An Insight Into Anaplastic Thyroid Cancer – Symptoms And Treatment.

Cancer is a group of diseases, all characterized by the presence of malignant tumors or mutated genes that have the potential to spread to other parts of the body. Cancers are of four types:

• Carcinoma
• Sarcoma
• Leukemia
• Lymphoma

Anaplastic Thyroid Cancer Most Aggressive Form Of Thyroid Cancer

Anaplastic Thyroid Cancer (ATC) is a very aggressive form of Thyroid Cancer, where cancerous cells grow uncontrolled in the thyroid gland. The cells of the ATC are highly abnormal, no longer resembling the original cells of the thyroid gland. The prognosis available is very scarce and poor because of the aggressive nature of the disease and its resistance to treatment.

ATC is a quite uncommon form of cancer accounting for only about 1-2% of cases, but because of its high mortality, it is responsible for 20-50% of deaths due to thyroid cancer. The median time of survival after diagnosis is 3-6 months, and it occurs more commonly in women than men.

Symptoms:

Anaplastic thyroid cancer is very fast-growing. This means symptoms can progress rapidly in only a few weeks.

1. Anaplastic Thyroid Cancer usually manifests itself as a rapidly growing mass in the neck area.
2. ATC symptoms manifest because it commonly compresses local structures, such as the esophagus, carotid arteries, recurrent laryngeal nerve, and the trachea.
3. This condition when compression of local anatomic structures takes place may cause symptoms such as difficulty controlling the voice, hoarseness, difficulty swallowing, or trouble breathing.
4. Other symptoms include cough, neck pain, or symptoms which occur because of the spread of cancer to distant sites in the body, such as the brain.
5. ATC might, at times, also manifest as coughing up blood.
6. There will also be difficulty in swallowing food or pills and pressure and shortness of breath when you lie down on your back.
7. As cancer grows, you might also notice enlarged lymph nodes or difficulty in breathing/ loud breathing because of the trachea being restricted.

Causes:

It has not yet been found what might be the cause of Anaplastic Thyroid Cancer. It could be a mutation of another, less aggressive form of thyroid cancer. Or, it might also be the result of a series of genetic mutations, there is not yet a clear understanding of why these mutations happen. However, it seems that ATC cannot be genetically inherited.

However, certain conditions might increase your chances of developing Anaplastic Thyroid Cancer.

• If you are 60 or older
• If you have a goiter
• If you have a history of exposure of the chest and neck to radiation.

Diagnosis:

Fine-needle aspiration is essential for obtaining a sample of the thyroid tissue to allow for microscopic examination. This helps an experienced pathologist to differentiate ATC from other diseases, which might be forms of thyroid cancer.

It is very important to distinguish between ATC and poorly-differentiated thyroid cancer as this might affect further treatment.  The presence of PAX-8 positive staining and association with different thyroid cancer that is adjacent to the ATC are methods that support the diagnosis.

ATC is divided into several different subclasses based on the microscopic characteristics it exhibits. These include the sarcomatoid, the squamoid, the osteoclastic, the paracellular, the rhabdoid, and the carcinomasarcoid variants.

As of 2019, even though these ATC subtypes are recognized, this classification has not led to differences in the management of the disease. ATC is always considered to be stage IV cancer when it is diagnosed. It is further divided into three more stages:

1. Stage 4A: It means the cancer is only in your thyroid.
2. Stage 4B: It means that cancer has spread into the tissue around the thyroid and possibly the lymph nodes.
3. Stage 4C: It means that cancer has spread to distant sites, such as the lungs, bones, or brain, and possibly the lymph nodes.

There are no reliable laboratory tests yet for ATC. It is through the Ultrasound imaging of ATC lesions hypoechoic mass (appears dark on ultrasound) is revealed, with an invasion of the local structures and may help to better characterize the presence or absence of neck lymph node metastases.

 If surgery is planned, however, then a contrast-enhanced computed tomography (CT) scan of the neck is imperative. A PET scan is preferred for staging ATC but a CT scan of the neck, chest, abdomen, and pelvis could be substituted if the former is unavailable. Magnetic resonance imaging (MRI) of the brain is also often recommended to assess for distant metastases.

Treatment:

It is important to treat Anaplastic thyroid cancer immediately since it spreads quickly. For about half of the people who receive a diagnosis, cancer has already spread to other organs. In these cases, treatments are mostly focused on slowing its progression and keeping you as comfortable as possible.

Unlike some other types of thyroid cancer, anaplastic thyroid cancer doesn’t respond to radioiodine therapy or thyroid-stimulating hormone suppression with thyroxine as it is a very aggressive form of cancer.

Your doctor will discuss with you in detail the available treatment options. He can help you choose one that is best suited for both your condition and personal preferences.

Surgery

Your doctor may refer to your cancer as being “respectable.” This means that it can be surgically removed. If your cancer is unresectable, it means that it has invaded nearby structures and cannot be completely removed with surgery. Anaplastic thyroid cancer is usually found to be unresectable.

Other surgeries are available, but they are palliative. This means that they are designed to improve your quality of life instead of treating cancer.

Radiation and chemotherapy

Chemotherapy alone does not seem to be very effective against this type of cancer. However, it sometimes becomes more effective when combined with radiation therapy. Radiation is directed at the tumor / cancerous cells to shrink the tumor or slow its growth. It typically has to be done five days a week for four to six weeks.

Radiation could also be used following the surgery. This combination can help improve the overall outlook for people who have stage 4A or 4B anaplastic thyroid cancer.

Clinical trials

By joining a clinical trial, you might be able to gain access to investigational drugs or treatments that are otherwise unavailable. At the same time, you will be helping researchers learn more about anaplastic thyroid cancer in hopes of developing more effective treatments for it in the future.

Support:

It might be very overwhelming to know that you have Anaplastic Thyroid Cancer. You may connect with certain organizations to learn more about ATC:

• Thyroid Cancer Survivors’ Association.
• American Cancer Society.
• CancerCare.