Wednesday, October 21, 2020

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Thyroid Cancer: Anaplastic Cancer

Anaplastic thyroid cancer is the least common type of thyroid cancer

Anaplastic tumors are the least common (only 1% of all thyroid cancer cases) and most deadly of all thyroid cancers. This cancer has a very low cure rate with the very best treatments. Most patients with anaplastic thyroid cancer do not live 1 year from the day they are diagnosed.

Anaplastic thyroid cancer often arises within a more differentiated thyroid cancer or even within a goiter. Like papillary cancer, anaplastic thyroid cancer may arise many years (more than 20) following radiation exposure. Cervical metastasis (the spread of the cancer to lymph nodes in the neck) are present in the vast majority (more than 90%) of cases at the time of diagnosis. The presence of lymph node metastasis in these cervical areas causes a higher recurrence rate and is predictive of a high mortality rate.

What are some common anaplastic thyroid cancer symptoms? The most common way this cancer becomes evident is by you or a family member noticing a growing mass on your neck. When the doctor feels the neck mass, it is usually large and very hard. These tumors grow very rapidly, and you may say that you never noticed it until a few days or weeks ago, and now it seems to get bigger every few days.

Anaplastic thyroid cancer invades adjacent structures and metastasize extensively to cervical lymph nodes and distant organs, such as the lungs and bones. Tracheal invasion is present in 25% at the time of presentation (said differently, in about 25% of cases, the anaplastic cancer has grown out of the thyroid and into the trachea). This is why many patients with anaplastic thyroid cancer will need a tracheostomy, while almost nobody with the other types of thyroid cancer will need one.

Anaplastic thyroid cancer that spreads to the lungs is present in 50% of patients at the time of diagnosis. Most of these cancers are so aggressively attached to vital neck structures that they are inoperable at the time of diagnosis. (The surgeon can’t remove it because it’s growing into other neck structures). Even with aggressive therapy protocols, such as hyperfractionated radiation therapy, chemotherapy, and surgery, survival at 3 years is less than 10%.

Characteristics of Anaplastic Thyroid Cancer

  • Peak onset of anaplastic thyroid cancer is age 65 years old and older.
  • It’s very rare in young patients.
  • It’s more common in males than females by a 2:1 ratio.
  • It typically presents as a rapidly growing neck mass.
  • It can occur many years after radiation exposure.
  • The spread to lymph nodes of the neck is present in more than 90% of cases.
  • The distant spread (to lungs or bones) is very common even when it’s first diagnosed.
  • The overall cure rate is very low.
  • It typically requires a very aggressive treatment plan with surgery, radiation, and sometimes even chemotherapy.
  • It often requires a tracheostomy to maintain the patient’s airway.

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