POST GRADUATE IN SURGERY
VICTORIA HOSPITAL
BANGALORE
2. / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
3. / COURSE OF STUDY AND SUBJECT / M.S. IN GENERAL SURGERY
4. / DATE OF ADMISSION TO THE COURSE / 20 AUG 2013
5. / TITLE OF THE TOPIC / CLINICO-PATHOLOGICAL STUDY AND MANAGMENT OF VARIOUS TYPE OF THYROID CARCINOMA
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
6. BRIEF RESUME OF INTENDED WORK
6.1. NEED FOR THE STUDY
Malignant tumours arising from thyroid gland are very slow growing.Thyroid cancer is most common endocrine malignancy but represent 1% of all malignancies.There has been increasing incidence of thyroid cancer.1 Thyroid nodules are a common clinical condition. The clinical evaluation of nodule is a common problem,albeit multidisciplinary one, confronting the clinician. Vast majority are benign but concern is that such a swelling may harbour malignancy demands prompt and accurate diagnosis. Further more it is clear that properly treated differentiated thyroid carcinoma is associated with excellent prognosis. Thyroid tumours occurring in the thyroid gland can be either Primary or Secondary. Among the primary tumours the main types are, 1. Papillary, 2. Follicular, 3. Medullary, 4. Anaplastic tumours and 5. Lymphomas.The natural history of thyroid carcinoma allows surgeon to perform a more prolonged and thoughtful preoperative work up and evaluation. Investigation should be with minimum inconvenience to the patient and most cost effective. FNAC is now the corner stone of investigation for many of these patients and evaluation. By FNAC accuracy in diagnosis of thyroid neoplasm of upto 90% can be achieved. Most thyroid cancers are treatable and even curable by surgery if diagnosed early, but it is possible that they can even recur following incomplete or inadequate surgery. Even then these recurrences can be treated by additional methods of treatment like radiotherapy and chemotherapy. The present study intends to describe various modes of clinical presentations and their correlations with histo-pathological features, role of investigations and the management of different types of thyroid cancers.
6.2. REVIEW OF LITERATURE.
The name "thyroid" was given to this small gland in the neck by Thomas Wharton, who named it after the shape of an ancient Grecian shield.Leonardo da Vinci was the first to draw the thyroid, in 1500, and it was mentioned in Hindu holy texts in 300 BC. Medical discoveries over the years have led to cures that continue to improve the lives of people suffering from thyroid disease.2
Thyroid tumours are the most common endocrine neoplasms. Themanagement of a patient with typical thyroid cancer is effective and usually consists of surgical resection, followed by medical therapy and regular surveillance.3 Thyroid cancer constitutes about 1% of all malignant tumours and highly differentiated types account for 0.8% of all human malignancies. Thyroid cancer ranks among the 5 most frequent cancers in the 15 to 40 age group. For 5 year survivors, the relative survival for years 5-10 is in range of 99%.4
Thyroid cancer is a slowly progressing disease and has an overall favourable outcome, with only 9% of patients dying from it. The relatively indolent nature of thyroid malignancy is generally ascribed to the inherent, innocuous biologic behaviour that is characteristic of these neoplasms.5 More than 90% of thyroid carcinomas, including papillary, follicular, and medullary carcinomas are well differentiated.
In 1977,E.Williamset al6studied on comparison between thyroid carcinoma among iodine rich andnormal iodine intake areas.Thisstudy revealed increased incidence of papillary carcinoma in iodine rich areaand thatof follicular carcinoma in endemic goitre areas.Malignant lymphoma and lymphocytic thyroiditis were high iniodine deficient areas.This suggests different histological types of malignancy are influenced by differentetiological factors.
There are certain pitfalls in FNAC diagnosis of thyroid. A safe and reliable differential diagnosis between thyroid and parathyroid neoplasms on morphological ground alone is difficult in cytological smears due to absence of well established criteria due to overlapping of cytological features of these lesions.7 With increasing accuracy of FNAC various studies have shown that the percentage of patients undergoing thyroidectomy has decreased by 25%-50%, and the yield of carcinoma in patients who undergo surgery has increased from 15% to up to 50%.8
Survival rates have improved over time with prominent decreases in mortality, especially for women and among middle aged groups presumably owing to earlier detection and possibly because of more effective treatment.3
6.3. OBJECTIVES OF STUDY
1. To study the clinical presentation of carcinoma thyroid.
2. To study various pathological types of carcinoma thyroid based on FNAC,HPE and other relative investigation.
3. Various treatment modalities, complications and prognostic factors.
7: MATERIALS AND METHOD :
7.1: SOURCE OF DATA
The source of data are collected from the subjects satisfying the inclusion and exclusion criteria , from in-patients and the in-patient registry of Victoria hospital and Bowring and Lady Curzon hospital during period of oct 2013 to may 2015.
7.2. METHODS OF COLLECTION OF DATA
·The patients selected for this study are those who are admitted withclinically palpable thyroid swelling.
·Based on detailed history, thorough clinical examination and relevant investigations like FNAC,Ultra Sound (USG)of thyroid and others, the diagnosis of carcinoma thyroid will be made.
A) INCLUSION CRITERIA
Patients with clinico pathologically and histo pathologically proven thyroid cancer, will be selected for this study.
B) EXCLUSION CRITERIA
1. Patients with benign thyroid swelling.
C) SAMPLE SIZE : 50
D) STUDY DESIGN : Prospective study
E) STUDY PERIOD: October 2013 to May 2015
F) SATISTICAL METHOD : Descriptive statistical method
7.3 INVESTIGATION AND INTERVENTIONS REQUIRED FOR STUDY
- Routine hematological investigation
- Thyroid profile
- Ultra sonography
- Isotope scan
- Bone scan(only in case of follicular carcinoma)
7.4. HAS ETHICAL CLEARENCE HAS OBATINED FROM YOUR
INSTITUTION
YES
8. LIST OF REFERENCES.
1. HtweTT,Hamdi MM,Swethadri GK,Wong JOL,Soe MM,Abdullah MS.Incidence of thyroid malignancy among goitrous thyroid lesions from the Sarwak General Hospital 2000-2004.Singapore Med J2009;50(7):724-728.
2. Geeta Lal and Orlo.H. Clark, Thyroid, Para Thyroid, and adrenal Chapter 38,Charles BrunicardiF.Schwartz’s Principles of Surgery, 9thedition,McGraw Hill CompaniesInc2010, pp1344.
3. Schlumberger.M J, Papillary and Follicular Thyroid Carcinoma,NorthEnglandJournalofMed 1998;338:297-306.
4. Sharon L. Collins Thyroidcancer, Controversies and etiopathogenesis, Thyroid Disease endocrinology, surgery, nuclear medicine and radiotherapy,2ndEdition, Stephen.A.Falk, Lippincott-Raven Publishers,1997, 495-557.
5. Robbins J et al. Thyroid cancer: A lethal Endocrine Neoplasm. Ann Intern Med1991;115:133-147.
6. WilliamsED,DoniachI,BjarnasonO,MichieW.Thyroid cancer in iodine rich area.A histopathological study.Cancer1977;39:215-22.
7. Seleni ST, Gakiopoulou H, Kauantzas N, Ayrogiannis G, Givalos N, Stratiosputsouris EF. CANCER. Cytopahtology CA section. American Cancer Society Journal of Cancer. 2001;111(2):130-6.
8. Management of thyroid carcinoma. Surgical guide lines of thyroid carcinoma2001;7(3):202-220.
9. SIGNATURE OF CANDIDATE:
10. REMARKS OF GUIDE:
1..Thyroid malignancy is increasing in incidence.
2.An attempt is made to study different type of malignancies , prognosis and management.
3.Early detection and treatment will increase the life span and decrease tha morbidity and mortality of the patients
11. NAME AND DESGNATION OF
11.1. GUIDE DR. SHASHIKALA V
ASSOCIATE PROFFESOR OF SURGERY
VICTORIA HOSPITAL
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE
11.2. SIGNATURE
11.3. CO GUIDE (If any)
11.4. SIGNATURE:
11.5. HEAD OF DEPARTMENT DR. DURGANNA T
PROFESSOR AND HOD
DEPARTMENT OF SURGERY
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE
11.6 SIGNATURE:
12. REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2. SIGNATURE
2