Anaplastic thyroid cancer is difficult to treat because it is very aggressive and can spread rapidly within the neck and metastasize to distant parts of the body. It is less predictable than other thyroid cancers; however, one thing that all long-term survivors have in common is the sense of urgency in diagnosis and treatment.
It is important to work with a doctor or team of doctors who have experience with anaplastic thyroid cancer. You must be your best advocate. Take a family member or friend to appointments if possible. Take notes. Ask questions. If you are unable to travel to a major medical/ cancer facility with experience, many of the larger, more experienced institutions are happy to advise your local doctors on the best treatment options. Do not be afraid to ask your local doctors to collaborate with experts at more experienced centers on your treatment plan given the rarity of this diagnosis. It is also important to understand the risks and benefits involved with various treatment options.
Anaplastic thyroid cancer does not respond to radioactive iodine therapy (See Radioactive Iodine brochure) or Thyroid Stimulating Hormone (TSH) suppression, which are commonly used in patients with other forms of differentiated (papillary and follicular) thyroid cancer.
Treatment of anaplastic thyroid cancer, is best done through a multidisciplinary team (endocrinologist, medical oncologist, radiation oncologist, surgeon and others), and typically consists of combining surgery with external beam radiation and chemotherapy.
The American Thyroid Association recommends surgery for all patients with anaplastic thyroid cancer unless the patient has other medical conditions that would make surgery too risky. Unfortunately, in many cases, surgery is not possible due to the large size, location and invasive behavior of the tumor. It should be noted that there are long-term survivors who were not able to have surgery but could complete an aggressive combination of radiation and chemotherapy.
External beam radiation directs precisely focused X-rays to areas that need to be treated—often the tumor itself or cancer that has spread to bones or other organs. Radiation can kill or slow the growth of the cancer.
Typically, chemotherapy is given as an enhancement to the radiation to make the cancer more susceptible to the radiation or make the radiation more effective. New chemotherapy agents that have shown promise treating other advanced cancers are becoming more widely available for the treatment of advanced thyroid cancer. These drugs rarely cure advanced cancers that have spread widely throughout the body but they can slow down or partially reverse the growth of the cancer. These treatments are usually given by an oncologist. Chemotherapy drugs used in thyroid cancer include taxanes (paclitaxel or docetaxel), anthracyclines (doxorubicin), and platinum analogs (cisplatin or carboplatin). These drugs are used either alone or in combination.
In some cases, palliative care is given to manage symptoms of the cancer and side effects of the treatment. This may include clearing the airway via tracheostomy, placing a feeding tube, or giving pain medication. Palliative care is given in addition to treating the cancer and does not necessarily mean the cancer treatment will not be effective. Palliative care services are usually covered by health insurance. Medicare and Medicaid also pay for palliative care, depending on the situation.
Just as each patient is an individual, each anaplastic thyroid cancer presents differently and responds to treatment differently. Advances are being made every day in the treatment of advanced thyroid cancers including undifferentiated and anaplastic thyroid cancers. The treatment is challenging but it is important to not give up hope when first diagnosed.