1. ANAPLASTIC THYROID CANCER
Dr. TALAL MGBOUL
R(2)

2. Definition
 Extremely aggressive
undiffrentiated tumor of thyroid
follicular epithelium.

3. Epidemiology
 1-2person per million person .
 Account 0.9 – 9.8 % of all thyroid cancer.
 Usually patient with anaplastic cancer older
than those with diffrentiated cancer.
 Mean age at diagnosis is 65 years and less
than 10% are younger than 50 years.
 60-70% of cases occurs in women.
 20% of patient have history of diffrentiated
thyroid cancer.

4.  Transformation from diffrentiated to anaplastic
cancer has been prescribed in patient who was
followed with serial biopsies.
 Up to have of patient have ahistory of
multinodular goiter and some have history of
partial thyroidectomy.

5. Study regarding ATC
 1st study : Done in mayo clinic for 82 cases with
ATC .
 Result: most common manifistation is rapid growth
of thyroid mass frequently in preexisting goiter.
 Favourable prognostic feature seem to be with
unilateral tumor diameter of tumor less than 5cm
with no invasion of adjacent tissue and absence of
nodal involvment.
 For resectable lesions thyroid lobectomy with wide
margin of adjacent soft tissue on the side to tumor
seem to be safe.
 Total thyroidectomy & radical neck dissection result
in increase complication rate and have no
advantage over more conservative approach.

6.  2nd study was done in university of texas for
120 case of anaplastic cancer .
 Result:
 Significant percetage of 35% of patient had
areas of well diffrentiated thyroid cancer.
 Papillary thyroid carcinoma is the most
common type associated with ATC.
 This 2 study support the hypothesis that
anaplastic tyroid carcinoma arises from
preexisting well diffrentiated thyroid carcinoma.

7. Disease presentation :nearly all
presented with thyroid mass.
 Clinical manifistation:
 Rapidly inlarged mass 85%.
 Neck pain and tenderness from thyroid mass.
 Dyspnea in case of compression to
aerodigetive tract 35%.
 Dysphagia 30%.
 Hoarsness 25%.
 Chest pain &bone pain & headache&
confusion &abd pain (metastases).

8. Physical examination
 Most of patient with bilateral but assymetric
thyroid enlargment ,goiter is typically hard &
nodular .
 50% may have enlarged cervical lymph nodes.

9. Diagnosis
 FNA: Spindle cell & pleomorphic giant cell
tumor.
 Surgical biopsy:
 Used if FNA show necrotic or inflammed tissue
without specific diagnosis.

10. Metastases :
Regional nodal metastasis & vocal cord paralysis
seen in upto 30-40%.
Distant spread in present in about 75%of cases
at the time of diagnosis.
Lung 80%
Bone 6-15%
Brain 5-15%

13. Staging :
 TNM CLASSIFICATION:
 All anaplastic carcinoma is stage IV
Stage IV contains 3 stages:
IV A ; Tumor is limited to the thyroid and
surgically resected.
IV B : Tumor extending beyond thyroid and
considered surgically unresected.
IV C: Tumor presented with distant metastasis.

14. TREATMENT
Mant therapeutical options:
1) surgery.
2) External radiotherapy
3) Chemotherapy
4) Mutlimodality therapy
5) New therapies

15. Surgery:
 Most patients present at an advanced stage, making
curative surgical resection not feasible
 Some studies suggest that in a select subset of
patients with localized disease, survival can be
improved by achieving complete resection of all
gross disease.

17. Palliative management
 One of the central issues in the management of
ATC is palliation. Palliative management is meant
to prevent death from asphyxiation.
 Securing a safe airway is a critical component of
this effort.
 Airway management may be elective or emergent,
depending on the patient’s presentation

18. Airway obstruction occurs by one of
three mechanisms
1) external compression of the trachea (the
most common cause)
2)intraluminal tumor extension
3) bilateral vocal cord paralysis
 Patient with either stridor or rapid tumor growth
should considered for tracheostomy since
further airway compromised is expected.

19. RADIOTHERAPY
Achieving local control is important since death from
ATC is usually a consequence of uncontrolled local
disease.
Although ATC is relatively radioresistant, some
studies have shown palliative local control in 68%
to 80% of patients.
Fractioned dose: 1,6 Gy/session, twice a day,
triweekly, for a total dose of 57,6 Gy in 40 days.

20. CHEMOTHERAPY:
 Chemotherapy plays an important role in the
management of ATC since the majority of patients
present with or develop distant metastases

21. NEW THERAPIES
 1) Anti Tumor vascular targeting agent :
 One target,two way both inhibit tumor blood
supply.

A) Antiangiogenic approach
 Prevent new vessel formation
 Acts slowly – weeks
 Promiscuous for all angiogenesis; impairs
wound-healing
 Tolerability issues

22. 
Vascular-disrupting approach
 Collapse and occlude pre-existing tumor
vessels
 Acts rapidly – hours
 Highly selective for abnormal vasculature
 Well tolerated

23. 2)Tyrosine kinase inhibitors:
 s a pharmaceutical drug that inhibits tyrosine
kinases. Tyrosine kinases
are enzymesresponsible for the activation of
many proteins by signaltransduction cascades.
The proteins are activated by adding
aphosphate group to the protein
(phosphorylation). TKIs are typically used as
anti-cancer drugs.

24. Sorafenib (tyrosine kinase
inhibitor)

25. thank u