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Tell me about medullary cell cancer of the thyroid, and how would you manage it? |
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Tell me about medullary cell cancer of the thyroid, and how would you manage it?
Incidence – rare
Age- 50yrs peak incidence. Familial cases present younger
Genetics – 80% sporadic but 20% associated MEN2A and MEN2B
RET mutations. Chromosome 10.
Pathology
– Arise from parafollicular cells.
– Multicentric
– Local and lymph node spread
Clinically
– present as a lump in the neck or from ectopic hormone production e.g diarrhoea.
– Secrete a range of hormones + peptides calcitonin, 5HT, ACTH, CEA
– Screen for MEN
o BP check in the clinic
o 24hour catechoamines
o Calcium levels +/- PTH
Treatment
Total thyroidectomy + en bloc dissection of LN’s
Prognosis
90% 10yr survival
Follow up
Calcitonin and CEA
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