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Anaplastic Thyroid Cancer (ATC)
Anaplastic thyroid carcinoma is an aggressive form of cancer of the thyroid gland. It is one of the fastest growing tumors in humans. Unlike other forms of thyroid cancer (papillary, follicular, medullary, and their variants) it spreads quickly to other organs. It does not respond to the radioiodine therapy or TSH suppression with thyroxine used for some of the other types of thyroid cancer.
Only about 1% of thyroid cancers are of the anaplastic type.
ATC occurs most often in people over age 60. It is a very rare disease. About 300 new cases are diagnosed in the USA every year (with a median age of 67).
The cause of ATC is unknown. It sometimes arises within a preexisting thyroid cancer that has been less aggressive, such as a papillary thyroid cancer.
From the National Library of Medicine:
Also, something called “stridor” can occur. Stridor is harsh-sounding breathing caused by a restricted airway.
Thyroid function tests are usually normal.
ATC can progress in different individuals in different ways. Here is a typical scenario.
A patient, or a family member, notices a lump in the neck and some hoarseness in the voice. The patient goes to see the doctor.
The doctor feels a tumor in the thyroid and refers the patient to an endocrinologist or an oncologist. The endocrinologist or oncologist determines whether the tumor is malignant or benign, and, if malignant, the cancer type. This can usually be done with a fine needle aspiration (FNA) or with a core needle biopsy, but sometimes a surgical biopsy is done. The tumor tissue is examined by a pathologist experienced in the identification of thyroid tumors.
The tumor may grow to the point that it compresses the airway, or trachea, and causes difficulty in breathing.
If airway compression occurs, a tracheostomy is often done to place a plastic tube in the airway below the tumor. This is usually done by an endocrine surgeon; an ear, nose, and throat (ENT) surgeon; or a general surgeon experienced in this procedure.
The surgeon also evaluates the patient to determine if the tumor can be safely resected. Unlike the situation with most other thyroid cancers, surgical removal is often inadvisable because of the potential complications and the low likelihood that the tumor can be completely removed.
Sometimes the tumor also compresses the food pipe (esophagus), interfering with the patient's ability to swallow. This situation requires a feeding tube to be inserted into the stomach through the wall of the stomach or intestine.
Then, a team of physicians recommends a course of treatment. This team typically consisting of a surgeon, a chemotherapy oncologist (cancer doctor who specializes in using drugs to treat cancer), an endocrinologist, and a radiotherapy oncologist (cancer doctor who specializes in using radiation to treat cancer).
In about half of patients with ATC, the cancer has already spread to other organs at the time of diagnosis, usually to the lungs and/or bones.
In all ATC cases, speed and a sense of urgency in treatment are important because of the extremely fast tumor growth rate. For more thoughts on this, see the section titled ATC Treatment Urgency.
The survival statistics are grim, but there are long-term survivors of ATC.
The problem with statistics is that while they are valid for a group, they say nothing about what will actually happen to any one person. Be sure to read the section titled Survivor Stories before getting too discouraged.
Many believe that the survival statistics can become a self-fulfilling prophecy, and that if doctors and patients aggressively pursue treatment despite the statistics, the survival statistics will improve.
Overall, not much is known about the cause of ATC. It does not appear to be hereditary. It is associated with goiter, and some believe that it is a mutation from another form of thyroid cancer. However, the exact cause has not been determined. The current thoughts are that it results from a chain of genetic mutations, but it isn't clear what triggers these mutations.
The question "why did this happen to me?" usually follows the question "will I survive this?"
It is natural to blame the ATC on various things that happened in the past of someone diagnosed with ATC, but it is unlikely that any of the things we think of were actually the cause. Still, we all wish we "knew" what caused it.
Comments from ATC Survivors and Caregivers
There is usually a feeling among ATC patients and their families of "if only the ATC was diagnosed earlier, things would be OK now." While in hindsight this may seem clear, the fact is that ATC is so deadly because it is so hard to detect early and progresses so rapidly. Even when detected early, patients in the overwhelming majority of instances go on to develop distant (metastatic) disease.
Therefore, almost everyone with ATC is in the same boat of being diagnosed "late." So, people with ATC or their families should not spend too much time feeling guilty about not seeking care earlier. We also need to recognize that early diagnosis of ATC may have been difficult or impossible for one’s doctors, too.
The following points are not intended to excuse uninformed medical care, but they do highlight the need for the development of techniques for earlier detection. Here are some facts about ATC that show why it is so hard to diagnose.
Consequently, ATC is difficult to diagnose early, so let go of the guilt.
Last updated: March 23, 2006