Treatment of anaplastic thyroid cancer

The treatment for anaplastic thyroid cancer will depend on the stage of the cancer and your general health.

Possible treatments include:

• radiotherapy
• chemotherapy
• surgery
• targeted therapies and immunotherapies.

For many people, anaplastic thyroid cancer has already spread when it is diagnosed. In this case, treatment aims to try and slow the growth of the cancer. This may improve your symptoms and give you a better quality of life.

As well as treatment to try to slow the growth of the cancer, you will be offered supportive (palliative) care, with medicines to manage any symptoms.

A very small number of people may be able to have surgery to remove the cancer if it has not spread out with the thyroid gland.

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can: 

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.
• Visit our thyroid cancer forum to talk with people who have been affected by thyroid cancer, share your experience, and ask an expert your questions.

Radiotherapy is often the main treatment used to treat anaplastic thyroid cancer. It uses high-energy x-rays and works by destroying cancer cells in the area being treated. You may be offered radiotherapy to:

• help slow down the growth and possibly shrink the cancer if surgery is not possible
• help control any symptoms the cancer is causing – for example, swallowing problems if the cancer is pressing on the gullet (oesophagus)
• reduce the risk of the cancer coming back after surgery.

Chemotherapy is sometimes given with radiotherapy. This is called chemoradiation. 

Before you start your treatment, it needs to be carefully planned. Planning makes sure that the radiotherapy is aimed precisely at the cancer. This means it causes the least possible damage to the surrounding healthy tissue.

You will need to have a mould or mask made before your treatment is planned. This is to keep your head still while you have treatment.

You normally have radiotherapy as a series of short, daily outpatient treatments. You then have a rest with no treatment at the weekend. It is given in the radiotherapy department using equipment similar to a large x-ray machine. How many treatments you have depends on the aim of your treatment. Your doctor or nurse will be able to tell you how many treatments you are likely to have.

You may develop side effects during radiotherapy. These usually improve slowly after treatment finishes. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Radiotherapy can cause general side effects such as tiredness (fatigue).

Side effects of radiotherapy to the neck can include:

• pain when swallowing
• a dry mouth or throat
• taste changes
• dark or red sore skin
• a hoarse voice.

Your doctor, specialist nurse or radiotherapist will discuss any possible side effects with you before you start your treatment.

Sometimes chemotherapy is given at the same time as radiotherapy. This is called chemoradiation or chemoradiotherapy. Giving chemotherapy in combination with radiotherapy helps make the treatment more effective. But it can make the side effects of treatment worse. There are different ways of giving chemoradiation. Your doctor, radiographer or specialist nurse can give you more information.

Surgery for anaplastic thyroid cancer usually involves removing the whole thyroid gland. This is called a total thyroidectomy.

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. 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).

Your surgeon may need to remove some of the tissue around the thyroid gland. This may be needed if the cancer has started to spread outside the thyroid gland and into the surrounding tissue. Often it is not possible to operate because the tumour has spread too far into other parts of the neck. 

A small number of people may have radiotherapy, chemotherapy or chemoradiation after surgery.

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 body needs to function at its normal rate. You will have regular blood tests to check your thyroid hormones are at the right level. If you have any questions about your medication, talk to your doctor, specialist nurse or pharmacist.

For many people with anaplastic thyroid cancer, it has spread outside the thyroid gland. This means the aim of treatment is to control any symptoms. This is called supportive care or palliative care. Surgery, radiotherapy and chemotherapy are sometimes used to control symptoms.

Your cancer doctor or nurse may also refer you to a palliative care nurse. They are specialists in giving support and helping to control symptoms. They can also arrange some practical help at home if you need it.