thyroid甲状腺癌全英文简版ppt课件.ppt

Thyroid CancerShuguang Hospital General Surgery VINCENT Rao2024/3/19 2024/3/19 周二周二THYROID CANCER 3 what to do with it?TREATMENT 4 HOW BAD IS IT?PROGNOSIS 1 where is it？ANATOMY 2 why did it happen？ETIOLOGY 2024/3/19 2024/3/19 周二周二1.Apperance:1.Apperance:the largest the largest endocrine endocrine glands:butterfly-shaped of glands:butterfly-shaped of two side lobes connected two side lobes connected by isthmus.by isthmus.2.Location:2.Location:below the thyroid below the thyroid cartilage,around larynx cartilage,around larynx and tracheaand trachea。5 5 cm long,cm long,3 3 cm wide cm wide and and 2 2 cm thick cm thick。top to the middle of top to the middle of thyroid cartilage,down to thyroid cartilage,down to the fifth or sixth tracheal the fifth or sixth tracheal ringring。THYROID ANATOMY2024/3/19 2024/3/19 周二周二From skin to From skin to thyroidthyroid：skinskin superficial superficial fasciafascia（platysmaplatysma）superficial layer of superficial layer of deep fascia deep fascia infrahyoid musclesinfrahyoid musclesPretracheal fasciaPretracheal fasciathyroidthyroid THYROID ANATOMY 2024/3/19 2024/3/19 周二周二3.Nerves and vessels 3.Nerves and vessels (both coupled):(both coupled):2 nerves:superior 2 nerves:superior laryngeal nerve+laryngeal nerve+recurrent laryngeal recurrent laryngeal nerve.nerve.2 arterys:superior and 2 arterys:superior and inferior thyroid arterysinferior thyroid arterys3 veins:superior 3 veins:superior、middle and inferior middle and inferior thyroid veins.thyroid veins.4.Lymphatic drainage:4.Lymphatic drainage:knowing the way how knowing the way how throid cancer cell throid cancer cell transfers is the transfers is the foundation tofoundation to lymphadenectomy.lymphadenectomy.THYROID ANATOMY2024/3/19 2024/3/19 周二周二Diagram of cervical lymph node levelsLevel Level I IA A :bounded by anterior bounded by anterior belly and hyoid bone.belly and hyoid bone.Level Level I IB:B:bounded by the bounded by the anterior and posterior bellies anterior and posterior bellies and the mandible.and the mandible.LevelLevel VI VI(Central(Central compartment lymph compartment lymph nodes)nodes):bounded by hyoid bounded by hyoid bone,the common carotid bone,the common carotid arteries and the sternum arteries and the sternum.Although level VI is large in.Although level VI is large in area,the few lymph nodes area,the few lymph nodes that it contains are mostly in that it contains are mostly in the paratracheal regions the paratracheal regions near the thyroid gland.near the thyroid gland.Level VII:Level VII:superior superior mediastinum lymph nodes.mediastinum lymph nodes.2024/3/19 2024/3/19 周二周二Diagram of cervical lymph node levelsLevel VLevel V：posterior triangle of neck posterior triangle of neckLevel II:Level II:bounded by skull base,bounded by skull base,stylohyoid muscle,hyoid bone stylohyoid muscle,hyoid bone horizontal line and horizontal line and posterior edge of the posterior edge of the sternocleidomastoid muscle.sternocleidomastoid muscle.Level III:Level III:begins at the inferior edge begins at the inferior edge of level II and is bounded by the of level II and is bounded by the laryngeal strap muscles anteriorly,laryngeal strap muscles anteriorly,by the posterior border of the by the posterior border of the sternocleidomastoid muscle sternocleidomastoid muscle posteriorly,and by a horizontal posteriorly,and by a horizontal plane extending posteriorly from the plane extending posteriorly from the inferior border of the cricoid inferior border of the cricoid cartilage.cartilage.Level IV:Level IV:begins at the inferior begins at the inferior border of level III and is bounded border of level III and is bounded anteriorly by the strap muscles,anteriorly by the strap muscles,posteriorly by the posterior edge of posteriorly by the posterior edge of the sternocleidomastoid muscle,the sternocleidomastoid muscle,and inferiorly by the clavicle.and inferiorly by the clavicle.2024/3/19 2024/3/19 周二周二lymph node metastases of Thyroid cancerStudy shows that:VI is often the first level The second is level III、IVLevel VII、II、V、I is not frequent.2024/3/19 2024/3/19 周二周二THYROID CANCER 3 what to do with it?TREATMENT 4 HOW BAD IS IT?PROGNOSIS 1 where is it？ANATOMY 2 why did it happen？ETIOLOGY 2024/3/19 2024/3/19 周二周二 ETIOLOGYBased on classification:Papillary thyroid cancer(75%to 85%of cases)Papillary thyroid cancer(75%to 85%of cases)often often in young females excellent prognosis.relevant to in young females excellent prognosis.relevant to radiotherapy,TSH,excessive iodine intake.radiotherapy,TSH,excessive iodine intake.Follicular thyroid cancer(10%to 20%of cases)Follicular thyroid cancer(10%to 20%of cases)occasionally seen in patients with Cowden occasionally seen in patients with Cowden syndrome.relevant to iodine deficiency.syndrome.relevant to iodine deficiency.Medullary thyroid cancer(5%10 to 8%of cases)Medullary thyroid cancer(5%10 to 8%of cases)cancer of the parafollicular cells,relevant to gene.cancer of the parafollicular cells,relevant to gene.Anaplastic thyroid cancer(Less than 5%10)Anaplastic thyroid cancer(Less than 5%10)It is not It is not responsive to treatment and can cause pressure responsive to treatment and can cause pressure symptoms,could DIE quickly.symptoms,could DIE quickly.2024/3/19 2024/3/19 周二周二THYROID CANCER 3 what to do with it?TREATMENT 4 HOW BAD IS IT?PROGNOSIS 1 where is it？ANATOMY 2 why did it happen？ETIOLOGY 2024/3/19 2024/3/19 周二周二DiagnosisTreatmentDIGNOSIS:1.Any throid mass having the following conditions should be considered malignant.General condition General condition：children(50%);male(increased children(50%);male(increased rate);femal(over 60 or under 30).rate);femal(over 60 or under 30).Symptom Symptom Sign:Sign:painless;small and hard and fixed painless;small and hard and fixed solitary nodule;rapid growth(Ominous sign).solitary nodule;rapid growth(Ominous sign).Accessory examination Accessory examination：calcification;enlargement of neck lymph nodes.calcification;enlargement of neck lymph nodes.2.Gold standard:pathological examination(fine-needle aspiration biopsy(FNAB).2024/3/19 2024/3/19 周二周二DiagnosisTreatmentTreatmentLet General Surgeons do their jobs.The surgical methods differ from cancer types and lymphatic metastasis.surgical methodType of cancer cellLymphatic metastasis2024/3/19 2024/3/19 周二周二Central lymph node dissection functional neck dissectionmodified radical neck dissection(MRND)radical neck dissection(RND)ThyroidectomyThyroidectomy DiagnosisTreatment2024/3/19 2024/3/19 周二周二THYROID CANCER 3 what to do with it?TREATMENT 4 HOW BAD IS IT?PROGNOSIS 1 where is it？ANATOMY 2 why did it happen？ETIOLOGY 2024/3/19 2024/3/19 周二周二Staging Prognosis2024/3/19 2024/3/19 周二周二Staging Prognosis2024/3/19 2024/3/19 周二周二Staging PrognosisT1aT1bT2T32024/3/19 2024/3/19 周二周二Staging PrognosisT4aT4bN1aN2b2024/3/19 2024/3/19 周二周二Staging PrognosisM12024/3/19 2024/3/19 周二周二Staging Prognosis2024/3/19 2024/3/19 周二周二祝大家中秋节快乐，工作顺利，身体健康！Thank You!