Anaplastic thyroid cancer overview

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Differentiating Anaplastic thyroid cancer from other Diseases

Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

In 1811, the first thyroid cancer case was reported. Thyroid cancer was first described by William Stewart Halsted, an American surgeon in the late nineteenth century. Anaplastic thyroid cancer arises from cells of thyroid, which are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3) and is always considered as stage IV. Genes involved in the pathogenesis of follicular thyroid cancer include P53 and BRAF. Anaplastic thyroid cancer must be differentiated from other diseases that cause neck masses such as goiter, Grave's disease, Hurthle cell carcinoma, follicular thyroid cancer, papillary thyroid carcinoma, follicular adenoma, sarcoma, and medullary thyroid carcinoma.[1]. Depending on the extent of the tumor at the time of diagnosis, the prognosis of anaplastic thyroid cancer may vary. However, the prognosis is generally regarded as poor. The presence of metastasis is associated with a particularly poor prognosis among patients with anaplastic thyroid cancer. According to the American Joint Committee on Cancer (AJCC)[2] there are 4 stages of anaplastic thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of lymph node regions involved, and metastasis. The hallmark of anaplastic thyroid cancer is swelling in the neck. A positive history of irradiation of head and neck, rapid growth of the nodule, and family history of anaplastic thyroid carcinoma is suggestive of anaplastic thyroid cancer. The most common symptoms of anaplastic thyroid cancer include swelling in the neck, pain in the front of the neck, and hoarseness of voice. Surgery is the mainstay of treatment for anaplastic thyroid cancer.

Historical Perspective

In 1811, the first thyroid cancer case was reported. Thyroid cancer was first described by William Stewart Halsted, an American surgeon in the late nineteenth century.

Pathophysiology

Anaplastic thyroid cancer arises from cells of thyroid, which are secretory cells that are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3) and is always considered as stage IV. Genes involved in the pathogenesis of follicular thyroid cancer include P53 and BRAF.

Causes

Genetic mutation is suspected to be the main cause of anaplastic thyroid cancer.

Differential Diagnosis

Anaplastic thyroid cancer must be differentiated from other diseases that cause neck masses such as goiter, Grave's disease, Hurthle cell carcinoma, follicular thyroid cancer, papillary thyroid carcinoma, follicular adenoma, sarcoma, and medullary thyroid carcinoma.[3]

Epidemiology and Demographics

Females are more commonly affected with follicular thyroid cancer than males. The incidence of follicular thyroid cancer increases with age; the median age at diagnosis is 6th to 7th decades.

Risk Factors

Common risk factors in the development of anaplastic thyroid cancer are iodine deficiency, family history of thyroid cancer, and radiation exposure.

Natural history, Complications and Prognosis

Depending on the extent of the tumor at the time of diagnosis, the prognosis of anaplastic thyroid cancer may vary. However, the prognosis is generally regarded as poor. The presence of metastasis is associated with a particularly poor prognosis among patients with anaplastic thyroid cancer.

Staging

According to the American Joint Committee on Cancer (AJCC)[4] there are 4 stages of anaplastic thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of lymph node regions involved, and metastasis.

History and Symptoms

The hallmark of anaplastic thyroid cancer is swelling in the neck. A positive history of irradiation of head and neck, rapid growth of the nodule, and family history of anaplastic thyroid carcinoma is suggestive of anaplastic thyroid cancer. The most common symptoms of anaplastic thyroid cancer include swelling in the neck, pain in the front of the neck, and hoarseness of voice.

Physical Examination

Patients with anaplastic thyroid cancer usually appear thin and cachectic. Physical examination of patients with anaplastic thyroid cancer is usually remarkable for thyromegaly, lymphadenopathy and anxiety.

Laboratory Findings

Laboratory findings consistent with the diagnosis of anaplastic thyroid cancer include elevated T3, elevated T4, and decreased thyroid stimulating hormone.

Chest x-ray

Chest x ray may be helpful in the diagnosis of anaplastic thyroid cancer.

CT

CT scan may be helpful in the diagnosis of anaplastic thyroid cancer.

MRI

MRI may be helpful in the diagnosis of anaplastic thyroid cancer. MRI may also be performed to detect metastases of anaplastic thyroid cancer to brain and bones.

Echocardiography or Ultrasound

Neck ultrasound may be performed to detect anaplastic thyroid cancer.

Other Imaging Findings

PET may be helpful in the diagnosis of anaplastic thyroid cancer. PET may also be performed to detect metastases of anaplastic thyroid cancer to brain and bones.[5]

Other Diagnostic Studies

Other diagnostic studies for anaplastic thyroid cancer include laryngoscopy, which demonstrates vocal cord immobility.

Biopsy

On biopsy, anaplastic thyroid cancer is characterized by trabecular or solid follicular tumor cells that invade tumor capsule and surrounding vascular structures.

Medical Therapy

Pharmacologic medical therapies for anaplastic thyroid cancer include radioactive iodine therapy and adjuvant radiotherapy.

Surgery

Surgery is the mainstay of treatment for anaplastic thyroid cancer.

Prevention

Effective measures for the prevention of anaplastic thyroid cancer include avoidance of diets low in iodine and avoidance of ultraviolet exposure.

Reference

  1. Thyroid Cancer Cancer.gov (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#section/_6- Accessed on October, 29 2015
  2. Stage Information for Thyroid Cancer Cancer.gov (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015
  3. Thyroid Cancer Cancer.gov (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#section/_6- Accessed on October, 29 2015
  4. Stage Information for Thyroid Cancer Cancer.gov (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015
  5. Thyroid Cancer Canadian Cancer Society (2015). http://www.cancer.ca/en/cancer-information/cancer-type/thyroid/diagnosis/?region=sk- Accessed on November, 19 2015

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