Thyroid Cancer: Anaplastic Cancer

This page includes more advanced information on a specific type of thyroid cancer. . . Anaplastic Thyroid Cancer. Please read our Introduction to Thyroid Cancer page first which gives a general overview of all types of thyroid cancer since it will make this page easier to understand.

Anaplastic tumors are the least common (about 0.5 to 1.5%) and most deadly of all thyroid cancers. This cancer has a very low cure rate with the very best treatments allowing only 10 % of patients to be alive 3 years after it is diagnosed. Most patients with anaplastic thyroid cancer do not live one 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 (>20) following radiation exposure. Cervical metastasis (spread of the cancer to lymph nodes in the neck) are present in the vast majority (over 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. The most common way this cancer becomes evident is by the patient or his/her family member noticing a growing neck mass. When the doctor feels the neck mass it is usually large, diffuse, and very hard. These tumors grow very rapidly and the patient will state that this neck mass seemed like they never noticed it until a few days or weeks ago, and now it seems to get bigger every few days.

Anaplastic cancers invade adjacent structures and metastasize extensively to cervical lymph nodes and distant organs such as lung and bone. 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 grown 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. Spread (metastasis) to the lung is present in 50% of patients at the time of diagnosis of anaplastic thyroid cancer is made. 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--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 age 65 and older
• Very rare in young patients
• Males more common than females by 2 to 1 ratio
• Typically presents as rapidly growing neck mass
• Can occur many years after radiation exposure
• Spread to lymph nodes of the neck present in more than 90% of cases
• Distant spread (to lungs or bones) is very common even when first diagnosed
• Overall cure rate very low
• Typically requires a very aggressive treatment plan with surgery, radiation and sometimes even chemotherapy.
• Often requires the patient to get a tracheostomy to maintain their airway.

Management of Anaplastic Thyroid Cancer

The major problem with anaplastic thyroid cancer, is that it is usually too aggressive and invasive when it is diagnosed. Therefore, only a small portion of patients can undergo surgical resection of the cancer in hopes of cure. For those patients which are diagnosed at an earlier stage, total thyroidectomy is necessary. Many patients, especially those who have advanced cancer and cannot undergo surgical resection, will benefit from external-beam radiation (this is different from radioactive iodine). Some chemotherapy treatments may also be beneficial to patients with anaplastic thyroid cancer.

CASE STUDY -- October 2004 through September 4, 2005

In October 2004, three weeks after his 80th birthday, Chief Justice William Rehnquist was diagnosed with anaplastic thyroid cancer. It was not announced for a number of weeks what type of thyroid cancer he had--only that he had thyroid cancer.  But if we look at our list above we can see that his case is classic for anaplastic thyroid cancer. He receives some of the best medical care in the world including annual physical exams. The mass in his neck was rapidly growing and obviously was not present a year earlier--this is very typical of anaplastic thyroid cancer. He is in the correct age group for anaplastic cancer. The very day of his diagnosis, he underwent a tracheostomy--a procedure that is typical of patients with anaplastic thyroid cancer and extremely rare for the other types of thyroid cancer (which are much more common). He immediately began external-beam radiation therapy--again classic for anaplastic thyroid cancer and almost never used for the typical papillary or follicular thyroid cancers. He began chemotherapy treatments which are essentially never used for papillary, follicular, and hurthle cell thyroid cancers.

On Thursday, January 20, 2005 Chief Justice Rehnquist swore in George W Bush as president for his second term. The Chief Justice appeared to be doing very well. He has a tough road in front of him, and we wish him very well. He is getting the best care in the world.

On Saturday, September 3, 2005 Chief Justice Rehnquist died in his home at the age of 80. He was one of America's most beloved justices and leaves behind a great legacy. Sadly for America, his case is typical of anaplastic thyroid cancer, he died of a disease that was diagnosed less than 11 months earlier. Not all anaplastic cancers die, but it is extremely important that this disease is caught early and treated aggressively. 

Overview of Thyroid Cancer

More about Papillary Thyroid Cancer and Follicular Thyroid Cancer [more common & much more curable]

Learn more about a Clinical Trial for Anaplastic Thyroid Cancer sufferers

Surgical Operations for thyroid tumors (includes descriptions and drawings of different thyroid operations)

Thyroid Nodules and thyroid masses, an overview

Characteristics of Worrisome Thyroid Masses and the need to biopsy them