Monday, February 26, 2024

Md Anderson Anaplastic Thyroid Cancer

End Points And Statistical Methods

Anaplastic thyroid cancer survivor uses voice for MD Anderson

Descriptive statistics were used to summarize the patients characteristics. The 2 test was used to examine the association between two categorical variables. The following covariates were analyzed: age gender race history of smoking ECOG performance status histology TSH level calcitonin level history of thyroidectomy radioactive iodine number of prior therapies local recurrence metastases in the liver, lung, lymph nodes, bone, or mediastinum number of metastatic sites leukocyte count hemoglobin level platelet count and levels of albumin, lactate dehydrogenase, calcium, phosphorus, alkaline phosphatase, bilirubin, and serum creatinine.

Best response was assessed by an M. D. Anderson radiologist every two cycles of therapy , using RECIST criteria . PR was defined as a 30% or greater decrease in the sum of the longest diameter of target lesions, excluding complete disappearance of disease. Progressive disease was defined as a 20% or greater increase in the sum of the longest diameter of target lesions. Stable disease was defined as smaller changes that did not meet the criteria for a PR or PD. For patients treated with more than one therapy, data for survival and progression-free survival from the first therapy were used. Waterfall plot analysis was used to capture antitumor efficacy . Responses shown in the waterfall plot were grouped according to standard RECIST guidelines.

Q& a: Anaplastic Thyroid Cancer

If you or a loved one has been diagnosed with anaplastic thyroid cancer, it may be hard to find others whove received the same diagnosis. Thats because anaplastic thyroid cancer is only diagnosed in about 500 to 800 patients in the United States each year — most age 60 or older.

And, because anaplastic thyroid cancer is extremely rare, theres limited reliable information on this disease.

To help, we spoke with Below, she explains the basics of anaplastic thyroid cancer diagnosis and discusses the latest treatment advances.

How is anaplastic thyroid cancer diagnosed?

Anaplastic thyroid cancer is typically diagnosed by removing and examining a small sample of a patients tissue, known as a biopsy. But because biopsied cells can appear in a variety of shapes and forms, diagnosis can be difficult and often inaccurate.

The pathology report may not always use the words anaplastic thyroid cancer. If you see another term, such as undifferentiated, dedifferentiated, sarcoma of the thyroid, sarcomatoid, squamous, spindle cell or giant cell on the report, you may want to seek a second opinion from an thyroid cancer expert before starting treatment.

How is anaplastic thyroid cancer typically treated?

What causes anaplastic thyroid cancer?

Some genetic mutations in the tumor can cause cells to grow out of control, leading to cancer. Anaplastic thyroid cancer patients commonly have the BRAF, RAS, p53 and PI3K mutations.

Treating Anaplastic Thyroid Cancer

Shortly after his first appointment at MD Anderson, Hernandez got a call that would turn his story around. A new study was in the works at MD Anderson.

The primary investigator is the institutionâs Dr. Mark Zafereo, professor of Head and Neck Surgery. He also serves as section chief of Head and Neck Endocrine Surgery and associate medical director of the Head and Neck Center.

Hernandezâs tumor had the specific genetic profile to make him a candidate for the trial â a BRAF mutation, which is found in 10 to 50 percent of anaplastic thyroid cancers.

While anaplastic thyroid cancer is rare, MD Anderson still sees a number of patients with the condition, sometimes even one to two a week, Zafereo said.

In the past, he said, the prognosis would always be dismal, unlike other thyroid cancers that could be easily treated.

âThis is a completely different ball game,â Zafereo said. âItâs so fast-growing that by the time a patient goes to see a specialist, a major operation is very difficult or impossible.â

The tumor would grow so quickly and take away a patientâs ability to eat, speak and breathe â and then metastasize to other parts of the body.

âItâs a life-threatening and scary situation for patients,â Zafereo said. âAs of even about five years ago, patients had about a three-month survival rate.â

He and his colleagues were working to change those odds.

The only issue is that the disease would start growing again.

Also Check: Braf Mutation Papillary Thyroid Cancer

Thyroid Cancer Risk Factors

Although the exact cause of thyroid cancer is unknown, certain risk factors have been identified. They include:

Not everyone with risk factors gets thyroid cancer. However, if you have risk factors it is a good idea to discuss them with your doctor.

Some cases of thyroid cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.

How Is Anaplastic Thyroid Cancer Treated

Overcoming BRAF/MEK Inhibition Resistance in Anaplastic Thyroid ...

Anaplastic thyroid cancer is difficult to treat because it is very aggressive and can spread rapidly within the neck and metastasize to distant parts of the body. It is less predictable than other thyroid cancers however, one thing that all long-term survivors have in common is the sense of urgency in diagnosis and treatment.

It is important to work with a doctor or team of doctors who have experience with anaplastic thyroid cancer. You must be your best advocate. Take a family member or friend to appointments if possible. Take notes. Ask questions. If you are unable to travel to a major medical/ cancer facility with experience, many of the larger, more experienced institutions are happy to advise your local doctors on the best treatment options. Do not be afraid to ask your local doctors to collaborate with experts at more experienced centers on your treatment plan given the rarity of this diagnosis. It is also important to understand the risks and benefits involved with various treatment options.

Anaplastic thyroid cancer does not respond to radioactive iodine therapy or Thyroid Stimulating Hormone suppression, which are commonly used in patients with other forms of differentiated thyroid cancer.

Treatment of anaplastic thyroid cancer, is best done through a multidisciplinary team , and typically consists of combining surgery with external beam radiation and chemotherapy.

Recommended Reading: What Can I Take For Thyroid Pain

Anaplastic Thyroid Cancer Survivor: I Wish Id Gone To Md Anderson First

Everything I have today, I owe to my voice. God granted me a wonderful singing voice at a very young age, and it served me well until I was almost 62. It allowed me to work in the music industry for my entire adult life. And it gave me the opportunity to perform around the world with one of Americas most iconic bands: The Beach Boys.

Three years ago, I underwent thyroid cancer surgery near my home in California. Nerve damage from that surgery paralyzed one of my vocal cords, effectively ending my singing career.

Thats why Im using my voice today in a different way: to tell people about MD Anderson. Because if it wasnt for their doctors, I wouldnt still be here. And I might not have a voice at all.

Life-changing surgery, corrected diagnosis led me to MD Anderson

I came to MD Anderson after the first thyroid surgery changed my life. The realization that I wouldnt be singing anymore was devastating. But the next bit of news my local doctor delivered was almost worse.

Biopsied tissue revealed that I actually had anaplastic thyroid cancer. And anaplastic thyroid cancer accounts for less than 1% of all thyroid cancer cases diagnosed annually. Its very aggressive, and theres no cure.

Unfortunately, my cancer was already fairly advanced. It hadnt spread to my brain yet, but it had invaded a few of my bones. My local doctors didnt think I had very long to live. But I wasnt ready to give up.

Why I joined an immunotherapy clinical trial at MD Anderson

Cancer Free For Christmas

Once Hernandez came to MD Anderson, his care went into high gear the hospital offers the FAST, or Facilitating Anaplastic thyroid cancer Specialized Treatment, team to speed up care.

The broad multidisciplinary team includes oncologic endocrinologists, medical oncologists, radiation oncologists, pathologists, pulmonologists and head and neck endocrine surgeons.

âWe really make this disease a priority,â Zafereo said. âTime is of the essence when youâre talking about anaplastic thyroid cancer. It grows day by day.â

As soon as Hernandez showed the BRAF mutation, he was eligible for the trial. He started receiving chemotherapy on Nov. 5, 2021, treated by Dr. Steven Waguespack, oncologic endocrinologist

âHe had a rapid response to the drugs,â Zafereo said. âIt shrunk the tumor down.â

Then, he was eligible for an operation, which was scheduled for Feb. 2. He began radiation on Feb. 28 for six weeks.

Now, Hernandez is cancer free.

âGoing back to where we were five years ago, his life would have been limited to months,â Zafereo said. âItâs a major success story, and our entire team is so excited about the results.â

But Hernandezâs battle with anaplastic thyroid cancer is not over, the surgeon said. He still takes chemo drugs and undergoes immunotherapy every three weeks.

Last month, Hernandez was invited to the Gateway for Cancer Researchâs gala in Chicago as a guest of honor.

âHe got choked up,â Senft recalled.

Also Check: Afirma Test For Thyroid Nodules

Prognostic Factors And Risk Stratification

In multiple retrospective studies analyzing disease course and aiming to identify prognostic factors for ATC, reported OS was highly variable ranging from few weeks to several years . This implies that although ATC is fatal in most cases, risk stratification might be helpful. This would allow the distinction of patients in whom best supportive care should be administered from patients who may be considered for more aggressive treatment, ideally as part of a clinical trial.

Retrospective multicenter studies have shown that ATC survival is stage dependent . In a study including 699 ATC patients diagnosed between 2003 and 2008, survival, regardless of treatment approach, was 9 months in patients with stage IVA disease, 4.8 months in stage IVB disease and 3 months in stage IVC disease .

Negative prognostic markers such as older age, initial distant metastatic disease, large primary tumor diameter and elevated white blood count have been described in several retrospective studies .

In a recent retrospective Germany multicenter study including 100 ATC patients, pre-therapeutic prognostic factors for longer survival were age < 70 years, absence of distant metastases and complete local resection .

In a single-center Chinese study a prognostic score, which comprised age , blood platelet count , WBC and stage , was evaluated in a cohort of 42 patients. In multivariate analysis, risk group and therapeutic regimen were independent prognostic factors .

What Are The Different Types Of Thyroid Cancer

John Stamos and anaplastic thyroid cancer survivor Jeffrey Foskett give back to MD Anderson

Thyroid cancer is categorized based on the type of thyroid cells where the cancer begins and how the cancer cells appear under a microscope.

There are two kinds of cells found in the thyroid.

Follicular cells are the most common. They produce thyroid hormone, which is important for growth, mental function and helping the body create energy. Most thyroid cancers develop from follicular cells.

Parafollicular cells, also known as C cells, produce a small amount of the hormone calcitonin, which helps control calcium metabolism. Most parafollicular cells are in the upper third of each lobe. Medullary thyroid cancer is the only thyroid cancer that develops from parafollicular cells.

Thyroid cancers can also be categorized based on the appearance of their cells. Cancer cells that look most like normal, healthy cells are called well differentiated. Patients with well differentiated thyroid cancers are most likely to be disease-free at the end of treatment. Poorly differentiated and undifferentiated cancer cells look less and less like healthy cells. These forms of thyroid cancer are usually harder to treat and the outlook for these patients is worse.

Doctors believe most thyroid cancers start as well differentiated. As the cancer grows, its cells can develop additional mutations, changing it into a less differentiated, harder-to-treat type of thyroid cancer.

Read Also: What Are The Signs Of Thyroid Cancer Returning

Anaplastic Thyroid Cancer Clinic

Anaplastic thyroid cancer is a very rare and aggressive disease that requires accurate diagnosis and immediate treatment.

MD Anderson’s Facilitating Anaplastic Thyroid Cancer Specialized Treatment Team, or FAST, is a collaboration of renowned thyroid cancer experts in oncologic endocrinology, medical oncology, head and neck surgery and radiation therapy. The FAST multidisciplinary team is dedicated to confirming your cancer diagnosis and developing a treatment plan within seven business days of your first appointment.

Everything I have today, I owe to my voice. God granted me a wonderful singing voice at a very young age, and it served me well until I was almost 62. It allowed me to work in the music industry for my entire adult life. And it gave me the opportunity to perform around the world with one of Americas most iconic bands: The Beach Boys.

Three years ago, I underwent thyroid cancer surgery near my home in California. Nerve damage from that surgery paralyzed one of my vocal cords, effectively ending my singing career.

Thats why Im using my voice today in a different way: to tell people about MD Anderson. Because if it wasnt for their doctors, I wouldnt still be here. And I might not have a voice at all.

Life-changing surgery, corrected diagnosis led me to MD Anderson

Why I joined an immunotherapy clinical trial at MD Anderson

Thankful for my three bonus years, and any more yet to come

Follicular Cell Thyroid Cancers

From well differentiated to undifferentiated, the types of thyroid cancer from follicular cells are:

Papillary thyroid cancer: This is typically the least aggressive type of thyroid cancer. It accounts for about 80% of thyroid cancer diagnoses. While papillary thyroid cancer usually occurs in only one lobe of the thyroid gland, it appears in both lobes in 10%-20% of cases. Papillary thyroid cancer is most common in women of childbearing age. Its treatment is successful in most patients.

Follicular thyroid cancer: This accounts for about 10% of thyroid cancers. Though it can be more aggressive than papillary thyroid cancer, follicular thyroid cancer usually grows slowly. Treatment for follicular thyroid cancer is similar to papillary thyroid cancer and is successful for most patients.

Both papillary and follicular thyroid cancer are considered well differentiated cancers. Well differentiated thyroid cancer tends to stay contained within the thyroid gland. When it does spread outside the thyroid, the most common locations of spread, or metastasis, are lymph nodes, lungs, bones and the liver.

Hürthle cell thyroid cancer: Also called oxyphilic cell carcinoma, Hürthle cell carcinoma was considered a type of follicular thyroid cancer until recently. Most patients diagnosed with Hürthle cell carcinoma do well, but the outlook may change based on the extent of disease at the time of diagnosis.

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Cancer History Does Not Affect Survival Odds For Adults With Anaplastic Thyroid Carcinoma

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Overall survival rates for adults diagnosed with anaplastic thyroid carcinoma are similar between those with a history of cancer and those with no previous cancer diagnosis, according to findings published in Thyroid.

Jennifer Rui Wang

Anaplastic thyroid cancer patients with prior histories of other cancers have similar survival outcomes as patients without a prior cancer history,Jennifer Rui Wang, MD, assistant professor in the department of head and neck surgery at The University of Texas MD Anderson Cancer Center, told Healio. As such, patients with prior cancer histories should not be excluded from clinical trials and multimodality treatment, which are important determinants of outcome in this aggressive disease.


The study included 451 adults diagnosed with anaplastic thyroid carcinoma . Median overall survival after diagnosis was 8.4 months, with 39% of the cohort alive 1 year after diagnosis and 22% alive 2 years after diagnosis.

Of those diagnosed with anaplastic thyroid carcinoma, 23% had a history of nonthyroid cancer at diagnosis. The most common prior cancer was nonmelanoma skin cancer. Among women, breast cancer was the most common prior cancer, whereas prostate cancer was most common among men. Prior nonthyroid cancer did not affect treatment regimens for anaplastic thyroid carcinoma.

For more information:

Fast Clinic Gives Anaplastic Thyroid Cancer Patients Hope And Time

Pin on Words of Wisdom

Historically, anaplastic thyroid cancer patients have had few treatment options, and those that existed often came too late. But MD Andersons FAST clinic is speeding up the start of treatment for this aggressive cancer and giving patients new treatment options, including clinical trials.

Max Nickless says he wasnt too optimistic when his wife, Becky, drove him 15 hours from their home in Indiana to see thyroid cancer specialist , at MD Anderson in February 2017. The outlook from local doctors was so poor that hed already picked out photos and music for his funeral.

Max had anaplastic thyroid cancer the most aggressive form of the disease. Anaplastic is a medical term used to describe cancer cells that divide rapidly.

Anaplastic thyroid cancer is probably one of the deadliest human cancers, says Stephen Lai, M.D., Ph.D., professor of Head and Neck Surgery. Its rare only about 1,000 cases per year in the U.S. and most patients die within three to six months after diagnosis.

When I talked to Dr. Cabanillas on Wednesday, Max was still eating and drinking, and everything was normal, Becky says. But by Saturday, he had trouble swallowing, a lot of trouble breathing, and I was really worried about driving him to Houston.

The cancers rapid progression wasnt unusual. Anaplastic thyroid cancer is so aggressive that by the time many patients are fully evaluated, their disease is often beyond help. Or at least, thats the way it used to be.

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How Is Anaplastic Thyroid Cancer Diagnosed

Anaplastic thyroid cancer can present in several ways. Most often it presents as a lump or nodule in the neck. These tumors grow very quickly and often growth can be visible to the patient or the family and friends of the patient. In some cases, anaplastic thyroid cancer presents as a neck mass with difficulty swallowing, difficulty breathing, or hoarseness if one of the vocal chords is paralyzed by the tumor.

Typically, a fine needle aspiration or core biopsy is performed. Once the diagnosis is confirmed, a full assessment of the patients overall health should be completed. This includes blood tests, as well as imaging scans to determine if and where the cancer has spread.

All patients with Anaplastic Thyroid Cancer are diagnosed as Stage IV due to the aggressive nature of this tumor. There are three sub-stages:

  • Stage IVA: Anaplastic thyroid cancer is present only in the thyroid
  • Stage IVB: Anaplastic thyroid cancer is present in the thyroid and in the neck, but not in other parts of the body
  • Stage IVC: Anaplastic thyroid cancer is present in the thyroid as well as other parts of the body, such as the bones, lungs or brain

About 10% of patients have anaplastic thyroid cancer that is present only in the thyroid, and approximately 40% of those diagnosed have cancer that is localized in the neck and/or lymph nodes. The remaining patients have anaplastic thyroid cancer that has metastasized to other parts of the body at the time of diagnosis.

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