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  • • History of irradiation to the neck (in some patients)

    • Painless or enlarging nodule, dysphagia or hoarseness

    • Firm or hard, fixed thyroid nodule; cervical lymphadenopathy

    • Family history of thyroid cancer

    • Appears later in life

    • Invasive, nonencapsulated tumor

    • Patients often die of local recurrence, pulmonary metastases, or both

    • Microscopically, has 3 different types:

    • 1. Giant cell

      2. Spindle cell

      3. Small cell

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Epidemiology

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  • • Occurs principally in women beyond middle life (peak incidence in the seventh decade of life)

    • 1% of all thyroid cancers

    • 50% have clinically positive cervical lymph nodes at presentation

    • 30% have distant metastases at presentation

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Symptoms and Signs

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  • • Hard, irregular anterior neck mass

    • Quickly enlarging mass

    • May be tender

    • Dyspnea or stridor

    • Dysphagia or odynophagia

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  • • These tumors are reliably diagnosed by fine-needle aspiration biopsy

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  • • History and physical exam

    • Fine-needle aspiration biopsy

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  • • Complete surgical resection is the best chance for cure

    • Local recurrence after surgical treatment is the rule

    • Combination therapy with chemotherapy and external beam radiation offers the best palliation, but is rarely curative

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Surgery

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Indications

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  • • All tumors should be excised as completely as possible

    • Tracheostomy below the tumor may be helpful for patients with actual or impending airway compromise

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Contraindications

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  • • Advanced metastatic disease

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Medications

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  • • Radioiodine ablation 6 weeks after surgery

    • Thyroid-stimulating hormone suppression with thyroid hormone (may have little effect since cells are undifferentiated)

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Treatment Monitoring

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  • • Monthly physical exam for local recurrence

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Prognosis

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  • • Almost all patients have recurrence and die of the disease

    • Life expectancy after diagnosis is typically about 6 months

    • 1-year survival is 5-15%

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References

Kebebew E et al: Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005;103:1330.  [PubMed: 15739211]

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Practice Guidelines

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