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Eric J. Sherman, MD, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, discusses the treatment of anaplastic thyroid cancer with intensity-modulated radiation therapy (IMRT), paclitaxel, and pazopanib.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Anaplastic Carcinoma of Thyroid
  • Anaplastic Carcinoma of Thyroid Gland
  • Anaplastic Thyroid Carcinoma

What is Anaplastic Thyroid Cancer? (Definition/Background Information)

  • The thyroid gland is a butterfly-shaped gland located in the front of the neck. It is responsible for secreting thyroid hormones that monitor our body temperature, heart rate, blood pressure, and weight.
  • Anaplastic Thyroid Cancer is a rare cancer of the thyroid gland. The cancer arises when genetic mutations transform healthy cells into abnormal cancer cells. It is one of 4 types of thyroid carcinoma that is fast-growing and invasive, which makes it difficult to treat.
  • These cancer cells are allowed to grow and multiply at very high rates. Unlike normal cells, these cancer cells do not die, and as a result, they form tumors. Additionally, cancer cells can spread to other tissues or regions of the body resulting in metastatic Anaplastic Thyroid Cancer.
  • The diagnosis is usually made through a biopsy, which is examined by a pathologist under a microscope.
  • The treatment of choice is surgical excision and radiation therapy; however, the prognosis is generally very poor.

Who gets Anaplastic Thyroid Cancer? (Age and Sex Distribution)

  • Anaplastic Thyroid Cancer is rare and accounts for approximately 1-2% of all thyroid cancers. It is typically diagnosed in adult individuals, aged 65 years and above
  • This type of cancer affects women, 2-times more than men
  • Individuals of all race/ethnic background are prone to the condition

What are the Risk Factors for Anaplastic Thyroid Cancer? (Predisposing Factors)

The risk factors associated with Anaplastic Thyroid Cancer include:

  • Age: Individuals over the age of 65 years
  • Personal or family history of goiter: Many patients with Anaplastic Thyroid Cancer have had long-standing goiters (non-cancerous enlargement of the thyroid)
  • Exposure to radiation: A history of exposure to radioactive materials, or radiation to the head/neck, can increase one’s risk for this form of thyroid cancer

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Anaplastic Thyroid Cancer? (Etiology)

As with the other types of thyroid cancer, the cause of Anaplastic Thyroid Cancer is currently unknown.

  • Anaplastic Thyroid Cancer occurs when healthy cells of the thyroid become cancer cells, as a result of genetic mutations. Mutations allow the cancer cells to grow and multiply uncontrollably to form new cancer cells
  • Thyroid cancer cells lose their ability to die, forming a tumor/mass in the thyroid. They can also invade nearby tissues and other regions of the body

What are the Signs and Symptoms of Anaplastic Thyroid Cancer?

The signs and symptoms of Anaplastic Thyroid Cancer include:

  • Coughing-up blood
  • Difficulty swallowing or breathing
  • Hoarseness, voice changes
  • Lumps located in the neck
  • Rapid weight loss due to loss of appetite

How is Anaplastic Thyroid Cancer Diagnosed?

Any patient with a history of growing neck mass is typically evaluated immediately, for thyroid cancer. Diagnostic measures for Anaplastic Thyroid Cancer could include the following:

  • A thyroid scan can be performed to create an image of the thyroid gland using radioactive iodine
  • An ultrasound of thyroid can be useful in determining the nature of the nodules in the thyroid, by creating a visual image of the thyroid
  • In fine-needle aspiration (FNA), a thin needle is inserted into the neck and/or nodules, removing sample cells that can be examined for signs of cancer
  • A thyroid biopsy can likewise be used to diagnose an individual with Anaplastic Thyroid Cancer. In this procedure, a sample of thyroid tissue is removed and checked for cancer

After a diagnosis of Anaplastic Thyroid Cancer is made, other scans and tests, can help determine the size of the nodules, their location, and the extent to which the cancer has spread. These tests include:

  • CT and MRI scan; whole-body scans
  • X-ray of the chest
  • An examination involving a laryngoscopy, or a fiber-optic scope, can be performed to determine if the vocal cords are affected

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Anaplastic Thyroid Cancer?

A possible complication associated with Anaplastic Thyroid Cancer is the spread (metastasis) of the cancer, to a variety of organs in the body.

How is Anaplastic Thyroid Cancer Treated?

Anaplastic Thyroid Cancer is different from the other types of thyroid cancer in that, it is invasive and spreads quickly, making treatment efforts less effective. The best treatment plan for an individual with Anaplastic Thyroid Cancer is dependent on the following factors:

  • Their age
  • Size of the nodule
  • The extent to which the cancer has spread

There are 3 main treatment options for Anaplastic Thyroid Cancer: Surgery, radiation therapy, and chemotherapy

  • A surgical procedure called thyroidectomy may be performed to completely remove the thyroid gland. This procedure is performed only when the cancer is confined to the thyroid, and is intended to decrease symptoms of the cancer
  • Anaplastic Thyroid Cancer can spread to other nearby regions, such as to the windpipe. When the windpipe is affected, a procedure called tracheostomy may be performed. A tracheostomy is a surgically created opening through the front of the neck and into the windpipe. During this procedure, a tracheostomy tube is inserted into this opening to maintain breathing
  • Radiation therapy is used before and after surgery, to help shrink the tumor. It may be a treatment option for individuals, whose tumors cannot be surgically removed. Radiation therapy involves the use of x-rays to kill cancer cells.
  • Chemotherapy uses drugs to kill any cancer cells present throughout the body, or to prevent the cancer from spreading. It is administered through the bloodstream, and may also help inreducing pain.

Clinical trials are also another possible treatment option for individuals diagnosed with Anaplastic Thyroid Cancer. There are clinical trials studying the effects of thyroidectomy, followed by chemotherapy and radiation therapy. Other clinical trials are studying new treatments for thyroid cancers. Clinical trials may not guarantee a cure; but, it may be an opportunity to experiment with new cancer treatment options.

How can Anaplastic Thyroid Cancer be Prevented?

Currently, the cause of Anaplastic Thyroid Cancer formation is unknown, and there are no known preventative methods.

What is the Prognosis of Anaplastic Thyroid Cancer? (Outcomes/Resolutions)

  • Anaplastic Thyroid Cancer is a fast-growing and aggressive cancer that is difficult to treat. Furthermore, most individuals will have metastatic Anaplastic Thyroid Cancer, at the time of initial diagnosis. Thus, most patients with this type of thyroid cancer have a median survival of 3-6 months, from the time of diagnosis
  • However, there are measures that can be taken to ensure patients are comfortable. For instance, a tracheostomy tube can allow comfortable breathing, or a gastrostomy tube (feeding tube) can allow easier swallowing
  • In most cases, a complete removal of the thyroid gland does not prolong one’s life

Additional and Relevant Useful Information for Anaplastic Thyroid Cancer:

The 4 types of thyroid carcinoma are:

  • Papillary Thyroid Carcinoma
  • Follicular Thyroid Carcinoma
  • Medullary Thyroid Carcinoma
  • Anaplastic Thyroid Carcinoma

What are some Useful Resources for Additional Information?

American Cancer Society (ACS)
1599 Clifton Road, NE Atlanta, GA 30329-4251
Toll-Free: (800) 227-2345
TTY: (866) 228-4327
Website: http://www.cancer.org

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322 Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
TTY: (800) 332-8615
Email: cancergovstaff@mail.nih.gov
Website: http://www.cancer.gov

National Organization for Rare Disorders (NORD)
55 Kenosia Avenue Danbury, CT 06810
Phone: (203) 744-0100
Toll-Free: (800) 999-6673
Fax: (203) 798-2291
Email: orphan@rarediseases.org
Website: http://www.rarediseases.org

References and Information Sources used for the Article:

http://www.nlm.nih.gov/medlineplus/ency/article/000352.htm (accessed on 07/22/12)

http://www.cap.org/apps/docs/reference/myBiopsy/anaplastic.html (accessed on 07/22/12)

http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional/page8 (accessed on 07/22/12)

http://my.clevelandclinic.org/disorders/thyroid_cancer/hic_thyroid_cancer.aspx (accessed on 07/22/12)

http://endocrinediseases.org/thyroid/cancer_anaplastic_treatment.shtml (accessed on 07/22/12)

Helpful Peer-Reviewed Medical Articles:

Burnison, C. M., & Lim, S. (2012). Multimodal approach to anaplastic thyroid cancer.[Review].Oncology (Williston Park), 26(4), 378-384, 390-378.

Dackiw, A. P. (2010). Anaplastic thyroid cancer. [Case ReportsReview]. Cancer Treat Res, 153, 75-84. doi: 10.1007/978-1-4419-0857-5_5

Deshpande, H. A., Roman, S., & Sosa, J. A. (2013).New targeted therapies and other advances in the management of anaplastic thyroid cancer.[Review].CurrOpinOncol, 25(1), 44-49.doi: 10.1097/CCO.0b013e32835a448c

Granata, R., Locati, L., &Licitra, L. (2013). Therapeutic strategies in the management of patients with metastatic anaplastic thyroid cancer: review of the current literature. [Review].CurrOpinOncol, 25(3), 224-228.doi: 10.1097/CCO.0b013e32835ff44b

Kojic, S. L., Strugnell, S. S., & Wiseman, S. M. (2011). Anaplastic thyroid cancer: a comprehensive review of novel therapy. [Review]. Expert Rev Anticancer Ther, 11(3), 387-402. doi: 10.1586/era.10.179

Sosa, J. A., Balkissoon, J., Lu, S. P., Langecker, P., Elisei, R., Jarzab, B., . . .Ondrey, F. (2012). Thyroidectomy followed by fosbretabulin (CA4P) combination regimen appears to suggest improvement in patient survival in anaplastic thyroid cancer. [Multicenter Study Research Support, Non-U.S. Gov't Review]. Surgery, 152(6), 1078-1087. doi: 10.1016/j.surg.2012.08.036

Pasieka, J. L. (2003). Anaplastic thyroid cancer. Current opinion in oncology, 15(1), 78-83.

Neff, R. L., Farrar, W. B., Kloos, R. T., & Burman, K. D. (2008). Anaplastic thyroid cancer. Endocrinology and Metabolism Clinics, 37(2), 525-538.