Editing Parathyroid cancer


== Epidemiology ==

* One of the rarest human     cancers - 11 per 10,000,000 per year
* <1% of all patients with     primary HPT
* Can occur in patients with     familial HPT
* Median age 57yo
* Men and women equally

== Pathophysiology ==

* Almost uniformly functional
* Mostly >3cm in size when     excised

== Presentation ==

* Generally severe primary HPT
* 50% have a palpable neck mass
* Often have RLN palsy
* Often calcium >3.49mmol/L,     PTH 3-10x normal, increased ALP

== Operative findings ==

* Solid firm mass with a     grayish white appearance and a firm consistency
* Normal tissue planes between     parathyroid and thyroid are absent
* Invasion of thyroid or straps
* Cervical lymph node mets are     uncommon (3%)

== Management ==

* Medical
** Manage the hypercalcaemia      prior to OT if severe
** Radioresistant and      chemotherapy is ineffective
** Bisphosphonate or cinacalcet      to control hypercalcaemia long-term
* Surgical
** En bloc resection of the      cancer and any adjacent involved structures
*** If RLN resected, consider       reconstruction with ansa cervicales graft
*** May need to resect       trachea/oesophagus
** Cervical lymph node      dissection only if actual metastases are suspected or seen

== Prognosis ==

* Recurrence rates 40-70%     within 2-5 years
* Most commonly metastasises to     lung and bone
* Disease specific survival     median 75 months

[[Category:Endocrine]]