Failure to Diagnose & Delay in Treatment of Thyroid Cancer

Evaluate breaches in the standard of care when determining a Failure to Diagnose & Delay in Treatment of Thyroid Cancer

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the patient present with swelling of the throat?
    Yes
    Not assessed
    Answer unknown
    Why is this important?
    Thyroid carcinoma most commonly presents as a painless thyroid nodule or mass.
    (2001) 163 ESCANL 2 143-156

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question

  • To determine which tests should be given next.
  • Which of the following laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis.
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  • Which of the following diagnostic imaging studies were performed?(Choose all that apply) Why is this important?
    Answer this question
    Diagnostic imaging studies need to be performed for the evaluation of malignancy in patients with a palpable thyroid nodule.
    (2006) 15 ESURON 1 43-55

  • Was a fine needle aspiration (FNA) of the thyroid nodule and the cervical lymph nodes performed? Why is this important?
    Answer this question
    A Fine Needle Aspiration (FNA) is currently considered the most effective, accurate, safe, and cost-effective method for the pre-operative distinction between benign and malignant thyroid nodules. Papillary Thyroid Carcinoma (PTC), Hurthle cell, and Medullary Thyroid Carcinoma (MTC) commonly metastasize to cervical lymph nodes. Clinically evident cervical lymph node metastases occur in approximately 35 percent of patients with PTC. Up to 75 percent of patients with MTC will have cervical lymph node metastases.
    (2013) 184 ESJSUR 1 193-199

  • Was the fine needle biopsy indicative of a thyroid malignancy? Why is this important?
    Answer this question
    Fine-needle aspiration biopsy is the preferred technique for obtaining thyroid follicular cells from thyroid nodules. Cytopathologicexamination of these cells provides the best information available, short of surgical excision, to assess whether a nodule is benign or malignant.
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  • Was a biopsy performed? Why is this important?
    Answer this question
    Appropriate and careful diagnostics of a nodular lesion in the neck before surgery has crucial significance for choosing optimal method of surgical treatment which has great influence on mortality rate and reducing complications.
    (2010) 43 EOTCNA 2 229-238

  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    Once a diagnosis has been made, and in many cases if a diagnosis is unclear, referral to the appropriate specialists needs to be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized.
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  • Was the thyroid cancer staged? Why is this important?
    Answer this question
    Thyroid cancer is staged according to the American Joint Committee on Cancer TNM (tumor, node, metastasis) system with separate group staging based upon tumor histology.
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  • With which type of thyroid cancer was the patient diagnosed? Why is this important?
    Answer this question
    The three major types of thyroid cancer are papillary, follicular, and medullary. A fourth type is anaplastic. Prognosis depends on the type of thyroid cancer, presence of metastasis, the aggressiveness of the tumor,and the patient's age and overall health. (1997) 65 EAORNJ 4 710,712,714-716,719-722,725

  • Which of the following imaging studies were performed to identify the tumors?(Choose all that apply) Why is this important?
    Answer this question
    In anaplastic tumors, neck computed tomography scan and chest radiography need tobe performed at the time of diagnosis.
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  • What was the type of lesion? Why is this important?
    Answer this question
    The diagnosis of the lesion can be resectable or unresectable and the treatment varies accordingly.
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  • Was the patient’s airway managed effectively? Why is this important?
    Answer this question
    If unresectable, airway management with or without tracheostomy and pain control are critical.
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  • Were chemotherapy and radiotherapy initiated? Why is this important?
    Answer this question
    Cytotoxic chemotherapy may occasionally be beneficial in patients with progressive symptomatic thyroid cancer that is unresponsive or not amenable to surgery, radioiodine therapy, or external radiotherapy.
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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • What was the size and extent of the thyroid tumor? Why is this important?
    Answer this question
    Goals of treatment include surgical removal of the malignant tumor, treatment of local and distant spread, provision of long-term follow-up and surveillance to ensure early detection of recurrences, palliative treatment for patients with untreatable anaplastic tumors, and screening of family members in the case of medullary carcinoma.
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  • Which of the following surgical procedures were performed? Why is this important?
    Answer this question
    For patients with small papillary carcinomas confined to one nodule of the thyroid a lobectomy plus isthmusectomy may be considered. The isthmus refers to tissue that forms a bridge between the two lobes of the thyroid.
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  • Was a total thyroidectomy performed? Why is this important?
    Answer this question
    Total or near total thyroidectomy is performedfor patients with bilateral lobe thyroid cancer.
    (2008) 37 ENMCNA 2 437-455

  • Was a modified radical neck dissection performed? Why is this important?
    Answer this question
    The presence of diseased nodes lateral to the jugular vein indicates a need for a modified radical neck dissection.
    (2013) 184 ESJSUR 1 193-199