1. THYROID CANCER - PAPILLARY CARCINOMA
BY: DR.FARIS MOHSIN AL-ABEEDI

2. Papillary carcinoma is a relatively
common well-differentiated thyroid
cancer. Papillary/follicular carcinoma
must be considered a variant of
papillary thyroid carcinoma (mixed
form). Despite its well-differentiated
characteristics, papillary carcinoma
may be overtly or minimally invasive.
In fact, these tumors may spread
easily to other organs. Papillary
tumors have a propensity to invade
lymphatics but are less likely to
invade blood vessels. Papillary
carcinoma appears as an irregular
solid or cystic mass in a normal

3. CHARACTERISTICS OF PAPILLARY THYROID
CANCER
*Peak onset ages are 30 to 50 years old.
*Papillary thyroid cancer is more common in females than in males
by a 3:1 ratio.
*The prognosis directly related to tumor size. (Less than 1.5 cm
[1/2 inch] is a good prognosis.)
*This cancer accounts for 85% of thyroid cancers due to radiation
exposure.
*In more than 50% of cases, it spreads to lymph nodes of the neck.
*Distant spread (to lungs or bones) is uncommon.
The overall cure rate is very high (near 100% for small lesions in
young patients).

4. CAUSES
About 80% of all thyroid cancers diagnosed in the United States are
papillary carcinoma type. It is more common in women than in
men. It may occur in childhood, but is most often seen in adults
around the
age of 45.
The cause of this cancer is unknown. A genetic defect may be
involved.
Radiation increases the risk of developing thyroid cancer. Exposure
may occur from:
*High-dose external radiation treatments to the neck, especially
during childhood, used to treat childhood cancer or some benign
childhood conditions.
*Radiation due to atomic bomb testing in the Marshall Islands and the
1986 Chernobyl nuclear disaster in the Ukraine, mostly in children.
*Radiation given through a vein (through an IV) during medical tests
and treatments does not increase the risk of developing thyroid

5. EXAMS AND TESTS
If you have a lump on your thyroid, your doctor
will order blood tests and possibly
an ultrasound of the thyroid gland, CT scan
If the ultrasound shows that the lump is bigger
than 1.0 centimeter, a special biopsy called
a fine needle aspiration (FNA) will be performed.
This test helps determines if the lump is
cancerous.
Thyroid function tests are usually normal in
patients with thyroid cancer.

8. This CT scan shows a thyroid cancer tumor in the
throat, encircling, narrowing, and displacing the
windpipe (trachea).

9. SYMPTOMS
Thyroid cancer usually begins as a small
lump (nodule) in the thyroid gland, which
is located at the center part of the front of
the neck.
While some small lumps may be
cancer, most thyroid nodules are
harmless and are not cancerous.
Most of the time, there are no other
symptoms.

10. Micrograph of papillary thyroid carcinoma demonstrating
prominentpapillae with fibrovascular cores. H&E stain.

11. Micrograph showing that the papillae in papillary thyroid
carcinoma are composed of cuboidal cells. H&E stain.

12. Micrograph (high power view) showing nuclear changes in
papillary thyroid carcinoma (PTC), which include groove
formation, optical clearing, eosinophilic inclusions and

13. Treatment
There are three types of thyroid cancer treatment:
*Surgery
*Radioactive iodine
*Medication
Surgery is done to remove as much of the cancer as possible. The bigger
the lump, the more of the thyroid gland must be removed. Frequently, the
entire gland is taken out.
After the surgery, most patients should receive radioactive iodine, which is
usually taken by mouth. This substance kills any remaining thyroid tissue. It
also helps make medical images more clear, so doctors can see if there is
any additional cancer.
If surgery is not an option, external radiation therapy can be useful.
After surgery or radioactive iodine, the patient will need to take medication
called levothyroxine sodium for the rest of their life. This replaces the
hormone that the thyroid would normally make

14. Other follow-up
Most patients who had thyroid cancer need
to a blood test every 6 - 12 months to
check thyroid levels. Other follow-up tests
that may done after treatment for thyroid
cancer include:
Ultrasound of the thyroid done in the first
year
An imaging test called a radioactive iodine

15. (PROGNOSIS)
The survival rate for papillary thyroid cancer is
excellent. More than 95% of adults with such cancer
survive at least 10 years.
The prognosis is better for patients younger than 40
and for those with smaller tumors.
The following factors may decrease the survival rate:
*Age over 45
*Cancer has spread to distant parts of the body
*Cancer has spread to soft tissue
*Large tumor

16. DIFFERENTIAL DIAGNOSIS
De Quervain Thyroiditis
Goiter
Goiter, Nontoxic
Goiter, Toxic Nodular
Graves Disease
Hurthle Cell Carcinoma
Thyroid Lymphoma
Thyroid Nodule
Thyroid, Anaplastic Carcinoma
Thyroid, Follicular Carcinoma
Thyroid, Medullary Carcinoma