ABOUT ANAPLASTIC THYROID CANCER (ATC)
- The thyroid is a butterfly-shaped endocrine gland located in the lower front of your neck.
- The thyroid gland is responsible for sending out thyroid hormones to the rest of your body.
- Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally.
- Thyroid cancer is a malignant tumor of the thyroid gland.
- Thyroid cancer is a common type of cancer, but anaplastic thyroid cancer, or ATC, is rare and only makes up 1% or less of all thyroid cancers. ATC affects one to two people per one million per year in the US.
- There are four types of thyroid cancers, of which ATC is the least common. ATC grows and spreads more rapidly than any other type.
- ATC is also known as undifferentiated thyroid cancer because the cells do not in any way resemble normal thyroid cells. In contrast, the cells in other thyroid cancers are abnormal but retain some healthy thyroid cell features (they are called differentiated thyroid cells).
- There are no known causes for ATC, however it usually occurs in individuals aged 60 or older.
- About half of all patients with ATC have had or currently have another type of thyroid cancer.
- While overall survival statistics are discouraging – with an average survival rate of 6 months and approximately 1 in 5 alive after 12 months – it is important to note that there are long-term survivors and new effective treatment options.
- Rapid and definitive diagnosis
The sooner ATC can be caught and treated, the better your chances are for long-term survival.
- Coordinate early care with a multidisciplinary healthcare team
This should include endocrinologists, surgeons, radiation oncologists, medical oncologists and providers specializing in supportive care.
- Identify the extent of the disease, including size of tumor(s), location(s) and any genetic mutations
This is important, because it will help determine the best course of action for treating your ATC.
- Start counseling to establish goals of care
Counseling and setting realistic goals is an important step in your path to finding the best management option. Counseling works best when it also includes your family, friends and any other loved ones. This will include a listing of risks and benefits for each decision that needs to be made during your care.
- Evaluate options for surgery
If you are a candidate for surgery, your healthcare team may be able to remove the tumor(s). This is your best chance for long-term survival.
- Decisive decision making on all available treatment option(s)
Because ATC is so aggressive, many patients will require radiation, chemotherapy and/or targeted therapy. These therapies may also come with side effects, so you and your healthcare team will discuss which option(s) are best for your unique situation.
- Keep an open dialogue about end of life preparations
While ATC is curable, it is an extremely aggressive disease, and it can spread quickly. You shouldn’t postpone end of life discussions with friends, family and loved ones. You should decide who should make medical decisions on your behalf if you are too ill to do so.
ASSESSMENT AND DIAGNOSIS OF ATC
- ATC can start as a neck mass, or bump in the throat area.
- The tumor growing on the thyroid can make your voice hoarse by invading the nerve that controls your vocal cords.
- The tumor can also make it difficult to breathe by blocking your windpipe.
- Difficulty swallowing, frequent coughing and coughing up blood, and loud breathing are other potential symptoms.
- Sometimes people can have ATC for a while and not notice it because the tumor remains small.
Evaluation and Diagnosis
- Evaluating a patient with ATC usually consists of one or more of the following:
- Laboratory tests (e.g. blood tests)
- Imaging (e.g. PET/CT scans or MRIs)
- Examinations/Procedures (e.g. laryngoscopy)
- Biopsies (e.g. ultrasound with fine needle aspiration, or FNA)
- Diagnosis of ATC would be based on biopsy (or other tissue assessment – i.e. core biopsy, excisional biopsy, surgical pathology)
- In addition to confirming a diagnosis of ATC, your healthcare providers will assess the tumor to look for genetic mutations that can help determine the best treatment option(s).
- It is important to complete all tests and assessments as quickly as possible. Do not delay!
- All patients with Anaplastic Thyroid Cancer are diagnosed as Stage IV due to the aggressive nature of this tumor.
- There are three sub-stages:
- Stage IVA: Anaplastic thyroid cancer is present only in the thyroid
- Stage IVB: Anaplastic thyroid cancer is present in the thyroid and in the neck, but not in other parts of the body
- Stage IVC: Anaplastic thyroid cancer is present in the thyroid as well as other parts of the body, such as the bones, lungs or brain
- On average, when patients are diagnosed with ATC, about 10% have Stage IVA, 40% have stage IVB, and 50% have Stage IVC.
- The sub-staging is important, as it will help you and your healthcare team decide on the best treatment options for you.