site (s)/ lymph no de (s) invo lve d
E

xte nsio n to / thro ug h

Ce rvic al e so pha g us; e xtrinsic (stra p) musc le s (o mo hyo id,

ste rno hyo id, ste rno thyro id, thyro hyo id); o ro pha rynx; skin; so ft tissue s o f ne c k; thyro id c a rtilag e ; thyro id g la nd

F

urthe r c o ntig uo us e xte nsio n

Me ta sta sis
9 Unkno wn if e xte nsio n o r me ta sta sis

55

L ARYNX: SUBGL OT T IS C32.2

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

56

SUMMARY ST AGE 2000: SUBGL OT T IS

0 I

n situ

No ninva sive ; intra e pithe lia l
1 L
c a lize d o nly
I

nva sive tumo r with no rma l vo c a l c o rd mo b ility c o nfine d to sub g lo ttis

T

umo r invo lve s a dja c e nt re g io n(s) o f la rynx

Vo c a l c o rds with no rma l o r impa ire d mo b ility
T

umo r limite d to la rynx WI T H vo c a l c o rd fixa tio n

L
c a lize d NOS

57

SLIDE 20

E so pha g us Sto ma c h 4/ 2/ 15 NAACCR 2014-2015 We b ina r Se rie s 20

SUMMARY ST AGE 2000: SUBGL OT T IS

2 Re g io na l b y dire c t e xte nsio n o nly
E

xte nsio n to :

Ba se o f to ng ue
Hypo pharynx NOS
Po stc ric o id a re a
Pre -e pig lo ttic tissue s
Pyrifo rm sinus (pyrifo rm fo ssa )
Va lle c ula

58

SUMMARY ST AGE 2000: SUBGL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
Ante rio r de e p c e rvic a l (la te ro tra c he a l) (re c urre nt

la ryng e a l)

Pa ra la ryng e al
Pa ra tra c he a l
Pre la ryng e al: De lphian no de
Pre tra c he a l
Ce rvic a l NOS

59

SUMMARY ST AGE 2000: SUBGL OT T IS

3 Re g io na l lymph no de (s) invo lve d o nly
I

nte rna l jug ula r, NOS:

De e p c e rvic a l, NOS:
L
we r NOS
Jug ulo -o mo hyo id (supra o mo hyo id)
Middle
Ma ndib ula r NOS
Sub ma ndib ula r (sub ma xilla ry)
Sub me nta l
Re tro pha ryng e a l
Re g io na l lymph no de (s) NOS

60

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SUMMARY ST AGE 2000: SUBGL OT T IS

4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

Co de s 2 + 3
5 Re g io na l NOS

61

SUMMARY ST AGE 2000: SUBGL OT T IS

7 Dista nt site (s)/ lymph no de (s) invo lve d
Dista nt lymph no de (s)
Me dia stinal
Supra c lavic ular (tra nsve rse c e rvic al)
Othe r dista nt lymph no de (s)

62

SUMMARY ST AGE 2000: SUBGL OT T IS

7 Dista nt site (s)/ lymph no de (s) invo lve d
E

xte nsio n to / thro ug h

Ce rvic al (uppe r) e so pha g us; c ric o id c a rtilag e ; e xtrinsic

(stra p) musc le s (o mo hyo id, ste rno hyo id, ste rno thyro id, thyro hyo id); o ro pha rynx; skin; so ft tissue s o f ne c k; thyro id c a rtila g e ; thyro id g la nd; tra c he a

F

urthe r c o ntig uo us e xte nsio n

Me ta sta sis
9 Unkno wn if e xte nsio n o r me ta sta sis

63

SLIDE 22

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L ARYNX: OVE RL APPING L E SION OR NOS C32.3, C32.8, C32.9

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

64

SUMMARY ST AGE 2000: L ARYNX OT HE R

0 I

n situ

No ninva sive ; intra e pithe lia l
1 L
c a lize d o nly
I

nva sive tumo r c o nfine d to site o f o rig in

I

mpa ire d vo c a l c o rd mo b ility

T

umo r invo lve s a dja c e nt re g io n(s) o f la rynx

T

umo r limite d to la rynx WI T H vo c a l c o rd fixa tio n

L
c a lize d NOS

65

SUMMARY ST AGE 2000: L ARYNX OT HE R

2 Re g io na l b y dire c t e xte nsio n o nly
E

xte nsio n to :

Hypo pharynx NOS
Po stc ric o id a re a
Pre -e pig lo ttic tissue s
Pyrifo rm sinus (pyrifo rm fo ssa )
Va lle c ula

66

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SUMMARY ST AGE 2000: L ARYNX OT HE R

3 Re g io na l lymph no de (s) invo lve d o nly
Ante rio r de e p c e rvic a l (la te ro tra c he a l) (re c urre nt

la ryng e a l)

Pa ra la ryng e al
Pa ra tra c he a l
Pre la ryng e al: De lphian no de
Pre tra c he a l
Ce rvic a l NOS

67

SUMMARY ST AGE 2000: L ARYNX OT HE R

3 Re g io na l lymph no de (s) invo lve d o nly
I

nte rna l jug ula r, NOS

De e p c e rvic a l, NOS
L
we r NOS
Jug ulo -o mo hyo id (supra o mo hyo id)
Middle
Uppe r NOS
Jug ulo dig astric (sub dig a stric )

68

SUMMARY ST AGE 2000: L ARYNX OT HE R

3 Re g io na l lymph no de (s) invo lve d o nly
Ma ndib ula r NOS
Sub ma ndib ula r (sub ma xilla ry)
Sub me nta l
Re tro pha ryng e a l
Re g io na l lymph no de (s) NOS

69

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SUMMARY ST AGE 2000: L ARYNX OT HE R

4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

Co de s 2 + 3
5 Re g io na l NOS

70

SUMMARY ST AGE 2000: L ARYNX OT HE R

7 Dista nt site (s)/ lymph no de (s) invo lve d
Dista nt lymph no de (s)
Me dia stinal
Supra c lavic ular (tra nsve rse c e rvic al)
Othe r dista nt lymph no de (s)

71

POP QUIZ

Ra dic a l la ryng e c to my a nd b ila te ra l ne c k

disse c tio n: 2 c m po o rly diffe re ntia te d ve rruc o us c a rc ino ma o f e pig lo ttis e xte nds into a nd thro ug h thyro id c a rtila g e with mic ro inva sio n o f the thyro id; 36 lymph no de s re mo ve d; 1 ma lig na nt ipsila te ra l c e rvic a l no de

72

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POP QUIZ

Wha t is the Summa ry Sta g e 2000?

a . 0 I

n situ

b . 1 L

c a lize d o nly

c . 2 Re g io na l b y dire c t e xte nsio n o nly

d. 3 Re g io na l lymph no de (s) invo lve d o nly

e . 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

f.

5 Re g io na l NOS

g . 7 Dista nt site (s)/ lymph no de (s) invo lve d

73

COL L ABORAT IVE ST AGE DAT A COL L E CT ION SYST E M (CS) V0205

L a rynx

74

CS SCHE MAS

L

a rynxGlo ttic

C32.0
L

a rynxSupra g lo ttic

C32.1
L

a rynxSub g lo ttic

C32.2
L

a rynxOthe r

C32.3, C32.8, C32.9

75

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SSF 1: SIZE OF L YMPH NODE S

Co de la rg e st dia me te r o f invo lve d re g io na l

no de s

Clinic a l a sse ssme nt
Co de size a s de sc rib e d in c linic a l o r ra dio g ra phic

e xa m

Pa tho lo g ic a sse ssme nt
Co de size a s de sc rib e d o n pa tho lo g y re po rt

76

SSF 3 – SSF 6: L YMPH NODE L E VE L S F OR HE AD AND NE CK

SSF

3: L e ve ls I

I

I I

SSF

4: L e ve ls I V, V, re tro pha ryng e a l no de s

SSF

5: L e ve ls VI , VI I , fa c ia l no de s

SSF

6: Pa ra pha ryng e a l, pa ro tid, a nd sub o c c ipita l/ re tro a uric ula r no de s

SSF 3 – SSF 6: NODE L E VE L S

Co de pre se nc e o r a b se nc e o f no de invo lve me nt
One dig it use d to re pre se nt lymph no de s o f a

sing le le ve l

I

f yo u o nly ha ve info rma tio n a b o ut o ne le ve l o f lymph no de s, c o de a ll o the r lymph le ve ls a s 0

I

f yo u kno w re g io na l lymph no de s a re po sitive b ut the lymph no de le ve l is unkno wn, c o de 000

I

f no lymph no de s a re invo lve d c linic a lly o r pa tho lo g ic a lly, c o de 000

SLIDE 27

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E

xtra c a psula r e xte nsio n

T

umo r within lymph no de s e xte nds b e yo nd the wa ll

f the no de into the pe rino da l fa t
Ma c ro sc o pic
Ma y b e de sc rib e d in g ro ss disse c tio n
T

a ke s prio rity o ve r mic ro sc o pic de sc riptio n

Mic ro sc o pic
Ma y no t b e e vide nt in g ro ss e xa m
De sc rib e d in mic ro sc o pic se c tio n o f pa th re po rt

SSF 9: E XT RACAPSUL AR E XT E NSION PAT HOL OGICAL L Y, L YMPH NODE S

79

DIAGNOSIS AND T RE AT ME NT

L a rynx

80

T RE AT ME NT

L

ARYNX

T

wo c a te g o rie s

Supra g lo ttic
Glo ttic
No sta nda rdize d NCCN g uide line s fo r sub g lo ttic

prima rie s b e c a use the y a re so ra re

81

SLIDE 28

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E ARL Y ST AGE

I

n situ

E

ndo sc o pic re mo va l

Stripping
L

a se r

Ra dia tio n the ra py
Clinic a l T

1-T 2, N0, o r se le c t T 3’ s

Ra dia tio n
Pa rtia l la rynx pre se rving e ndo sc o pic surg e ry
Ra dia tio n a nd/ o r c he mo the ra py if a dve rse fe a ture s

82

CT

3 N0- 1

Co nc urre nt syste mic the ra py o r ra dia tio n
I

f re sidua l tumo r, the n ma y ha ve a ne c k disse c tio n

if c linic a l N1 prio r to the ra py, the y will do c linic al a sse ssme nt

4-8 we e ks a fte r the ra py c o mple te d. I f this is po sitive the y will do a ne c k disse c tio n.

L

a ryng e c to my with ipsila te ral thyro ide c to my

Ne c k disse c tio n if c N1
Sa lva g e surg e ry a nd ne c k disse c tio n if re sidua l tumo r o f the

prima ry site

I

nduc tio n c he mo the ra py

Clinic a l tria ls

83

SURGE RY

He mila ryng e c to my (30)
L

e ft o r rig ht ha lf o f la rynx inc luding thyro id c a rtila g e , fa lse c o rd, ve ntric le , a nd true vo c a l c o rd.

Pa rtia l la ryng e c to my (30)
Pa rt o f thyro id c a rtila g e a nd c o rre spo nding po rtio ns o f la ryng e a l muc o sa .
Supra g lo ttic la ryng e c to my (33)
Pa rt o f la rynx supe rio r to the true vo c a l c o rd (tra nse c tio n thro ug h the ve ntric le s).
T
ta l la ryng e c to my (41)
E

ntire la rynx.

Ra dic a l la ryng e c to my (42)
E

ntire L a rynx a nd a dja c e nt site s

SLIDE 29

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SURGE RY

Unre se c ta b le tumo r
Surg e o n do e s no t fe e l the y c a n re mo ve a ll g ro ss

tumo r

L
c a l c o ntro l o f the tumo r will no t b e a c hie ve d
Sa lva g e surg e ry
Pa tie nts who do no t ha ve a c o mple te c linic a l

re spo nse to c he mo the ra py o r ra dia tio n ma y ha ve sa lva g e surg e ry

85

CT

3 N2- 3

Co nc urre nt syste mic the ra py o r ra dia tio n
If re sidua l tumo r, the n ma y ha ve a ne c k disse c tio n
Will do c linic a l po st tre a tme nt a sse ssme nt 4-8 we e ks a fte r

the ra py c o mple te d. If this is po sitive the y will do a ne c k disse c tio n.

L

a ryng e c to my with ipsila te ra l thyro ide c to my

Ne c k disse c tio n if c N1
Sa lva g e surg e ry a nd ne c k disse c tio n if re sidua l tumo r o f

the prima ry site

I

nduc tio n c he mo the ra py

Clinic a l tria ls

86

CT

4A

T
ta l la ryng e c to my with thyro ide c to my a nd

ne c k disse c tio n if indic a te d fo llo we d b y a djuva nt ra dia tio n a nd/ o r c he mo the ra py

87

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QUE ST IONS?

Quiz 1

88

T HYROID

89 90

"T hyro id I ma g e " b y Cla ire Mo o re - http:/ / suite 101.c o m/ a rtic le / g ra ve s-dise a se -ma y-b e -c o nfuse d- with-o the r-hype rthyro id-diso rde rs-a 411522. L ic e nse d unde r Pub lic Do ma in via Wikime dia Co mmo ns

https:/ / c o mmo ns.wikime dia .o rg / wiki/ F

ile :T hyro idI ma g e .jpg # / me dia / F ile :T hyro idI ma g e .jpg

SLIDE 31

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T hyro id Gla nd C73.9 Pa ra thyro id Gla nd C75.0

I llustra tio n c o urte sy o f the Ame ric a n So c ie ty o f Clinic a l Onc o lo g y. I llustra tio n c o urte sy o f the Ame ric a n So c ie ty o f Clinic a l Onc o lo g y.

T HYROID HIST OL OGY

F
llic ula r c e lls
T

hyro id ho rmo ne (thyro xine + triio dthyro xine )

C c e lls (pa ra fo llic ula r

c e lls)

Ca lc ito nin
L

ympho c yte s

Stro ma l c e lls

SLIDE 32

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T HYROID HIST OL OGY

Ma in histo lo g ic type s
Diffe re ntia te d –10 ye a r surviva l is 93%
Pa pilla ry (80%)
F
llic ular (11%)
Hurthle (3%)
Me dulla ry (4%)-10 ye a r surviva l is 85%
Ana pla stic (2%)-10 ye a r surviva l is 76%

*Ba se d o n 53,856 pa tie nts tre a te d fo r thyro id c a nc e r b e twe e n 1985 a nd 1995

MPH RUL E S- OT HE R

Re quir e d Histology Combine d with… Combination T e rm Code

Pa pilla ry a nd F

llic ular

Pa pilla ry c a rc ino ma, fo llic ular va ria nt 8340 Me dulla ry F

llic ular

Mixe d me dulla ry fo llic ular c a rc ino ma 8346 Me dulla ry Pa pilla ry Mixe d me dulla ry pa pillary c a rc ino ma 8347

QUE ST ION

Ho w ma ny prima rie s sho uld b e re po rte d whe n

a c o mple te thyro ide c to my spe c ime n sho ws two tumo rs: 1.8 c m pa pilla ry c a rc ino ma with ta ll c e ll fe a ture s (8344/ 3) a nd a 0.4 c m pa pilla ry thyro id c a rc ino ma (8260/ 3)?

SLIDE 33

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QUE ST ION

I

s pa pilla ry thyro id c a rc ino ma a n NOS histo lo g y q ua lifying fo r rule M16, thus le a ding to a sing le prima ry, o r wo uld M17 a pply (multiple prima rie s)?

T

he histo lo g y c o de s a re diffe re nt a t the se c o nd dig it (8260 a nd 8344)?

While rule M16 do e sn't inc lude pa pilla ry thyro id

c a rc ino ma in the liste d histo lo g ie s, it se e ms like it ma y b e a n NOS histo lo g y fo r the thyro id. I n a dditio n, c o de 8260/ 3 is liste d a s NOS in the I CD-O-3.

97

ANSWE R

Apply rule M16 a nd a b stra c t a sing le prima ry.
T

he se two thyro id tumo rs, o ne pa pilla ry c a rc ino ma with ta ll c e ll fe a ture s (8344/ 3) a nd o ne pa pilla ry thyro id c a rc ino ma , fit the c rite ria fo r rule M16, a ltho ug h no t e xplic itly liste d the re .

We will c la rify this in the ne xt ve rsio n o f the rule s.

SE E R SINQ 20140083

T HYROID: CHAPT E R 8

AJCC Ca nc e r Sta g e

99

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AJCC CANCE R ST AGE : T HYROID

I

CD-O-3 T

po g ra phy Co de s
C73.9
I

CD-O-3 Histo lo g y Co de Ra ng e s

8000-8576, 8940-8950, 8980-8981

100

AJCC CANCE R ST AGE : T HYROID CL ASSIF ICAT ION

Clinic a l sta g ing
E

vide nc e prio r to tre a tme nt

I

nspe c tio n a nd pa lpa tio n o f thyro id g la nd a nd re g io na l lymph no de s

L

a ryng o sc o py

T

hyro id g la nd tumo r b io psy

I

ma g ing

Pa tho lo g ic sta g ing
E

vide nc e o b ta ine d in c linic a l sta g ing a nd in histo lo g ic study o f surg ic a lly re se c te d spe c ime n

101

AJCC CANCE R ST AGE : T HYROID

T

Ca te g o ry

T

X: Prima ry tumo r c a nno t b e a sse sse d

T

0: No e vide nc e o f prima ry tumo r

T

1: 2 c m o r le ss in g re a te st dime nsio n limite d to thyro id

T

1a : 1 c m o r le ss, limite d to thyro id

T

1b : Mo re tha n 1 c m b ut no t mo re tha n 2 c m in g re a te st dime nsio n, limite d to thyro id

T

2: Mo re tha n 2 c m b ut no t mo re tha n 4 c m in g re a te st dime nsio n limite d to thyro id

102

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AJCC CANCE R ST AGE : T HYROID

T

Ca te g o ry

T

3: Mo re tha n 4 c m in g re a te st dime nsio n limite d to thyro id o r a ny tumo r with minima l e xtra thyro id e xte nsio n

T

4a : Mo de ra te ly a dva nc e d dise a se . Any size e xte nding b e yo nd thyro id c a psule to inva de sub c uta ne o us so ft tissue s, la rynx, tra c he a , e so pha g us, o r re c urre nt la ryng e a l ne rve

T

4b : Ve ry a dva nc e d dise a se . I nva de s pre ve rte b ra l fa sc ia o r e nc a se s c a ro tid a rte ry o r me dia stina l ve sse ls

103

AJCC CANCE R ST AGE : T HYROID

T

Ca te g o ry All anaplastic c arc ino mas are c o nside re d T 4

T

4a : I ntra thyro ida l a na pla stic c a rc ino ma

T

4b : Ana pla stic c a rc ino ma with g ro ss e xtra thyro id e xte nsio n

104

AJCC CANCE R ST AGE : T HYROID

De sc ripto rs to sub divide T

c a te g o rie s

So lita ry tumo r – (s)
Multifo c a l tumo r – (m)

105

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AJCC CANCE R ST AGE : T HYROID

N Ca te g o ry:
NX: Re g io na l lymph no de s c a nno t b e a sse sse d
N0: No re g io na l lymph no de me ta sta sis
N1: Re g io na l lymph no de me ta sta sis
N1a : Me ta sta sis to L

e ve l VI (pre tra c he a l, pa ra tra c he a l, a nd pre la ryng e a l/ De lphia n) lymph no de s

N1b : Me ta sta sis to unila te ra l, b ila te ra l, o r

c o ntra la te ra l c e rvic a l (L e ve ls I , I I , I I I , I V, o r V) o r re tro pha ryng e a l o r supe rio r me dia stina l lymph no de s (L e ve l VI I )

106

AJCC CANCE R ST AGE : T HYROID

M Ca te g o ry
M0: No dista nt me ta sta sis
M1: Dista nt me ta sta sis

107

AJCC CANCE R ST AGE : T HYROID

Group T N M

Sta g e I Any T Any N M0 Sta g e I I Any T Any N M1

108

Papillary or follic ular (diffe re ntiate d) Unde r 45 ye ars

SLIDE 37

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AJCC CANCE R ST AGE : T HYROID

Group T N M

Sta g e I T 1 N0 M0 Sta g e I I T 2 N0 M0 Sta g e I I I T 3 T 1 T 2 T 3 N0 N1a N1a N1a M0 M0 M0 M0

109

Papillary or follic ular (diffe re ntiate d) 45 ye ars and olde r

AJCC CANCE R ST AGE : T HYROID

Group T N M

Sta g e I VA T 4a T 4a T 1 T 2 T 3 T 4a N0 N1a N1b N1b N1b N1b M0 M0 M0 M0 M0 M0 Sta g e I VB T 4b Any N M0 Sta g e I VC Any T Any N M1

110

Papillary or follic ular (diffe re ntiate d) 45 ye ars and olde r

AJCC CANCE R ST AGE : T HYROID

Group T N M

Sta g e I T 1 N0 M0 Sta g e I I T 2 T 3 N0 N0 M0 M0 Sta g e I I I T 1 T 2 T 3 N1a N1a N1a M0 M0 M0

111

Me dullary c arc inoma (all age groups)

SLIDE 38

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AJCC CANCE R ST AGE : T HYROID

Group T N M

Sta g e I VA T 4a T 4a T 1 T 2 T 3 T 4a N0 N1a N1b N1b N1b N1b M0 M0 M0 M0 M0 M0 Sta g e I VB T 4b Any N M0 Sta g e I VC Any T Any N M1

112

Me dullary c arc inoma (all age groups)

AJCC CANCE R ST AGE : T HYROID

Group T N M

Sta g e I VA T 4a Any N M0 Sta g e I VB T 4b Any N M0 Sta g e I VC Any T Any N M1

113

Anaplastic c arc inoma

POP QUIZ

2/ 2/ 15 50 ye a r o ld white fe ma le with pa lpa b le thyro id

ma ss

2/ 2/ 15 CT
f ne c k a nd c he st: Rig ht lo b e thyro id le sio n,

3.5 c m; no lympha de no pa thy; no lung a b no rma litie s

2/ 4/ 15 Ne e dle b io psy, thyro id: Pa pilla ry c a rc ino ma ,

mo de ra te ly diffe re ntia te d

2/ 18/ 15 T

hyro ide c to my with lymph no de sa mpling : 3.5 c m pa pilla ry c a rc ino ma , mo de ra te ly diffe re ntia te d, o f thyro id e xte nds into the c ric o thyro id a nd infe rio r pha ryng e a l c o nstric to r musc le s. 1 De lphia n no de po sitive o f 5 no de s re mo ve d

114

SLIDE 39

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POP QUIZ

Wha t is the AJCC c linic a l sta g e ?
Wha t is the AJCC pa tho lo g ic sta g e ?

115

T HYROID C73.9

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

116

SUMMARY ST AGE 2000: T HYROID

0 I

n situ

No ninva sive ; intra e pithe lia l
1 L
c a lize d o nly
Sing le o r multifo c a l inva sive tumo r(s) c o nfine d to

thyro id

I

nto o r thro ug h thyro id c a psule , b ut no t b e yo nd

L
c a lize d NOS

117

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SUMMARY ST AGE 2000: T HYROID

2 Re g io na l b y dire c t e xte nsio n o nly
E

xte nsio n to

Blo o d ve sse l(s) (ma jo r)
Ca ro tid a rte ry; jug ular ve in; thyro id a rte ry o r ve in
Cric o id c a rtilag e
E

so pha g us

L

a rynx

Ne rve s
Re c urre nt la ryng e al; va g us

118

SUMMARY ST AGE 2000: T HYROID

2 Re g io na l b y dire c t e xte nsio n o nly
E

xte nsio n to

Pa ra thyro id
Pe ric a psula r so ft/ c o nne c tive tissue
Ste rno c le ido ma sto id musc le
Stra p musc le (s): Omo hyo id, ste rno hyo id, ste rno thyro id
T

hyro id c a rtilag e

T

umo r is de sc rib e d a s “F I XE D to a dja c e nt tissue s”

119

SUMMARY ST AGE 2000: T HYROID

3 Re g io na l lymph no de (s) invo lve d o nly
Ante rio r de e p c e rvic a l (la te ro tra c he a l) (re c urre nt

la ryng e a l)

Pa ra la ryng e al
Pa ra tra c he a l
Pre la ryng e al: De lphian no de
Pre tra c he a l
Ce rvic a l NOS

120

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SUMMARY ST AGE 2000: T HYROID

3 Re g io na l lymph no de (s) invo lve d o nly
I

nte rna l jug ula r, NOS

De e p c e rvic a l, NOS
L
we r NOS
Jug ulo -o mo hyo id (supra o mo hyo id)
Middle

121

SUMMARY ST AGE 2000: T HYROID

3 Re g io na l lymph no de (s) invo lve d o nly
Me dia stina l NOS
Po ste rio r me dia stinal (tra c he o e so pha g e a l); uppe r a nte rio r

me dia stina l

Re tro pha ryng e a l
Spina l a c c e sso ry (po ste rio r c e rvic a l)
Supra c la vic ula r (tra nsve rse c e rvic a l)
Re g io na l lymph no de (s) NOS

122

SUMMARY ST AGE 2000: T HYROID

4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

Co de s 2 + 3
5 Re g io na l NOS

123

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SUMMARY ST AGE 2000: T HYROID

7 Dista nt site (s)/ lymph no de (s) invo lve d
Dista nt lymph no de (s)
Ma ndibular
Sub ma ndib ula r (sub ma xilla ry); sub me nta l
Othe r dista nt lymph no de (s)

124

SUMMARY ST AGE 2000: T HYROID

7 Dista nt site (s)/ lymph no de (s) invo lve d
E

xte nsio n to : Bo ne ; me dia stina l tissue s; ske le ta l musc le , o the r tha n stra p o r ste rno c le ido ma sto id musc le ; tra c he a

F

urthe r c o ntig uo us e xte nsio n

Me ta sta sis
9 Unkno wn if e xte nsio n o r me ta sta sis

125

POP QUIZ

2/ 2/ 15 50 ye a r o ld white fe ma le with pa lpa b le thyro id

ma ss

2/ 2/ 15 CT
f ne c k a nd c he st: Rig ht lo b e thyro id le sio n,

3.5 c m; no lympha de no pa thy; no lung a b no rma litie s

2/ 4/ 15 Ne e dle b io psy, thyro id: Pa pilla ry c a rc ino ma ,

mo de ra te ly diffe re ntia te d

2/ 18/ 15 T

hyro ide c to my with lymph no de sa mpling : 3.5 c m pa pilla ry c a rc ino ma , mo de ra te ly diffe re ntia te d, o f thyro id e xte nds into the c ric o thyro id a nd infe rio r pha ryng e a l c o nstric to r musc le s. 1 De lphia n no de po sitive o f 5 no de s re mo ve d

126

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POP QUIZ

Wha t is the Summa ry Sta g e 2000?

a . 0 I

n situ

b . 1 L

c a lize d o nly

c . 2 Re g io na l b y dire c t e xte nsio n o nly

d. 3 Re g io na l lymph no de (s) invo lve d o nly

e . 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

f.

5 Re g io na l NOS

g . 7 Dista nt site (s)/ lymph no de (s) invo lve d

127

CS V0205 T HYROID C73.9

128

SSF 1: SOL IT ARY VS. MUL T IF OCAL T UMOR

Re c o rd whe the r thyro id c a nc e r is so lita ry tumo r
r multifo c a l

129

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DIAGNOSIS AND T RE AT ME NT

T hyro id

130

DIAGNOSING T HYROID CANCE R

Physic a l e xa m
Blo o d te sts
Che c k le ve ls o f thyro id-stimula ting ho rmo ne (T

SH)

Che c k le ve ls o f c a lc ito nin

DIAGNOSING T HYROID CANCE R

I

ma g ing

Ultra so und
Ra dio io dine (thyro id) sc a n
Po sitro n e missio n to mo g ra phy (PE

T ) sc a n

Oc tre o tide sc a n
Bio psy
F

ine -ne e dle a spira tio n

Surg ic a l

SLIDE 45

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T HYROID NODUL E S

Ho t no dule
Ab so rb s io dine o n

thyro id sc a n

Co ld No dule
Do e s no t a b so rb io dine
n thyro id sc a n

T RE AT ME NT F OR PAPIL L ARY AND F OL L ICUL AR CARCINOMA

Surg e ry
I

psila te ra l lo b e c to my plus isthmuse c to my (23)

T
ta l thyro ide c to my (50)
Co mple tio n thyro ide c to my (50)
I
dine -131 (I
131 o r RAI

)

Unre se c ta b le tumo rs
Po st thyro ide c to my
Ra dia tio n T

re a tme nt Vo lume sho uld b e c o de d to 33-Who le Bo dy

T RE AT ME NT F OR PAPIL L ARY AND F OL L ICUL AR CARCINOMA

E

xte rna l Be a m Ra dia tio n

Ma y b e do ne with 131 I

tre a tme nt fo r lo c o re g io na l re c urre nc e

Ma y b e use d a s a djuva nt the ra py if tumo r do e s no t

sho w upta ke o f io dine

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T HYROXIN SUPPRE SSION OF T HYROID ST IMUL AT ING HORMONE (T SH)

S

ynthro id sho uld b e c o de d a s ho rmo na l tre a tme nt fo r thyro id c a nc e r.

T

his drug ha s two b e ne fits:

I

t supplie s the missing ho rmo ne the thyro id wo uld no rma lly pro duc e

I

t suppre sse s the pro duc tio n o f thyro id-simula ting ho rmo ne (T SH) fro m the pituitary g la nd. Hig h T SH le ve ls c o uld c o nc e iva bly stimulate a ny re ma ining c a nc e r c e lls to g ro w.

136

QUE ST ION

I

f a pa tie nt is ta king Synthro id prio r to b e ing dia g no se d with thyro id c a nc e r a nd ha ving to ta l thyro ide c to my, is Synthro id still c o de d a s ho rmo ne the ra py 1st c o urse o f tre a tme nt a fte r c a nc e r dire c te d surg e ry?

ANSWE R

Ye s, it is still c o nside re d 1st c o urse tre a tme nt

a nd the da te o f tre a tme nt wo uld b e the da te

f the pa tie nt's dia g no sis o f the thyro id

ma lig na nc y.

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T RE AT ME NT

Me dulla ry Ca rc ino ma
T
ta l thyro ide c to my a nd b ila te ra l c e ntra l ne c k

disse c tio n (le ve l VI )

E

xte rna l b e a m ra dia tio n

Ana pla stic Ca rc ino ma
Surg e ry if lo c a lize d
E

xte rna l b e a m ra dia tio n

Che mo the ra py

QUE ST IONS?

Quiz 2

140

COMING UP…

Co lle c ting Ca nc e r Da ta : Pa nc re a s
6/ 4/ 15
Survivo rship Ca re Pla ns
7/ 9/ 15

141

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AND T HE WINNE RS ARE … ..

142

CE CE RT IF ICAT E QUIZ/ SURVE Y

Phra se
L

ink

http:/ / www.surve yg izmo .c o m/ s3/ 2127403/ L

a rynx-a nd-T hyro id-2015

143