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Definition

Anaplastic thyroid carcinoma is a rare and aggressive form of cancer of the thyroid gland.

Causes

Anaplastic thyroid cancer is an invasive type of thyroid cancer that grows very rapidly. It occurs most often in people over age 60. It is more common in females than in males. The cause is unknown.

Anaplastic cancer accounts for only about less than 1% of all thyroid cancers in the United States.

Symptoms

Symptoms include:

• Cough
• Coughing up blood
• Difficulty swallowing
• Hoarseness or changing voice
• Loud breathing
• Lower neck lump, which often grows quickly
• Pain in the neck
• Vocal cord paralysis
• Overactive thyroid (hyperthyroidism)

Exams and Tests

A physical exam almost always shows a growth in the neck region. Other exams may include:

• An MRI or CT scan of the neck may show a tumor growing from the thyroid gland.
• A thyroid biopsy makes the diagnosis. The tumor tissue can be checked for genetic markers that may suggest targets for treatment, preferably within a clinical trial.
• An examination of the airway with a fiberoptic scope (laryngoscopy) may show a paralyzed vocal cord.
• A thyroid scan shows this growth to be "cold," meaning it does not absorb a radioactive substance.

Thyroid function blood tests are normal in most cases.

Treatment

This type of cancer cannot be cured by surgery.

Surgery combined with radiation therapy and chemotherapy may have a significant benefit.

Surgery to place a tube in the throat to help with breathing (tracheostomy) or in the stomach to help with eating (gastrostomy) may be needed during treatment.

For some people, enrolling in a clinical trial of new thyroid cancer treatments based on the genetic changes in the tumor may be an option.

The presence of a mutation in the BRAF gene is treatable with targeted medicines and may improve outcomes.

Support Groups

You can often ease the stress of illness by joining a support group of people sharing common experiences and problems.

Outlook (Prognosis)

The outlook with this disease is poor. Most people do not survive longer than 6 months because the disease is aggressive and there is a lack of effective treatment options.

Possible Complications

Complications may include:

• Spread of tumor within the neck
• Metastasis (spread) of cancer to other body tissues or organs

When to Contact a Medical Professional

Contact your health care provider if you notice:

• A persistent lump or mass in the neck
• Hoarseness or changes in your voice
• Cough or coughing up blood

References

Bible KC, Kebebew E, Brierley J, et al. 2021 American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2021;31(3):337-386. PMID: 33728999 pubmed.ncbi.nlm.nih.gov/33728999/.

National Cancer Institute. Anaplastic thyroid cancer (ATC). www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-endocrine-tumor/anaplastic-thyroid-cancer. Updated February 27, 2019. Accessed May 3, 2024.

Pearce EN, Hollenberg AN. Thyroid. In: Goldman L, Cooney KA. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 207.

Suh I, Sosa JA. Thyroid. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 37.

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