ROJoson PEP Talk: Thyroid Cancer Management - Part 1 - Fundamentals and Generalities

1. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 1
January 15, 2022
1400H - 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 1

3. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 1
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

4. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

5. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

6. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 1
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
Thyroid Cancer, Part
1. This is part of the
Cancer Course.

7. Definition of Terms in Title AND Delimitation of
Coverage of Talk:
Fundamentals – simplest and essential facts and
theories which can serve as a basis or foundation
and support for advanced information
Generalities – general statements of info, not
covering specifics and details
Medical Management – diagnosis and treatment
of thyroid cancer by physicians
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer

8. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Contents:
• Screening for thyroid cancer
• Symptoms that will lead to suspected presence
of thyroid cancer
• Clinical diagnosis of thyroid cancer
• Paraclinical diagnostic procedures for thyroid
cancer
• Treatment for thyroid cancer
• Surveillance of thyroid cancer
• Prognosis of thyroid cancer
• Palliative and hospice care for thyroid cancer
patients
PART 1
PART 2

9. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer

10. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
Screening for thyroid cancer means
looking for a thyroid cancer that may be
present in apparently healthy and
asymptomatic persons (both females and
males).

11. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
General Screening Methods
• Risk-assessment interview or
evaluation
• Risk-assessment interview and physical
examination
• Risk-assessment interview and physical
examination with use of instrumental
or laboratory diagnostic procedures
Screening for
thyroid cancer
means looking for a
breast cancer that
may be present in
apparently healthy
and asymptomatic
persons. [females
and males]

12. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
General Screening Methods
• Risk-assessment interview or
evaluation
Looking for higher risk for thyroid cancer
in a particular patient / person such as
• Family history of thyroid cancer
• History of radiation exposure esp. during
childhood
• History of excessive exposure to chemicals
If POSITIVE for
higher risk, proceed
to symptom-sign
evaluation (physical
examination) and if
indicated, do
instrumental or
laboratory
diagnostic
procedures.

13. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
General Screening Methods
• Risk-assessment interview or
evaluation
Looking for higher risk for thyroid cancer
in a particular patient / person such as
• Family history of thyroid cancer
• History of radiation exposure esp. during
childhood
• History of excessive exposure to chemicals
If NEGATIVE for
higher risk, MAY
STOP HERE or
BETTER STILL,
proceed to
symptom-sign
evaluation
(interview and
physical
examination) to
complete the basic
essentials of
screening.

14. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
General Screening Methods
• Risk-assessment interview and physical
examination
This constitutes the basic essentials of
screening.
If POSITIVE for
higher risk and with
SUSPECTED
PRESENCE of cancer
based on symptoms
and signs, proceed
to instrumental or
laboratory
diagnostic
procedures as
indicated.

15. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
General Screening Methods
• Risk-assessment interview and physical
examination
This constitutes the basic essentials of
screening.
If NEGATIVE for
higher risk and with
NO SUSPECTED
PRESENCE of cancer
based on symptoms
and signs, MAY STOP
HERE.

16. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
General Screening Methods
• Risk-assessment interview and physical
examination with use of instrumental
or laboratory diagnostic procedures
• DO instrumental or laboratory
diagnostic procedures only if POSITIVE
FOR HIGHER RISK FOR CANCER or / and
IF WITH SUSPECTED PRESENCE OF
CANCER BASED ON SYMPTOMS AND
SIGNS.
In this era of
commercialism in
medicine and health
care,
BEWARE of a lot of
hospitals and
laboratory clinics
peddling screening
packages for cancer.
Don’t be swayed
easily by the
marketing and
discount offers.

17. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
PHILIPPINES
Currently, no official nationwide thyroid cancer
screening program is available in the Philippines.

18. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
ROJoson Personal Recommendations:
• Neck and thyroid self-examination
monthly starting at age 18 and onwards
• If a mass is felt, consult a physician
right away.

19. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
How to do self-examination of the thyroid

20. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
How to do self-examination of the thyroid

21. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Screening for thyroid cancer
How to do self-examination of the thyroid

22. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Symptoms that will lead to suspected
presence of thyroid cancer

23. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Symptoms that will lead to suspected
presence of thyroid cancer
ALERT SYMPTOMS or SYMPTOM-CUES
• A lump on the central part of the neck
• A lump on the side of the neck
• A lump on the neck with persistent
hoarseness of voice
• Will expound on these in the section on
Clinical Diagnosis of Thyroid Cancer.

24. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Clinical diagnosis means a conclusion or
decision made by a physician after
examining a patient and after evaluation
of the data on symptoms and signs.
Symptoms are what are felt and observed
by the patient or a person on the body.
Signs are findings of a physician after
physical examination of a patient.

25. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Procedures in clinical diagnosis of cancer:
Patient has symptoms.
• Physician evaluates the symptoms to see if
these are alert signals or symptoms-cues for
cancer or not.
• Physician does physical examination to look for
sign-cues for cancer.
• Physician processes symptoms and signs to
determine whether cancer is present or not
(clinical diagnosis) – not cancer; cancer –
suspect, probable, most probable.

26. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Processes used in clinical diagnosis of
cancer:
• Pattern recognition
• Prevalence

27. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Processes used in clinical diagnosis of
cancer:
Pattern recognition process means realization
that the patient’s presentation conforms to a
previously learned picture or pattern of disease.
Prevalence process means choice of a diagnosis is
based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and system.

28. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Remember the definition and behavior of
thyroid cancer when looking for pattern
recognition in the alert symptoms or
symptom-cues.
Thyroid cancer is a
medical disease when
some of the thyroid
cells grow
uncontrollably with a
potential
to invade the adjacent
body tissues or organs
and
to spread to distant
tissues or organs.

29. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Symptoms that will lead to suspected
presence of thyroid cancer
ALERT SYMPTOMS or SYMPTOM-CUES
• A lump on the central part of the neck
• A lump on the side of the neck
• A lump on the neck with persistent
hoarseness of voice
Clinical diagnosis of thyroid cancer

30. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
ALERT SYMPTOMS or
SYMPTOM-CUES
• A lump on the
central part of the
neck
• A lump on the
side of the neck
• A lump on the
neck with
persistent
hoarseness of
voice
Clinical diagnosis of thyroid cancer

31. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
ALERT SYMPTOMS or
SYMPTOM-CUES
• A lump on the
central part of the
neck
• A lump on the
side of the neck
• A lump on the
neck with
persistent
hoarseness of
voice
Clinical diagnosis of thyroid cancer

32. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
ALERT SYMPTOMS or
SYMPTOM-CUES
• A lump on the
central part of the
neck
• A lump on the
side of the neck
• A lump on the
neck with
persistent
hoarseness of
voice
Clinical diagnosis of thyroid cancer
Suspect thyroid cancer if lump
/ lumps are
• HARD in consistency
• FIXED
• Accompanied by
• Persistent and
progressive hoarseness
• another lump on the side
of the neck (lymph node)
• a distant mass suggestive
of spread (bones / lungs)

33. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Suspect thyroid cancer if lump
/ lumps are
• HARD in consistency
• FIXED
• Accompanied by
• Persistent and
progressive hoarseness
• another lump on the side
of the neck (lymph node)
• a distant mass suggestive
of spread (bones / lungs)
In the absence of
cues for
malignancy,
more likely,
the lump / lumps
are BENIGN, NOT
CANCER (more
common).

34. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
More common types of thyroid cancer in
the Philippines
• Papillary thyroid carcinoma (90%)
• Follicular thyroid carcinoma (10%)
• Anaplastic carcinoma (1%)
• Medullary carcinoma (<1%)

35. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Behavior of
common types of
thyroid cancers
• Papillary
cancers
• Follicular
cancers
• Anaplastic
cancers
Papillary thyroid cancers usually spread via
the lymph channels
Follicular thyroid cancers usually spread
via the blood channels
Most common sites of metastasis:
• Bones
• Lungs

36. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Colloid
Adenomatous Goiter
or Papillary
Carcinoma

37. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Papillary Carcinoma
if nodule is HARD.

38. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Solitary and
Multiple Colloid
Adenomatous
Goiter

39. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Papillary thyroid
carcinoma

40. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Papillary thyroid
carcinoma

41. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Follicular thyroid
carcinoma

42. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Anaplastic thyroid
carcinoma

43. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer Colloid
Adenomatous
Nodule

44. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
Procedures in clinical diagnosis of cancer:
Patient has symptoms.
• Physician evaluates the symptoms to see if
these are alert signals or symptoms-cues for
cancer or not.
• Physician does physical examination to look for
sign-cues for cancer.
• Physician processes symptoms and signs to
determine whether cancer is present or not
(clinical diagnosis) – not cancer; cancer –
suspect, probable, most probable.

45. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Clinical diagnosis of thyroid cancer
At end of the clinical examination,
physician makes a clinical diagnosis:
Possible conclusion or decision:
• Not cancer
• Cancer suspect
• Cancer probable
• Cancer most probable
The next thing for
the physician to
decide is whether to
do a paraclinical
diagnostic
procedure or not –
instrumental or
laboratory
diagnostic
procedure

46. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer

47. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
The foremost indication for a paraclinical
diagnostic procedure can be stated this
way:
if you are not certain on the primary
clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.

48. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
To decide on indication of the paraclinical
diagnostic procedure,
the physician uses two processes –
- degree of certainty on the primary
clinical diagnosis and
- comparison of the treatment plans for
the primary and secondary clinical
diagnoses.
As a rule, there is no need
for a paraclinical
diagnostic procedure if:
• you are quite
certain of your
primary clinical
diagnosis.
• treatment plans for
primary and
secondary
diagnoses are the
same.

49. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3
If there is a need for a
paraclinical diagnostic
procedure, the
physician uses the B-
R-C-A processes.
B – stands for benefit;
R – risk; C – cost; A –
Availability.

50. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3
The physician gives or
lists the various
options of paraclinical
diagnostic procedures
and then gives data
on the BRCA.
With the data given,
the patient is asked
what s/he prefers.

51. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
Procedures Benefit (goal – to be
more definite on the
diagnosis)
Risk Cost (PhP) Availability
Option1 accuracy 99% acceptable 4000 available
Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available
Example of BRCA
comparative analysis
of paraclinical
diagnostic procedures

52. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
There are several
issues to discuss in
the selection of
paraclinical diagnostic
procedures to be done
for suspected cancer.
There are a lot of
confusion, not to say
errors, happening.
Issues
• Using the fad, the popular one without
comparative analysis (benefit, risk, cost and
availability) of other options (usually with no
considerations for cost-effectiveness and
patient preference)
• Shotgun approach ordering every possible test
just to catch a diagnosis
• Ordering tests not needed for diagnosis of
cancer NOT recommended

53. Paraclinical diagnostic procedures for
thyroid cancer
Thyroid lump / lumps / nodule / nodules
Examples of
physicians’ ordering
for paraclinical
diagnostic procedures
Shotgun approach
• Ultrasound
• Thyroid function
tests (FT4, FT3,
TSH)
• Thyroid scan
Targeted and sequential
with prioritization
approach
• Thyroid lump
examination (eg
ultrasound
if indicated
• Needle biopsy
Recommended
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
If hyperthyroidism /
hypothyroidism is
suspected, do
thyroid function
test.
Do thyroid scan only
as indicated.

54. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer

55. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
Needle aspiration +/-
biopsy

56. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer

57. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
Example of BRCA
comparative analysis
of paraclinical
diagnostic procedures
in a patient with a
dominant thyroid
mass
Procedures Benefit (goal –
to be more
definite on the
diagnosis)
Risk Cost Availability
Ultrasound Indirect (2+) No pain P √
Thyroid
scan
Indirect (1+) No pain
+ Radiation
PP
CT scan Indirect (3+) No pain
+ Radiation
PPPP
√
√
CT-scan is usually not
the first or initial test.

58. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Paraclinical diagnostic procedures for
thyroid cancer
Example of BRCA
comparative analysis
of paraclinical
diagnostic procedures
in a patient with a
dominant thyroid
mass
Procedures Benefit (goal –
to be more
definite on the
diagnosis)
Risk Cost Availability
Biopsy Direct info (4+
diagnostic
yield)
Pain PPP
Ultrasound Indirect (2+) No pain P √
Thyroid
scan
Indirect (1+) No pain
+ Radiation
PP
CT scan Indirect (3+) No pain
+ Radiation
PPPP
√
√
√ CT-scan is usually not
the first or initial test.

59. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
PART 1
PART 2
Summary
Take Away
Contents:
• Screening for thyroid cancer
• Symptoms that will lead to suspected presence
of thyroid cancer
• Clinical diagnosis of thyroid cancer
• Paraclinical diagnostic procedures for thyroid
cancer
• Treatment for thyroid cancer
• Surveillance of thyroid cancer
• Prognosis of thyroid cancer
• Palliative and hospice care for thyroid cancer
patients

60. Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer
Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
thyroid cancer.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management.

61. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
THYROID CANCER.
Cancer Course
–
Fundamentals
and
Generalities in
Medical
Management
of Thyroid
Cancer – Part 1