Thursday, November 30, 2023
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Assistant Professor, Department of Hematology/Oncology
Chief, Division of Head and Neck Medical Oncology
Fox Chase Cancer Center
Temple Health
Philadelphia, Pennsylvania
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This activity is intended for hematology/oncology specialists, endocrinologists, and otolaryngologists.
The goal of this activity is to improve clinicians' ability to manage patients with head and neck cancers that harbor NTRK gene fusions.
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As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Assistant Professor, Department of Hematology/Oncology
Chief, Division of Head and Neck Medical Oncology
Fox Chase Cancer Center
Temple Health
Philadelphia, Pennsylvania
None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.
This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Elizabeth is a 67-year-old retired dance teacher who stays active with her children and grandchildren. She was diagnosed with thyroid cancer 15 years ago and underwent a total thyroidectomy. Final pathology showed a 3.1-cm papillary thyroid tumor with extrathyroidal extension and 2 involved lateral cervical lymph nodes. She received adjuvant radioactive iodine (RAI) and was then monitored closely by her endocrinologist.
Three years ago, during a routine surveillance appointment, her thyroglobulin (Tg) levels had increased and she underwent ultrasound and computed tomography (CT) with contrast of her neck and chest. Small nodules in her chest were observed and RAI imaging was performed, showing the new nodules were RAI avid. She was again treated with RAI, and the post-treatment scans showed modest uptake. Initially, her Tg levels decreased, but then within 6 months, her Tg levels began to increase. Initial imaging showed stability of the pulmonary nodules, but then after a year, they started to grow. Six months ago, her Tg doubling time became < 6 months and the nodules were increasing further.
Elizabeth was referred to a medical oncologist and a needle biopsy of one of the pulmonary lesions was performed, confirming metastatic papillary thyroid carcinoma. She is asymptomatic and otherwise healthy, with no major comorbidities. Her history and initial workup are summarized in Table 1.
| Demographics/ patient Information |
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|---|---|
| Medical history |
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| Initial workup |
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BMI = body mass index; ECOG PS = Eastern Cooperative Oncology Group performance status; TSH = thyroid stimulating hormone.
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