Σταδιοποίηση σε Ca Θυρεοειδούς Αδένα

 

Ca Θυρεοειδούς Αδένα

AJCC Stages – Θηλώδης ή Θηλακιώδης (διαφοροποιημένο)

< 45 ετών

T

N

M

I

Any T

Any N

M0

II

Any T

Any N

M1

> 45 ετών

T

N

M

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

T1, T2, T3

N1a

M0

IVA

T4a

N0

M0

T4a

N1a

M0

T1, T2, T3, T4a

N1b

M0

IVB

T4b

Any N

M0

IVC

Any T

Any N

M1

AJCC Stages – Μυελοειδής (ανεξαρτήτως ηλικίας)

I

T1

N0

M0

II

T2

N0

M0

T3

N0

M0

III

T1, T2, T3

N1a

M0

IVA

T4a

N0

M0

T4a

N1a

M0

T1, T2, T3, T4a

N1b

M0

IVB

T4b

Any N

M0

IVC

Any T

Any N

M1

AJCC Stages – Αναπλαστικός

IVA

T4a

Any N

M0

IVB

T4b

Any N

M0

IVC

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤ 2 cm in greatest dimension limited to the thyroid

T1a

Tumor ≤ 1 cm, limited to the thyroid

T1b

Tumor > 1 cm but ≤ 2 cm in greatest dimension, limited to the thyroid

T2

Tumor > 2 cm but ≤ 4 cm in greatest dimension, limited to the thyroid

T3

Tumor > 4 cm in greatest dimension, limited to the thyroid or any tumor with minimal extrathyroid extension (e.g., extension to sternothyroid muscle or perithyroid soft tissues)

T4

 

T4a

Moderately advanced disease: Tumor of any size extending beyond the thyroid capsule to invade the subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve

T4b

Very advanced disease: Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels

Anaplastic carcinoma with gross extrathyroid extension

Αναπλαστικό

 

T4a

Intrathyroidal anaplastic carcinoma

T4b

Anaplastic carcinoma with gross extrathyroid extension

All (T) categories may be subdivided into (s) solitary tumor and (m) multifocal tumor; the largest determines the classification. 
¹All anaplastic carcinomas are considered T4 tumors.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis²

N1

Regional lymph node metastasis²

N1a

Metastasis to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)

N1b

Metastasis to unilateral, bilateral, or contralateral cervical (levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (level VII)

²Regional lymph nodes are the central compartment, lateral cervical, and upper mediastinal lymph nodes.

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Differentiated thyroid carcinoma (DTC)

  • May invade local structures, including
    • Trachea
    • Esophagus
    • Recurrent laryngeal nerves
    • Vascular structures
      • Carotid artery
      • Internal jugular vein
  • Tends to spread to local cervical lymph nodes
    • Paratracheal (level VI)
    • Deep cervical (levels III and IV)
    • Spinal accessory (level V)
    • Retropharyngeal chains
    • May extend into mediastinum along paratracheal nodal chain
  • Intrathyroid metastases and extension into adjacent structures can occur
  • Typically has hematogenous spread
  • Distant metastatic sites
    • Lung
    • Bone
    • CNS

Multiple sites Medullary thyroid carcinoma (MTC)

  • Tends to spread to local cervical nodes and then distant metastases
  • In general, similar route of spread to DTC

Anaplastic carcinoma

  • Locally infiltrative and destructive mass
  • Often encases local structures
  • Patients often have regional nodal spread and distant metastases at diagnosis

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Primary malignant tumors(WHO classification)

  • Malignant tumors of follicular cells
    • Papillary carcinoma (80%)
    • Follicular carcinoma (13%)
      • Hürthle cell carcinoma
    • Poorly differentiated carcinoma
    • Anaplastic (undifferentiated) Ca (1-2%)
      • Giant cell carcinoma
      • Small cell carcinoma
      • Spindle cell carcinoma
  • Malignant tumors of C cells
    • Medullary carcinoma (3-4%)
  • Malignant tumors of mixed follicular and C cells
  • Miscellaneous epithelial tumors
    • Squamous cell carcinoma
    • Adenosquamous carcinoma
    • Mucin-producing carcinoma
    • Mucoepidermoid carcinoma
  • Malignant nonepithelial tumors
    • Lymphoma (5%)
    • Sarcoma
  • Miscellaneous
    • Fibrosarcoma
    • Malignant hemangioendothelioma