Thyroid Cancer should be a Pre-operative diagnosis-Neil Tolley

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 5th Annual Endocrine Surgical Week at JPMC

Thyroid Cancer should be a 
Pre-operative diagnosis-Neil Tolley

Visiting faculty thanks the organizers for exceptional
hospitality, pledge to work as Pakistan’s ambassadors

KARACHI: Jinnah Postgraduate Medical Centre organized its 5th annual Endocrine Surgical Week which concluded on March 15th 2018.  Prof. Mark R. J.  Lansdown and Prof. Neil Tolley from UK were the two distinguished Master Trainers. The course was very well attended by Head & Neck Surgeons as well as general surgeons interested in endocrine diseases. Keeping up the past traditions the registration was mandatory but free and the participants also got CME credit for attending this academic activity.

The course formally started on March 12th in the morning with a presentation by Prof. Neil Tolley who talked on Thyroid Nodules. He gave details of 329 thyroid cancer cases wherein incidence of complications was 6%.  He also referred to 13% increase in the risk of salivary cancer.  Talking about risk factors for cancer he mentioned radiation exposure and familial syndrome, male old, young patients have rapid increase in size of the nodules. Other risk factors include previous thyroid cancer, lymphadenopathy, and evidence of local invasion.  He laid emphasis on clinical evaluation and the other investigations which will be required.  Patients with multinodular goiter, he opined, will require surgery.

Some patients, he further stated, may require ultrasound scan as well as FNA biopsy. The diagnosis is examiner dependent in the cases of radiological evaluation.  Cytological evaluation is also important. Thyroid cancer, Prof. Neil Tolley said should be a pre-operative diagnosis. In this series 95 patients were Type-5, eighty were Type-4 and twenty five Type-3 cancers. The chances of error in cancer diagnosis is between 17-60% and there is 6-7% significant alteration in management. He also talked about calcitonin screening, evidence based recommendations for evaluation. Micro carcinoma can be observed and one should discuss all these cases in a multidisciplinary team meeting.

During the discussion role of ultrasound in multinodular goiter in patients going for surgery was discussed in detail. It was pointed out that during evaluation every suspicious nodule should have an ultrasound. Cyst should be aspirated. Responding to another question Prof. Neil Tolley said that their pathologists do not like to do frozen section.

Inaugural session

Dr. Shamim Qureshi speaking in the inaugural session highlighted the importance of these academic activities which will help the participants to change their practice achieving excellence. In order to ensure that large number of surgeons could participant, they had not kept any registration fee as usual.

Prof. Naseem Baloch gave details of the earlier Endocrine Surgical Weeks held at JPMC and  thanked the eminent master trainers who had so far visited JPMC to train the local surgeons. He thanked Dr. Shamim Qureshi who he said was the moving spirit behind these academic activities. He also thanked members of his team and the pharmaceutical industry which had helped them to organize all this besides thanking the JPMC administration in general and its Executive Director in particular for providing all the help and assistance. Our basic aim he said was to improve patient care through such interactive sessions. It will help enhance our skills and we will be able to solve controversies in endocrine diseases.

Prof. Mumtaz Mahar the Patron of this CME programme who in fact initiated this while he was on the faculty of JPMC in his speech recalled that when he started this specialized training programme, he faced lot of resistance. It was said that I was taking people to narrow area but with the passage of time every one has realized the importance of these specialization approach. We started with colorectal cancer and then endocrine surgical week was added. In fact we have come a long way. We have made tremendous progress every year. Previously we just had one master trainer but now we always have two master trainers. Pharma industry has helped us a lot for which we are grateful to them.

Dr. Seemin Jamali Executive Director of JPMC also briefly spoke on the occasion. She welcomed the distinguished guest speakers from UK and hoped they will find their stay enjoyable. Prof. Mark and Prof.; Neil Tolley both said that they were delighted to come to Pakistan and look forward to interactive discussions. We all will learn from each other, they remarked. During the four days course, numerous topics related to endocrine diseases were discussed while the master trainers also showed some liver surgery.

Concluding Session

Speaking in the concluding session Dr. Seemin Jamali Executive Director of JPMC thanked the visiting faculty as it had provided the Pakistani surgeons an opportunity to learn from the experts. JPMC, she stated is the 1st public sector hospital where separate endocrine unit has been established. She lauded the efforts of the OT staff for their dedication   and announced rupees twenty five thousand cash award.  Cash prize were also announced for Dr. Maria, Dr. Naeem and Dr. Daleep. She also presented Mementoes to the overseas guest speakers and organizers.

 Dr. Nasim Baloch thanked all those who extended their valuable help and assistance to make the course successful. Our aim, he said, was to educate young surgeons, share experience and knowledge and solve the controversies which has been accomplished with the help of two brilliant speakers. The total number of registered participants was four hundred thirteen who had come from all over the country, he added.

Prof. Neil Tolley in his remarks said that he was not expecting the response we received from the participants, it has been a wonderful experience, at wonderful institution and people. I will have access baggage while going back home and overwhelming   response and respect from the people of Pakistan.  He also lauded the efforts of Prof. Shamim Qureshi and Prof. Nasim Baloch for hosting this meeting.

Prof. Mark Lansdown stated that he was worried while planning to visit Pakistan, but the hospitality extended to us is commendable. We are totally safe and happy and going back with better understanding and will work as Ambassador for Pakistan.

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