GENETIC CHANGES IN HURTHLE CELL CANCER

1.  RAS AMPLIFICATION, SEEN IN 40% OF CASES
2.  RET, PREDICTIVE OF SPREAD OF DISEASE, PRESENCE OF RET/PTC REARRANGEMENT
(NEGATIVE RET EXPRESSION SPRESD MORE)
3.OVEREXPRESSION OF P53
4. LOSS OF E-CADHERIN
5. AMPLIFICATION OF MYC
6. INCREASED TGF ALPHA
7. INCREASED INSULIN LIKE GROWTH FACTOR
8. INCREASED THYROTROPIN RECEPTOR AND ALPHA SUBUNIT OF G PROTEIN
9. OVEREXPRESSION OF P27 AND CYCLIN D3
10. PRESENCE OF GRIM 19

WATCH TRABECULAR PATTERN
WATCH FOR LEVEL OF INVASION OF BOTH CAPSULE AND BLOOD VESSEL

LOOK FOR  FAMILY HX
                     MASS, PAIN, DYSPNEA DYSPHAGIA, CHOKING SPELLS, HOARSENESS,
                     HORNER SYNDROME

OBTAIN
TSH, T3,T4, FREE T4
ANTI-PEROXIDASE ANTIBODY
ANTITHYROGLOBULIN ANTIBODY
THYROGLOBULIN LEVEL PARTICULARLY POST SURGERY
THYROID UPTAKE AND SCAN
U/S TO DETECT ADENOPATHY
OCTREOTIDE SCAN OR MORE RECENTLY PET SCAN

5 YEAR SURVIVAL  8-10%
10 YEAR SURVIVAL 18-20 %
10 YEAR SURVIVAL  30%

TREATMENT
1.SURGERY
2. IODINE BASED RADIATION
3. SOMETIME STANDARD RT
4. REPEAT IODINE RT FOR RECURRENCE AFTER UPTAKE BOOSTER
5. ROLE OF ANTI-VEGF +/- TAXANES