Thyroid Cancer, Anaplastic

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • Hard, irregular anterior neck mass

  • Quickly enlarging mass

  • May be tender

  • Dyspnea or stridor

  • Dysphagia or odynophagia

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

• • History and physical exam

  • Fine-needle aspiration biopsy

• • 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

Surgery

Indications

• • All tumors should be excised as completely as possible

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

Contraindications

• • Advanced metastatic disease

Medications

• • Radioiodine ablation 6 weeks after surgery

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

Treatment Monitoring

• • Monthly physical exam for local recurrence

Prognosis

• • 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%

References

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.NCCN.org/