The Role of Surgeons, Endocrinologists and Oncologists in Management of Anaplastic Thyroid Carcinoma - Abstract
Background: Anaplastic Thyroid Carcinoma [ATC] is an uncommon and lethal type of thyroid cancer. It accounts for only < 2 % of all thyroid cancer cases. It is the cause of about one-half of all thyroid carcinoma deaths. This cancer has a very low cure rate even with the best treatments. ATC invades adjacent structures and metastasizes extensively to cervical lymph nodes and distant organs. Tracheal invasion presents in 25% of the cases at the time of presentation that needs a tracheostomy. Only a small portion of patients can undergo surgical resection in hopes of curing it. In this study, we aimed to define the role of surgeons, Endocrinologists and Oncologists in management of anaplastic carcinoma of thyroid
Material and methods: In a retrospective study we reviewed the records of patients with [ATC] referred to our hospital Razi, Arya and Golsar Iran, Rasht city between 2004-2017. In all cases, the diagnosis was confirmed by pathological findings. The data including: symptoms, signs, diagnosis tools, surgical approaches, chemo radiation therapy and survival rate were collected and analyzed.
Results: We identified 41 patients with ATC. Twenty eight of patients were male and the remaining was female. Twenty five of patients presented with hard neck mass, 12 of these patients had sever dyspnea and dysphagia, Ten cases with hard neck mass and pain and ten of patients admit with dyspnea and strider. FNA and core needle biopsy was performed on 35 patients and anaplastic carcinoma of thyroid was documented in 29 patients and two patient revealed suspected cells in FNA. Ten patients admit with sever dyspnea and stride or that underwent tracheostomy and biopsy. The surgical intervention was conducted on 31 patients who diagnosed on FNA and core needle biopsy for [ATC]: Total thyroidectomy in 9 cases, subtotal thyroidectomy in 10 cases, debulking surgery in 12 cases and 5 cases just tracheostomy. Final pathology of all these patients was ATC. All patients referred for chemo radiation- therapy after the operation. All of our patients died between 1 to 10 months after surgery and chemoradiation therapy.
Conclusion: Surgical intervention even in early stage not increase survival but can improve the quality the life .We conclude the role of surgeon in ATC is to maintain a safe airway and tissue sample for definitive diagnosis. Endocrinologists role are early diagnosis and Oncologists can decrease the size of tumour.