Anaplastic thyroid cancer

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What is anaplastic thyroid cancer?

Anaplastic thyroid cancer (ATC) is the rarest type of cancer that starts in the thyroid gland. It is more common in women and mostly affects people over the age of 60. It usually grows more quickly than other types of thyroid cancer.

About 1 to 2 out of 100 (1 to 2%) of thyroid cancers are anaplastic.

We also have information about:

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Symptoms of anaplastic thyroid cancer

The most common symptom of anaplastic thyroid cancer is a mass or lump in the neck that grows quickly. Often, other symptoms develop within a few weeks, including:

  • difficulty breathing – caused by the thyroid tumour pressing on the windpipe (trachea)
  • difficulty swallowing – caused by the thyroid tumour pressing on the gullet (oesophagus)
  • a hoarse voice that has no obvious cause and does not go away after a few weeks
  • a cough
  • a feeling of pressure, pain or discomfort in the neck.

These symptoms can be caused by conditions other than cancer. But it is important to get them checked by your GP.

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Causes of anaplastic thyroid cancer

Doctors do not know the exact causes of anaplastic thyroid cancer. Having an enlarged thyroid gland or a history of papillary or follicular thyroid cancer may slightly increase the risk of developing it.

Diagnosis of anaplastic thyroid cancer

If you have symptoms, you will usually begin by meeting your GP, who will examine you. They will examine the lump or swelling in your neck and ask about any other symptoms you might have.

If they think that your symptoms could be caused by cancer, they will refer you to a specialist doctor.

You should have a hospital appointment usually within 2 weeks.

At the hospital, the specialist doctor will ask you about your general health and any previous medical problems. They will also examine you. You may have some of the following tests:

  • Blood tests

    You usually have blood tests to:

    • show how well your thyroid is working and to measure levels of thyroid hormones.
    • check your general health, by monitoring how well organs like your kidneys and liver are working.
    • measure levels of different blood cells in your blood.
  • Ultrasound of your neck

    An ultrasound scan uses sound waves to build up a picture of the inside of the neck and the thyroid gland. Your doctor will also check the lymph nodes in your neck to see if any of them are abnormal. The results of the ultrasound scan help the doctors decide if you need to have a fine needle aspiration. 

  • Fine needle aspiration (FNA)

    A doctor gently passes a small needle into the lump or swelling in your neck. They take a small sample of cells and examine it under a microscope, to check for any abnormal cells. This is a type of biopsy.

  • Core needle biopsy

    Some people may need another type of biopsy called a core needle biopsy. You have a local anaesthetic to numb the area so you should not feel any pain. Your doctor uses a needle slightly bigger than used for the FNA to take a sample of tissue from the lump. They use an ultrasound scan to guide the needle to the right area. 

We have more information about diagnosing thyroid cancer.

Waiting for test results can be a difficult time. We have more information that can help.

Further tests

Your specialist may arrange further tests to find out more about the cancer or to check whether it has spread: 

  • CT scan

    A CT scan takes a series of x-rays. These build up a three-dimensional picture of the inside of the body.

  • MRI scan

    An MRI scan uses magnetism instead of x-rays to build up a detailed picture of areas of your body.

  • PET scan

    PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body.

Tests on the cancer cells (molecular testing)

Your doctor may arrange tests to look for certain gene changes (mutations) in the thyroid cancer cells. This is called molecular testing.

Cells are taken from the biopsy or surgery to remove the thyroid. The results of this type of testing might help to diagnose thyroid cancer and affect the type of treatment you have. If the cancer cells show a change in the BRAF gene you might have targeted therapy drugs.

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Staging and grading of anaplastic thyroid cancer

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.

Knowing the stage and grade helps your doctors plan the best treatment for you.

We have more information about staging of anaplastic thyroid cancer.

Treatment for anaplastic thyroid cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your treatment will depend on:

Your doctor, cancer specialist, or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.

Your cancer team may also give you advice about preparing for your treatment. This is sometimes called prehabilitation. It helps to improve your fitness and diet and to get you ready mentally before treatment.

Anaplastic thyroid cancer is usually treated with cancer drug treatments or with radiotherapy. 

Surgery is not often used to treat anaplastic thyroid cancer. This is because anaplastic thyroid cancer has often spread outside the thyroid gland when it is diagnosed.

Treatments can also be given to control any symptoms. This is called supportive care or palliative care.

  • Targeted therapy

    Targeted therapy drugs target something in or around the cancer cell that is helping it grow and survive. They are often the main treatment for anaplastic thyroid cancer. You usually have these drugs as tablets or capsules. 

    The targeted therapy drugs dabrafenib and trametinib may be given together to treat anaplastic thyroid cancer. This depends on whether the cancer cells show a change in the BRAF gene. Some people might have a targeted therapy drug called lenvatinib along with an immunotherapy drug.

  • Immunotherapy

    Immunotherapy drugs use the immune system to find and attack cancer cells. Sometimes, the immunotherapy drug pembrolizumab and a targeted therapy drug called lenvatinib may be given together to treat anaplastic thyroid cancer.

  • Radiotherapy

    Radiotherapy uses high-energy rays to destroy the cancer cells. It can be given on its own or with chemotherapy (chemoradiation). Radiotherapy may be used to shrink the tumour before surgery. It may also be given after surgery to reduce the risk of the cancer coming back.

    If it is not possible to remove all of the tumour with surgery, radiotherapy may help to:

    • shrink the tumour
    • control any symptoms it is causing – for example, swallowing problems if the tumour is pressing on the gullet (oesophagus).
  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given on its own, or with radiotherapy. This is called chemoradiation.

    It may be given before surgery or radiotherapy to try to shrink the tumour or after surgery to reduce the risk of the cancer coming back. It can also be used if the cancer has spread to other parts of your body.

    The main chemotherapy drugs used to treat anaplastic thyroid cancer are:

    These drugs may be given on their own or in combination with other drugs.

  • Surgery

    Surgery is only suitable for a small number of people with anaplastic thyroid cancer. Your doctors may recommend it if the cancer has not grown outside the thyroid gland. Surgery usually involves removing the whole thyroid gland. This is called a total thyroidectomy.

    If the cancer has spread to the lymph nodes in the front and sides of the neck, the surgeon will remove them too (neck dissection).

    If your thyroid gland has been removed, you will need to take thyroid hormone replacement tablets (thyroxine) every day for the rest of your life. These replace the thyroid hormones your thyroid gland is not making.

    • You may have some treatments as part of a clinical trial.

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Advanced anaplastic thyroid cancer

For people with anaplastic thyroid cancer that has spread outside the thyroid gland, the aim of treatment is to control the growth of the cancer and reduce symptoms.

Your cancer doctor or nurse may also refer you to a palliative care team. They are specialists in giving support and helping to control symptoms. This is called supportive care or palliative care.

Your palliative care team can help to manage different symptoms, such as any problems with breathlessness, or pain. They can also refer you to a dietitian for advice and support if you are having any difficulties eating or swallowing.

Finding out you have advanced cancer can be difficult to cope with. You may feel shocked and find it hard to understand or accept. You may have questions about what to expect. Your doctor and specialist nurse are there to help.

We have more information about coping with advanced cancer.

After anaplastic thyroid cancer treatment

Follow-up after treatment for anaplastic thyroid cancer

You will have regular check-ups during and after your treatment. Follow-up appointments are a good time to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments.

We have more information about follow-up care after treatment.

More information and advice

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

Support after anaplastic thyroid cancer

People often have many different feelings during and after anaplastic thyroid cancer treatment. If you have finished treatment you may feel relieved it has ended but worried about what will happen in the future.

It is important to know where to get support or information if you need it. People often need support even if it has been some time since they finished cancer treatment. But sometimes it is difficult to know who to ask for help.

To find support:

The HOPE programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. 

Topics include goal setting, fatigue management, and wellbeing. You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk

Other organisations who offer information and support

There are also other organisations that can give you information and support. These include:

Related pages

About our information

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.

Cancer Information Development team

Author

Date reviewed

Reviewed: 01 October 2024
|
Next review: 01 October 2027
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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