Devita, Hellman, and Rosenberg's Cancer

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

360 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Median survival is between 3 and 4 months. Surgery is typically reserved

for local disease control, particularly in the absence of distant disease.

Radioactive iodine is ineffective in the treatment of anaplastic thyroid

cancer, and chemotherapy alone has modest effects on local response.

This patient is best served with concurrent chemoradiation.

Answer 25.13. The answer is E.

MTCs tend to metastasize early to cervical and mediastinal lymph nodes

and later to the liver, bones, and lungs. CEA and calcitonin are useful

tumor markers reflecting the disease burden. MTC is of neuroendocrine

origin and expresses a high level of somatostatin receptors; thus, it binds

to pharmacologic-radiolabeled somatostatin analogs. Octreoscan can be

used in selected cases with elevated calcitonin. Only limited evidence

showed that PET scan can also be helpful in the imaging of MTC.

Answer 25.14. The answer is A.

Hurthle cell carcinoma, or Oxyphil cell carcinoma, is a variant of follic-

ular cell carcinoma. It has the same malignant features, is known to have

poorer outcomes, and is less apt to concentrate radioactive iodine.

Answer 25.15. The answer is B.

Anaplastic thyroid carcinoma represents 1% to 3% of all thyroid cancers

and is typically fast growing. It is treated mainly with chemoradiation and

perhaps debulking surgery in selected cases, but is considered incurable.

It is always considered stage IV because of its extremely poor prognosis,

with a median survival of only 3 to 4 months.

Answer 25.16. The answer is D.

Doxorubicin is the most commonly used single chemotherapeutic agent

in metastatic thyroid carcinoma, with a modest partial response rate

reported to be approximately 30%. Taxanes are another group of agents

that has also been used in the treatment of metastatic thyroid carcinoma.

Answer 25.17. The answer is B.

Parathyroid carcinoma is a rare cancer. Surgery is the standard treatment

approach. Adjuvant external beam irradiation has been shown to reduce

the rate of recurrence. Resection of other uninvolved parathyroid glands

is not indicated because parathyroid carcinoma typically originates from

one parathyroid gland. Radioactive iodine, as well as chemotherapy, is

not generally effective in the treatment of parathyroid carcinoma. Bone

pain, pathologic fracture, or other evidence of bone disease occurs in

approximately 90% of patients, and renal stones occur in 50% to 80%

of patients.

Answer 25.18. The answer is E.

All of the mentioned options can be used in this case, but perhaps not

all are needed at the same time. IV hydration and IV bisphosphonate