1. DIAGNOSTIC EVALUATION
2. TREATMENT
3. III.ADJUVANT TREATMENT
4. FOLLOW UP
5. BIBLIOGRAPHY

I. DIAGNOSTIC EVALUATION:

Clinical Evaluation:

• Complete history and physical examination:
  
  Includes history of exposure to ionizing radiation, family history of thyroid cancer, prior history of goiter. The presence or absence of hoarseness, dysphagia and stridor should be documented.
  
  
• Complete examination of the head and neck:
  
  Includes inspection and palpation of the thyroid gland as well as the lateral aspects of the neck for cervical lymphadenopathy. The characteristics of the palpable thyroid mass such as size, consistency, number and fixation to trachea or larynx must be documented, as well as the presence of extrathyroidal extension to involve soft tissues in the central compartment of the neck or skin. The examination includes also laryngoscopy to document the mobility of vocal cords.
  
  In enlarged lymph nodes are present, their location (Group or Level I - VI), number, size, mobility, relationship to adjacent structures and staging should be documented.

Biopsy of Thyroid:

If anaplastic carcinoma is suspected because of size of tumor and fixation, a core biopsy using tru-cut or other core needle should be performed.

Imaging Studies:

• CAT or MRI scan of neck and chest

Laboratory Tests:

• Routine pre-op lab tests
• TSH, serum calcium

Consultations:

• Endocrinology
• Internal medicine as needed
• Oncology
• Radiation oncology

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Those rare patients who present with operable anaplastic thyroid carcinoma are usually discovered unexpectedly at frozen or permanent section. Most patients present with massive fixed tumors, which are unresectable. Those patients with unstable airway should be stabilized with endotracheal intubation if possible. Tracheotomy is often hazardous in this setting. Following biopsy, medical and radiation oncology consultations should be obtained.

Because anaplastic thyroid carcinoma is rare, large controlled studies of treatment are unavailable. Recent reports, suggest that combination treatment including accelerated radiation fractionation regimes, and radiosensitizing chemotherapy programs have improved local control. Some patients who have achieved a profound response to chemoradiotherapy seem to benefit from subsequent surgical resection.

Thyroidectomy following combined treatment can be considered if the patient remains free of distant metastases.

Chemotherapeutic agents which have been reported as effective include 5-FU, hydroxyurea, paclitaxel, and Adriamycin.

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Large controlled studies of adjuvant treatment are unavailable.

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• Follow-up should be monthly. Most patients will not survive the first year.

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Tennvall J, Lundell G, Hallquist A et al. Combined doxorubicin, hyperfractionated radiotherapy, and surgery in anaplastic thyroid carcinoma. Report on two protocols. The Swedish Anaplastic Thyroid Cancer Group. Cancer 1994; 74:1348-54.