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Anaplastic Thyroid Cancer ATA 2021

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Key Background 2 ➤ Anaplastic thyroid cancer (ATC) is derived from follicular thyroid cells ("thyrocytes") and is associated with the highest mortality risk of any thyroid-arising tumor, but accounts for only a small percentage of thyroid cancer cases overall. • ATC patients have a historical median survival of about 5 months and a 1-year overall survival of 20%. Guideline Grading System Strength of Recommendation Quality of Evidence S Strong Recommendation H High-quality evidence C Conditional Recommendation M Moderate-quality evidence W Weak Recommendation L Low-quality evidence GPS Good Practice Statement VL Very low evidence In Insufficient Table 1. Key Steps in the Management of Anaplastic Thyroid Cancer 1. Rapidly and definitively establish the diagnosis Because ATC is a highly dedifferentiated cancer that retains few characteristics of noncancerous thyroid cells, attaining a definitive diagnosis can be challenging, yet critical. Time is also of the essence because of the very rapid growth rate of ATC and due to the importance of early intervention in minimizing catastrophic airway compromise. • Differential considerations/mimics can include primary thyroid lymphoma, SCC of the head and neck, and metastatic cancer (especially from lung ). • Early assessment of tumor mutations is key in expanding therapeutic options. 2. Attain multidisciplinary team engagement and coordination Coordinate early multidisciplinary involvement of surgeons, radiation and medical oncologists, endocrinologists, and palliative care teams to arrive at options for best care as outlined below. 3. Determine extent of disease • Staging with imaging is required to classify as stage IVA, IVB, IVC; this is best done with FDG PET/CT and/or alternatively with dedicated body CT or MR imaging. • Extent of local invasion must also be evaluated in parallel to assist in surgical decision making, and requires laryngoscopy.

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