Incidental Anaplastic Thyroid Carcinoma

[Kroll2013]

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Dear colleagues, I need your opinion concerning Mypatient; 66 yo male patient , PS0, no major comprbidities, incidentally diagnosed of a small anaplastic thyroid carcinoma, following a partial thyroïdectomy for a multi nodules goiter. Size on pathology 8*5mm. No LND was done. Free margins. No BRAF mutation.

 

[RickyScott]

Full thryoidectomy and neck dissection followed by external chemo radiation. .5mm still half a billion cancer cells.

 

[Palex80]

If not already done: complete staging

 

[HemeOncHopeful19]

I’m Med Onc not Rad Onc, but…

 

[OTN]

I agree, full resection and postop RT asap along with whatever medonc wants to do if I ever get anaplastic thyroid cancer I want you to hit me with the kitchen sink so hard it damn near kills me

 

[evilbooyaa]

Agree with staging and full court surgical press to start including nodal dissection. While I, personally, would want adjuvant chemoRT as well just knowing how horrible a way to die local recurrence of ATC is, I am not aware of data in this sort of incidentally diagnosed population to 'mandate' adjuvant chemoRT assuming all additional surgery was negative.

 

[ramsesthenice]

Agree with staging and full court surgical press to start including nodal dissection. While I, personally, would want adjuvant chemoRT as well just knowing how horrible a way to die local recurrence of ATC is, I am not aware of data in this sort of incidentally diagnosed population to 'mandate' adjuvant chemoRT assuming all additional surgery was negative.

Not being funny, if I had an anaplastic thyroid cancer, I would probably "go out for a walk" and not come back. When people ask me what the scariest cancer is, I don't have to even hesitate.

 

[deleted1111261]

Not being funny, if I had an anaplastic thyroid cancer, I would probably "go out for a walk" and not come back. When people ask me what the scariest cancer is, I don't have to even hesitate.

and it's ugly cousin SNUC which took the smartest kid in our med school class. the worst.

 

[OTN]

Not being funny, if I had an anaplastic thyroid cancer, I would probably "go out for a walk" and not come back. When people ask me what the scariest cancer is, I don't have to even hesitate.

BRAF targeting has worked in a recent patient of mine, fortunately. Prior to that all my experiences led me down the "go out for a walk" path.

 

[temujim]

Dear colleagues, I need your opinion concerning Mypatient; 66 yo male patient , PS0, no major comprbidities, incidentally diagnosed of a small anaplastic thyroid carcinoma, following a partial thyroïdectomy for a multi nodules goiter. Size on pathology 8*5mm. No LND was done. Free margins. No BRAF mutation.

Prob the best possible ATC scenario. Agree with completion thyroidectomy and central/lat LND. Most likely PORT with maybe weekly paclitaxel.

 

[gmsquid]

Yeah this population actually does decent. Surgery and adjuvant paclitaxel RT. Modest chance of cure, though the lack of ct imaging of the basin in most of these patients may unmask a lot of disease

 

[ramsesthenice]

BRAF targeting has worked in a recent patient of mine, fortunately. Prior to that all my experiences led me down the "go out for a walk" path.

I have not personally treated one of these in years and am vary glad to hear maybe there is something. I also don't think I've ever seen it as a sub cm incidental finding and it makes sense this population may do comparatively better. As long as I was feeling good, I'd fight like hell. But, when the gig is up, I honestly don't know what I would do. There are not enough drugs in the world to make this a comfortable passing and in my experience, watching someone die essentially by strangulation is far more traumatic for the family than most other ways of dying from cancer (which are still bad...this is just a different kind of animal).

PS: I don't flippantly joke about suicide. As many of you on here know from my prior posts, I have experienced not 1, but 2 resident suicides over the years (neither in rad onc) and it is emotionally devastating. I apologize if I offended anyone with my comment. I was only trying to emphasize just how horrible this disease can be.

 

[deleted1111261]

I have not personally treated one of these in years and am vary glad to hear maybe there is something. I also don't think I've ever seen it as a sub cm incidental finding and it makes sense this population may do comparatively better. As long as I was feeling good, I'd fight like hell. But, when the gig is up, I honestly don't know what I would do. There are not enough drugs in the world to make this a comfortable passing and in my experience, watching someone die essentially by strangulation is far more traumatic for the family than most other ways of dying from cancer (which are still bad...this is just a different kind of animal).

PS: I don't flippantly joke about suicide. As many of you on here know from my prior posts, I have experienced not 1, but 2 resident suicides over the years (neither in rad onc) and it is emotionally devastating. I apologize if I offended anyone with my comment. I was only trying to emphasize just how horrible this disease can be.

I thought you put it very well. I also am not comfortable joking about suicide, but there are some medical circumstances where "taking a walk and not coming back" is completely reasonable and I think it was said tastefully.

 

[RickyScott]

Anaplastic ca that arises in follicular is more indolent than de novo ca. have had a few pts respond to braf/Mek but none for more than a year.