Devita, Hellman, and Rosenberg's Cancer

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

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

Question 25.3. A 42-year-old woman underwent FNA of a 3-cm left thyroid mass. No

palpable nodes were detected on physical examination or imaging. FNA

was suspicious of thyroid malignancy. What is the most appropriate next

step?

A. Total thyroidectomy

B. Left lobectomy but with fresh-frozen section to plan immediate fur-

ther resection

C. Left complete lobectomy and isthmusectomy, to be followed by total

thyroidectomy later if malignancy is confirmed

D. Plan to repeat FNA for further tissue evaluation

Question 25.4. A 41-year-old woman, who was treated 4 years ago for papillary thyroid

carcinoma with total thyroidectomy and bilateral neck dissection fol-

lowed by radioactive iodine ablation, is found on follow-up to have an ele-

vated thyroglobulin (TG) level (16 ng/mL) with negative TG antibodies.

Diagnostic whole-body iodine scan is negative, and thyroid-stimulating

hormone (TSH) is suppressed. What is the most appropriate next step?

A. Chest radiograph

B. Positron emission tomography (PET) scan

C. Surveillance

D. Neck imaging

Question 25.5. A 24-year-old woman underwent FNA of a left thyroid nodule, which

showed cells suspicious of neuroendocrine origin. She has been experienc-

ing intermittent diarrhea for the past 4 months. Family history includes

kidney stones in several members. The rest of the history and physical

examination results are normal. What is the most appropriate next step?

A. Obtain metanephrines and catecholamines/serum calcium/serum cal-

citonin/carcinoembryonic antigen (CEA)/RET proto-oncogene.

B. Obtain serum calcitonin/thyroglobulin/calcium/RET proto-onco-

gene, and then perform a total thyroidectomy.

C. Measure metanephrines and catecholamines/serum calcium/

calcitonin/CEA.

D. Perform a total thyroidectomy now, and then obtain postoperative

evaluation.

Question 25.6. A 54-year-old man underwent total thyroidectomy for suspected papillary

thyroid carcinoma on FNA. Pathologic examination confirmed a 3-cm

papillary carcinoma in the right lobe, without extracapsular extension;

all nodes examined were free of cancer. You recommend which one of the

following?

A. Radiation therapy

B. Radioactive iodine ablation

C. Chemotherapy

D. Concurrent chemotherapy and radiotherapy

E. Observation only