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.
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Possible treatments include:
- 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:
You and your doctor can decide together on the best treatment plan for you. Your doctor is an expert in the best treatments, but you know your preferences and what is important to you. You can decide how involved you want to be in your treatment plan.
Sometimes doctors need to review a treatment plan. This may be when more information about the cancer becomes available – for example after tests or scan results. It may mean making more decisions with your doctor.
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.
Planning your treatment
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.
Side effects of radiotherapy
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:
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:
- if the cancer has spread to other parts of your body
- before surgery or radiotherapy to try to shrink the tumour before treatment
- after surgery to reduce the risk of the cancer coming back.
The main chemotherapy drugs used are:
Other chemotherapy drugs are sometimes 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.
These drugs are sometimes used to treat anaplastic thyroid cancer. Targeted therapies target something in or around the cancer cell that is helping it grow and survive. Immunotherapy drugs use the body’s immune system to find and attack cancer cells.
The targeted therapy drugs dabrafenib and trametinib may be given together to treat anaplastic thyroid cancer. They only help if the cancer cells have a gene change (mutation) called a BRAF mutation. Your doctor can check for this mutation in the biopsy sample taken when you were diagnosed.
There are other types of targeted therapy or immunotherapy drugs. Some of these may be given as part of a clinical trial. Your cancer doctor can tell you more about these drugs and if there is a suitable trial for your situation.
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.
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.
Clinical trials (research trials) try to find new and better treatments for cancer. Because anaplastic thyroid cancer is rare, it can be more difficult to research new treatments. Ask your thyroid specialist if there are any clinical trials suitable for you.
ClinicalTrials.gov is a website that has up-to-date international clinical trials, including UK trials.
The interNational Anaplastic Thyroid Cancer Tissue Bank and Database Project (iNATT) was launched in 2013. It collects tissue, blood samples and clinical information from patients all over the world. They 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 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.
You may find it difficult to swallow. This can be caused by the tumour pressing on the gullet (oesophagus). If this happens, you may find it easier to eat softer foods or to drink liquid food supplements. You can ask your specialist to refer you to a dietitian for advice and support.
This can be caused by the tumour pressing on the windpipe (trachea), or if the cancer has spread to the lungs. If you have difficulty breathing, you may feel anxious or scared. Your doctor or specialist nurse can give you support and medicines to help.
Below is a sample of the sources used in our thyroid cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
British Medical Journal. Best Practice Guidelines, Thyroid cancer. 2020.
European Society Medical Oncology (ESMO): Thyroid cancer, Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up. 2019.
National Institute for Health and Care Excellence (NICE). TA535: Lenvatinib and Sorafenib for treating differentiated thyroid cancer after radioactive iodine. 2018. www.nice.org.uk/guidance/ta535 [accessed May 2021].
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. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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