Devita, Hellman, and Rosenberg's Cancer

LWBK1006-25 LWW-Govindan-Review December 12, 2011 19:21

CHAPTER 25 CANCER OF THE

ENDOCRINE SYSTEM

RAMI Y. HADDAD•MOUHAMMED AMIR HABRA

DIRECTIONS Each of the numbered items below is followed by lettered answers. Select the

ONE lettered answer that is BEST in each case unless instructed otherwise.

QUESTIONS

Question 25.1. A 37-year-old woman presents with a right anterior neck mass. She denies

dysphagia or hoarseness. There is no history of radiation exposure or

family history of cancer, and no palpable nodes are detected on physical

examination. Neck ultrasound reveals a 2.5-cm right thyroid solid nod-

ule without enlarged cervical lymph nodes. Fine-needle aspiration (FNA)

suggests the diagnosis of papillary thyroid carcinoma. You recommend

which one of the following as the initial management plan?

A. Total thyroidectomy

B. Right thyroid lobectomy

C. Total thyroidectomy with modified right neck dissection

D. Total thyroidectomy with bilateral neck dissection

Question 25.2. A 39-year-old woman underwent right thyroid lobectomy and isthmu-

sectomy after the incidental discovery of a 0.8-cm right thyroid nodule

with indeterminate FNA. On preoperative neck ultrasound, the left thy-

roid lobe appeared normal and there was no evidence of abnormal lymph

nodes. Pathologic examination revealed a 0.75-cm intrathyroidal papil-

lary carcinoma. The most appropriate management now is:

A. Thyroid hormone replacement if needed without further resection.

B. Radioactive iodine scan followed by radioactive iodine ablation if

there is neck uptake.

C. Surgical resection of remaining thyroid tissue followed by radioactive

iodine ablation.

D. Radioactive iodine ablation followed by thyroid hormone suppres-

sion.

Corresponding Chapters inCancer: Principles & Practice of Oncology,Ninth Edition: 107 (Molecular Biology of

Endocrine Tumors), 108 (Thyroid Tumors), 109 (Parathyroid Tumors), 110 (Adrenal Tumors), 111 (Pancreatic Neu-

roendocrine Tumors), 112 (Neuroendocrine (Carcinoid) Tumors and the Carcinoid Syndrome), and 113 (Multiple

Endocrine Neoplasias).

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