Treatment of anaplastic thyroid cancer
The main treatment for anaplastic thyroid cancer is radiotherapy. Chemotherapy is sometimes given with radiotherapy. This is known as chemoradiation.
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 lead to an improvement in symptoms and 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.
It is important to be fully aware of the benefits, possible disadvantages and side effects of the treatments you are offered. Your doctor or specialist nurse will explain these to you. You can then decide what is best for you. Making decisions about treatment in these circumstances is always difficult. You may need to discuss in detail with your doctor or specialist nurse whether you wish to have treatment. If you choose not to have it, you will still be offered supportive care.
Radiotherapy is often the main treatment used to treat anaplastic thyroid cancer. It uses high-energy x-rays to treat cancer. It works by destroying cancer cells in the area being treated. You may be offered radiotherapy:
- if the tumour cannot be removed with an operation
- to reduce the risk of the cancer coming back after surgery
- to shrink any tumours and slow down further growth
- to help control any symptoms the cancer is causing – for example, swallowing problems if the cancer is pressing on the gullet (oesophagus).
Chemotherapy is sometimes given with radiotherapy. This is known as chemoradiation (see below).
Although it is effective for some types of thyroid cancer, radioactive iodine treatment is not effective in treating anaplastic thyroid cancer.
Planning your treatment
Before you start your treatment, it needs to be carefully planned. Planning makes sure that the radiotherapy is aimed precisely at your cancer so that 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 your treatment.
You normally have radiotherapy as a series of short, daily outpatient treatments with a rest at the weekend. You have it in the radiotherapy department using equipment similar to a large x-ray machine. How many treatments you have will depend on the aim of your treatment. Your doctor or nurse will be able to tell you how many treatments you are likely to have.
Side effects of radiotherapy
You may develop side effects during radiotherapy. These usually disappear gradually over a few weeks or months 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).
Specific side effects of radiotherapy to the neck can include:
Your doctor, specialist nurse or radiotherapist will discuss any possible side effects with you before you start your treatment.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy:
- before surgery or radiotherapy to try to shrink the tumour before treatment
- after surgery to reduce the risk of your cancer coming back
- if the cancer has spread to other parts of your body.
The main chemotherapy drugs used are:
Other chemotherapy drugs may sometimes be used.
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 is only suitable for a small number of people with anaplastic thyroid cancer. Your doctors may recommend it if the cancer is contained within the thyroid gland. Surgery for anaplastic thyroid cancer usually involves removing the whole thyroid gland (total thyroidectomy). If the cancer has spread to the lymph nodes in the front and side of the neck, the surgeon will remove them too (neck dissection).
If the cancer has started to spread outside the thyroid gland into the surrounding tissue, your surgeon may need to remove some of the tissue around the thyroid gland. Often it is not possible to operate because the tumour has spread too far into other parts of the neck.
We have more information on what happens before and after surgery for thyroid cancer.
A small number of people may have radiotherapy, chemotherapy or chemoradiation after surgery.
Research trials are done to try to find new and better treatments for cancer. Because anaplastic thyroid cancer is rare, it is difficult to research new treatments. Ask your thyroid specialist if there are any clinical trials suitable for you.
The interNational Anaplastic Thyroid Cancer Tissue Bank and Database Project (iNATT) was launched in 2013. It is collecting tissue, blood samples and clinical information from patients all over the world. It may ask for your permission to use some of your samples for research. This information will be used to learn more about why and how this type of cancer develops, so that new ways of treating it can be developed.
For many people with anaplastic thyroid cancer, it will have spread outside the thyroid gland. The aim of treatment in this situation is to control any symptoms. This is called supportive care or palliative care. Surgery, radiotherapy and chemotherapy are sometimes used to control symptoms.
You may find it difficult to swallow. This can be caused by the cancer pressing on the gullet (oesophagus). You can ask your specialist to refer you to a dietitian for advice and support.
You may have pain or discomfort in your neck area. If the cancer has spread, you may have pain in other parts of your body. Your doctor or nurse will assess the pain and prescribe the painkillers that are best for you.
This can be caused by the cancer pressing on the windpipe (trachea), or if the cancer has spread to the lungs. If you have breathing difficulties, you may feel anxious or fearful. Your doctor or specialist nurse can give you support and may prescribe medication to help with this.