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What is anaplastic thyroid cancer?

Anaplastic thyroid cancer (ATC), also known as undifferentiated thyroid cancer, is one of the most aggressive and dangerous types of cancer. Cancer cells in this type of cancer do not have the same structure and function as normal thyroid cells. Normally, thyroid cells become mature and specialized cells that perform specific functions in the body through a process called differentiation. But in differentiated thyroid cancer, this differentiation process is disrupted and the cells remain immature and abnormal. Anaplastic thyroid cancer is very rare and accounts for only 1-2% of all thyroid cancers. This disease is more common in the elderly (with an average age of about 60 years) and in women.

Causes of anaplastic thyroid cancer

The exact cause of anaplastic thyroid cancer is still not fully known; But it is likely that a combination of genetic and environmental factors play a role in its creation. Most of the time, before the onset of this cancer, a problem has occurred in the thyroid gland. This cancer can develop in an enlarged thyroid gland (goiter). Also, a previous history of differentiated thyroid cancer (such as papillary cancer or follicular) can also be a cause of this cancer. In many cases, anaplastic thyroid cancer develops from a previously differentiated cancer that has not been properly treated or has progressed.

Stages of anaplastic thyroid cancer

The cancer stage describes the size of the tumor and how far it has spread to other parts of the body. In other words, the stage of cancer shows how far the disease has progressed. The cancer staging system is usually determined based on the size of the tumor and how far it has spread to the lymph nodes and other organs. But due to the aggressiveness and high speed of anaplastic thyroid cancer, its staging is different from other cancers.

In anaplastic thyroid cancer, the size of the tumor or metastasis to the lymph nodes does not play a role in determining the stage of the cancer. In fact, all anaplastic thyroid cancers are considered stage IV (four); Because at the time of diagnosis, they have usually spread to the tissues around the thyroid and neck lymph nodes. The only factor that is important in determining the stage of this cancer is its spread to distant organs such as lungs, liver or bones.

Quoted from the website thyroid.org owned by the American Thyroid Association (ATA) the stages of anaplastic thyroid cancer are as follows:

• Stage: IVA Only the thyroid gland and the lymph nodes adjacent to it are involved in cancer, and other organs have not yet been infected.
• Stage: IVB Cancer is present in the thyroid gland and neck tissues; But it has not yet reached other parts of the body.
• Stage: IVC In addition to the thyroid, the cancer has spread to other body organs such as bones, lungs or brain.

In about 10% of patients, anaplastic thyroid cancer is observed only in the thyroid gland. In approximately 40% of diagnosed cases, the cancer is localized in the neck or lymph nodes. In other patients, anaplastic thyroid cancer has metastasized to other parts of the body at the time of diagnosis.

Symptoms of anaplastic thyroid cancer

Anaplastic thyroid cancer often appears as a lump or nodule in the thyroid gland in the front of the neck. ATC tumors grow very quickly and are usually visible to the person with ATC or their family and friends. This tumor is usually painful and hard. Excessive growth of the tumor puts pressure on other neck structures and causes the following symptoms:

• Problem in swallowing (dysphagia)
• Difficulty in breathing (dyspnea)
• Hoarseness or voice change
• Persistent cough, with or without blood
• Vocal cord paralysis

People with anaplastic thyroid cancer that has spread (metastasized) may also have the following symptoms:

• Bone pain
• Swelling of lymph nodes
• weakness
• Nervous problems

Risk factors of developing anaplastic thyroid carcinoma

Some factors can increase the possibility of developing anaplastic thyroid cancer. The most important risk factors of this disease are:

Age: Most cases of this thyroid cancer occur in people aged 60 to 70.

Gender: Women are more susceptible to this type of cancer than men.

Medical history: A previous history of goiter or other thyroid cancers increases the risk of developing this thyroid cancer.

Exposure to radiation: If you have a history of radiation therapy in the head and neck area or exposure to radioactive materials, the risk of developing anaplastic thyroid cancer increases.

Blood type: Studies show that people with blood type B are at a higher risk of developing this cancer.

Diagnosis of anaplastic thyroid cancer

This thyroid cancer can spread quickly and within a few weeks. Therefore, it is very important to see a doctor immediately. The doctor will check the presence of any mass or tumor in the neck by examining you.

Diagnostic tests that are commonly used for anaplastic thyroid cancer include:

Thyroid biopsy:

In thyroid biopsy, a sample is removed from the tissue of the thyroid gland using a needle to be examined under a microscope for the presence of cancer cells.

Imaging tests:

Like MRI or CT scan.

Laryngoscopy:

In this method, the airways are examined through a special scope that enters the throat.

Thyroid scan:

This test shows whether the tumor absorbs the radioactive substance or not. If the tumor does not absorb the radioactivity, it means it is cancerous.

Treatment of anaplastic thyroid cancer

Anaplastic thyroid carcinoma (ATC) is difficult to treat because of its highly aggressive nature and ability to spread rapidly in the neck and to distant parts of the body, including the lungs, bones, and brain. As a result, ATC treatment will usually include a combination of the following methods:

Thyroid surgery:

If you have anaplastic thyroid cancer, your doctor may recommend surgery to remove the tumor; Unless you have other medical conditions that increase the risk of surgery. Debulking surgery is the most common treatment method in ATC.

This thyroid surgery is done with the goal of preserving the larynx. In this method, the doctor surgically removes as much of the tumor as possible; Especially any part of the tumor that may threaten your airway. Unfortunately, in many cases, surgery is not possible due to the large size, location and aggressiveness of the tumor. However, many people with ATC who were unable to undergo surgery, received a combined treatment including chemotherapy and radiation therapy and were able to live for several years after treatment.

Dr. Ahmad Fanai is a thyroid and parathyroid surgeon and a member of the American Thyroid Association. He, who is known as the Golden Paw thyroid surgeon, has a history of more than 5000 successful thyroid surgeries and more than 20 years of surgery. To make an appointment and consult with the best thyroid surgeon, you can fill out the online appointment booking form or call the numbers listed.

Radiotherapy:

This method is usually the main treatment for anaplastic thyroid cancer and may be prescribed alone, after surgery or in combination with chemotherapy. In radiation therapy, rays (strong currents of energy) are used to destroy cancer cells or prevent them from growing and dividing. In most cases, your doctor will recommend a special type of radiation therapy called external beam radiation therapy (EBRT). This treatment directs precise, focused X-rays to the areas that need treatment (often the tumor itself or cancer that has spread to the bones or other organs).

Chemotherapy:

Chemotherapy can be prescribed alone or together with surgery or radiation therapy. This method for anaplastic thyroid cancer is a type of cancer treatment that works by destroying cancer cells and preventing their proliferation, and is usually recommended as an adjuvant treatment. This means that chemotherapy after surgery or radiation therapy destroys the remaining cancer cells.

In fact, chemotherapy for ATC enhances radiation therapy to make the cancer more sensitive to radiation or to have a greater effect. Chemotherapy drugs rarely completely cure advanced cancers that have spread widely throughout the body; But they can slow down or partially reverse the growth of cancer.

Chemotherapy drugs used for anaplastic thyroid cancer include taxanes (paclitaxel or docetaxel), anthracyclines (doxorubicin), platinum analogs (cisplatin or carboplatin).

Targeted therapy:

Targeted therapy (Targeted therapy) is one of the new methods of fighting cancer, which destroys cancer cells by targeting specific weaknesses.

Immunotherapy:

Sometimes immunotherapy drugs are used to help control this thyroid cancer.

Palliative care:

Palliative care includes medical care that relieves pain, symptoms, and stress caused by serious illnesses. Palliative care is recommended to manage ATC symptoms and side effects of treatment and may include:

• Placing a tube in the throat to help breathing (tracheostomy)
• Placing a feeding tube in the stomach (gastrostomy tube or G tube)
• Prescription of pain medication

Anaplastic thyroid cancer outlook

Anaplastic thyroid cancer is highly aggressive and most people with it survive only a few months after diagnosis. The 5-year relative survival rate is 7%. This means that 7 out of 100 people will survive at least 5 years after diagnosis. Survival rates vary greatly depending on how far the cancer has spread. If the cancer is localized and limited to the thyroid, your 5-year relative survival rate is 39%.

For regional cancers that have spread beyond the thyroid to nearby areas, 11 out of 100 people will be alive within the next 5 years. But if the cancer has spread to the bones or other distant organs, the survival rate drops to 4%.

Last word

Anaplastic thyroid cancer is the rarest type of thyroid cancer, which is more common in women and usually affects people over 60 years old. This aggressive cancer progresses much faster than other types of cancer; Therefore, early diagnosis and timely treatment are necessary.

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