ThyroidCancerShuguangHospitalGeneralSurgeryVINCENTRaoTHYROIDCANCER3whattodowithit?TREATMENT4HOWBADISIT?PROGNOSIS1whereisit？ANATOMY2whydidithappen？ETIOLOGY1.Apperance:thelargestendocrineglands:butterfly-shapedoftwosidelobesconnectedbyisthmus.2.Location:①belowthethyroidcartilage,aroundlarynxandtrachea。②5cmlong,3cmwideand2cmthick。③toptothemiddleofthyroidcartilage,downtothefifthorsixthtrachealring。THYROIDANATOMY③④Fromskintothyroid：skin→superficialfascia（platysma）→superficiallayerofdeepfascia→infrahyoidmuscles→Pretrachealfascia→thyroidTHYROIDANATOMY③3.Nervesandvessels(bothcoupled):①2nerves:superiorlaryngealnerve+recurrentlaryngealnerve.②2arterys:superiorandinferiorthyroidarterys③3veins:superior、middleandinferiorthyroidveins.4.Lymphaticdrainage:knowingthewayhowthroidcancercelltransfersisthefoundationtolymphadenectomy.THYROIDANATOMY③Diagramofcervicallymphnodelevels•LevelIA:boundedbyanteriorbellyandhyoidbone.•LevelIB:boundedbytheanteriorandposteriorbelliesandthemandible.LevelVI(Centralcompartmentlymphnodes):boundedbyhyoidbone,thecommoncarotidarteriesandthesternum.AlthoughlevelVIislargeinarea,thefewlymphnodesthatitcontainsaremostlyintheparatrachealregionsnearthethyroidgland.•LevelVII:superiormediastinumlymphnodes.Diagramofcervicallymphnodelevels•LevelV：posteriortriangleofneck•LevelII:boundedbyskullbase,stylohyoidmuscle,hyoidbonehorizontallineandposterioredgeofthesternocleidomastoidmuscle.•LevelIII:beginsattheinferioredgeoflevelIIandisboundedbythelaryngealstrapmusclesanteriorly,bytheposteriorborderofthesternocleidomastoidmuscleposteriorly,andbyahorizontalplaneextendingposteriorlyfromtheinferiorborderofthecricoidcartilage.•LevelIV:beginsattheinferiorborderoflevelIIIandisboundedanteriorlybythestrapmuscles,posteriorlybytheposterioredgeofthesternocleidomastoidmuscle,andinferiorlybytheclavicle.lymphnodemetastasesofThyroidcancer•Studyshowsthat:•VIisoftenthefirstlevel•>>>>>•ThesecondislevelIII、IV•>>>>>•LevelVII、II、V、Iisnotfrequent.THYROIDCANCER3whattodowithit?TREATMENT4HOWBADISIT?PROGNOSIS1whereisit？ANATOMY2whydidithappen？ETIOLOGYETIOLOGYBasedonclassification:Papillarythyroidcancer(75%to85%ofcases)–ofteninyoungfemales–excellentprognosis.relevanttoradiotherapy,TSH,excessiveiodineintake.Follicularthyroidcancer(10%to20%ofcases)–occasionallyseeninpatientswithCowdensyndrome.relevanttoiodinedeficiency.Medullarythyroidcancer(5%[10]to8%ofcases)–canceroftheparafollicularcells,relevanttogene.Anaplasticthyroidcancer(Lessthan5%[10])–Itisnotresponsivetotreatmentandcancausepressuresymptoms,couldDIEquickly.THYROIDCANCER3whattodowithit?TREATMENT4HOWBADISIT?PROGNOSIS1whereisit？ANATOMY2whydidithappen？ETIOLOGYDiagnosis＆TreatmentDIGNOSIS:1.Anythroidmasshavingthefollowingconditionsshouldbeconsideredmalignant.❶Generalcondition：children(50%);male(increasedrate);femal(over60orunder30).❷Symptom＆Sign:painless;smallandhardandfixedsolitarynodule;rapidgrowth(Ominoussign).❸Accessoryexamination：calcification;enlargementofnecklymphnodes.2.Goldstandard:pathologicalexamination(fine-needleaspirationbiopsy(FNAB)).Diagnosis＆TreatmentTreatmentLetGeneralSurgeonsdotheirjobs.Thesurgicalmethodsdifferfromcancertypesandlymphaticmetastasis.surgicalmethodTypeofcancercellLymphaticmetastasisCentrallymphnodedissectionfunctionalneckdissectionmodifiedradicalneckdissection(MRND)radicalneckdissection(RND)ThyroidectomyDiagnosis＆Treatment＋THYROIDCANCER3whattodowithit?TREATMENT4HOWBADISIT?PROGNOSIS1whereisit？ANATOMY2whydidithappen？ETIOLOGYStaging＆PrognosisStaging＆PrognosisStaging＆PrognosisT1aT1bT2T3Staging＆PrognosisT4aT4bN1aN2bStaging＆PrognosisM1Staging＆Prognosis祝大家中秋节快乐，工作顺利，身体健康！ThankYou!
