Hello Ellie5710,
I never like to answer this type of question, as it involves less
than a positive answer. Keep in mind that your husband?s condition
can?t be predicted or diagnosed online, and that this information is
for informational purposes only. Your husband?s overall health, along
with his doctor are the best predictors of what to expect. The fact
that your husband has survived for five years is a blessing, and
hopefully attests to his ability to resist this next round with
cancer.
Sadly, 75% of ATC patients suffer from a metastasis, and 80% of
those have a metastasis to the lung.
?Anaplastic tumors are the least common (about 0.5 to 1.5%) and
most deadly of all thyroid cancers. This cancer has a very low cure
rate with the very best treatments allowing only 10 % of patients to
be alive 3 years after it is diagnosed. Most patients with anaplastic
thyroid cancer do not live one year from the day they are diagnosed.
Anaplastic thyroid cancer often arises within a more differentiated
thyroid cancer or even within a goiter.?
?Anaplastic cancers invade adjacent structures and metastasize
extensively to cervical lymph nodes and distant organs such as lung
and bone. Tracheal invasion is present in 25% at the time of
presentation (said differently, in about 25% of cases, the anaplastic
cancer has grown out of the thyroid and grown into the trachea). This
is why many patients with anaplastic thyroid cancer will need a
tracheostomy while almost nobody with the other types of thyroid
cancer will need one. Spread (metastasis) to the lung is present in
50% of patients at the time of diagnosis of anaplastic thyroid cancer
is made. Most of these cancers are so aggressively attached to vital
neck structures that they are inoperable at the time of diagnosis (the
surgeon can't remove it--it's growing into other neck structures).
Even with aggressive therapy protocols such as hyperfractionated
radiation therapy, chemotherapy, and surgery, survival at 3 years is
less than 10%.?
?Tragically, the five year survival from this type of cancer is less
than 5%, with most patients dying within just a few months of the
diagnosis. Treatment with radiation therapy or chemotherapy may shrink
the tumor slightly and make breathing more easy in those patients who
are suffering from shortness of breath. Occasionally, a tracheostomy
(a hole which is surgically cut in the patients windpipe) may allow
easier breathing, but will not cure this aggressive form of cancer.
With advances in research, we hope that additional treatment options
will be available soon.?
http://cpmcnet.columbia.edu/dept/thyroid/anaplastic.html
?Age appears to be the single most important prognostic factor.[11]
The prognostic significance of lymph node status is controversial. One
retrospective surgical series of 931 previously untreated patients
with differentiated thyroid cancer found that female gender,
multifocality, and regional node involvement are favorable prognostic
factors.[14] Adverse factors included age older than 45 years,
follicular histology, primary tumor >4 cm (T2-3), extrathyroid
extension (T4), and distant metastases.[14,15]
Other studies, however, have shown that regional lymph node
involvement had no effect [16,17] or even an adverse effect on
survival.[12,13,18] Diffuse, intense immunostaining for vascular
endothelial growth factor in patients with papillary cancer has been
associated with a high rate of local recurrence and distant
metastases.[19] An elevated serum thyroglobulin level correlates
strongly with recurrent tumor when found in patients with
differentiated thyroid cancer during postoperative evaluations.[20,21]
Serum thyroglobulin levels are most sensitive when patients are
hypothyroid and have elevated serum thyroid-stimulating hormone
levels.[22] Expression of the tumor suppressor gene p53 has also been
associated with an adverse prognosis for patients with thyroid
cancer.?
http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/healthprofessional
?The major problem with anaplastic thyroid cancer is that it is
usually too aggressive and invasive when it is diagnosed. Therefore,
only a small portion of patients can undergo surgical resection of the
cancer in hopes of cure. For those patients who are diagnosed at an
earlier stage, total thyroidectomy is necessary. Many patients,
especially those who have advanced cancer and cannot undergo surgical
resection, will benefit from external-beam radiation (this is
different from radioactive iodine). Some chemotherapy treatments may
also be beneficial to patients with anaplastic thyroid cancer.?
?Greater than 40% of patients present with cervical lymphadenopathy,
30% present with true vocal cord paralysis, 90% present with direct
invasion of adjacent structures and 50% present with distant
metastasis. Approximately 75% of patients with ATC will develop
distant metastasis during the course of their disease. Distant
metastasis occurs in the lung (80%), bone (6-15%), brain (5-13%), and
in the gastrointestinal tract.?
?The benefit of radiotherapy in treatment of ATC is also
controversial. ATC is relatively radioresistant, so radiation is more
a palliative treatment. Radiation has been shown to achieve 68-80%
local control, but also has greater treatment morbidity. Levendag
reported a series of 51 patients who received radiation.?
?Future studies in the treatment of ATC just underway include
elucidating a more detailed understanding of dedifferentiation at the
molecular level, a better understanding of genes involved in cell
regulatory pathways, chromosome mapping (i.e. chromosome 7 and 16),
and clinical trials involving the use of gene therapy. Several gene
therapy experiments are already underway. Adenovirus-mediated p53
gene therapy has shown to increase chemosesitivity to adriamycin and
doxorubicin.
Bone morphogenic protein (BMP-7) has been demonstrated to inhibit
proliferation of ATC cells by G1 arrest. Bovine seminal ribonuclease
induced a high rate of apoptosis in ATC cells. Injection into nude
mice with established ATC tumors resulted in a complete regression of
the tumor. Other studies include the use of histone deacetylase
inhibitors to promote apoptosis and differential cell cycle arrest in
ATC cells. Human sodium iodide symporter, when transfected into ATC
cells in vivo and in vitro established the uptake of iodide.
The prognosis for ATC remains dismal. The current treatment of ATC
has not changed the prognosis or outcome, regardless of the modality.
Future study at the molecular level, as well as treatment at the
molecular level remains the only hope to change the outcome of this
aggressive malignancy.?
http://www.utmb.edu/otoref/Grnds/Anaplastic-thyroid-Ca-050511/Anaplastic-thyroid-Ca-050511.htm
?If thyroid cancer spreads (metastasizes) outside the thyroid,
cancer cells are often found in nearby lymph nodes, nerves, or blood
vessels. If the cancer has reached these lymph nodes, cancer cells may
have also spread to other lymph nodes or to other organs, such as the
lungs or bones.
When cancer spreads from its original place to another part of the
body, the new tumor has the same kind of abnormal cells and the same
name as the primary tumor. For example, if thyroid cancer spreads to
the lungs, the cancer cells in the lungs are thyroid cancer cells. The
disease is metastatic thyroid cancer, not lung cancer. It is treated
as thyroid cancer, not as lung cancer. Doctors sometimes call the new
tumor "distant" or metastatic disease.?
http://thyroid.about.com/od/thyroidcancer/a/overview.htm
?Hormone therapy uses hormones to stop cancer cells from growing.
In treating thyroid cancer, hormones can be used to stop the body from
making other hormones that might make cancer cells grow. Hormones are
usually given as pills.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be
taken by pill, or it may be put into the body by a needle in the vein
or muscle. Chemotherapy is called a systemic treatment because the
drug enters the bloodstream, travels through the body, and can kill
cancer cells outside the thyroid.?
?Recurrent Thyroid Cancer
The choice of treatment depends on the type of thyroidcancer the
patient has, the kind of treatment the patient had before, and where
the cancer comes back. Treatment may be one of the following:
? Surgery with or without radioactive iodine. A second surgery may be
done to remove tumor that remains.
? Radioactive iodine.
? External-beam radiation therapy or radiation therapy given during
surgery to relieve symptoms caused by the cancer.
? Chemotherapy.
? Clinical trials of new treatments.?
http://ycctrials.med.yale.edu/detail.asp?nm=CDR62709
?All anaplastic thyroid carcinomas are considered T4 and those with
extrathyroidal extension are staged as T4b and are therefore
unresectable. This is consistent with the poor prognosis that is
associated with anaplastic thyroid carcinomas especially those which
have extended beyond thyroid capsule.?
http://www.nccs.com.sg/epub/CU/vol3_04/staging_m.htm
?Thyroid cancers can also spread through the bloodstream. Cancer
cells gain access to distant organs via the bloodstream and the tumors
that arise from cells' travel to other organs are called metastases.
Cancers of the thyroid generally spread locally or to lymph nodes
before spreading distantly through the bloodstream. Hence, the
incidence of distant metastases is low, with less than 5% of papillary
thyroid cancers showing distant spread and between 5 and 20% of
follicular thyroid cancers exhibiting metastases. If spread through
the bloodstream does occur, the lungs and bones are the most common
organs involved.?
http://www.oncolink.com/types/article.cfm?c=7&s=26&ss=770&id=107
Treatment Options
==================
Please discuss any treatment options or clinical trials with your
husband?s doctor -your best source of advice. Please don?t waste your
money or disregard your doctor?s advice for the numerous quack/snake
oil remedies that you may find online.
?As is true of many cancers, the treatment of lung cancer depends
upon a variety of factors. The most important factors are the
histopathologic (diseased tissue) type of tumor that is present and
its stage. Once a lung cancer has been staged, the physician and
patient can discuss treatment options. An individual then has a better
idea of the value of different forms of therapy. Other factors that
are taken into account include the person's general health, medical
problems that may affect treatment (such as chemotherapy), and tumor
characteristics.?
?Photodynamic therapy (PDT) may be especially useful for the care of
persons with inoperable lung cancer. Photodynamic therapy begins with
the injection of a light-activated drug (e.g.,
photofrin/polyhaematoporphyrin, lumin). Then, during bronchoscopy
(examination of the airways using a flexible scope), the lung tumor is
illuminated by a laser fiber that transmits light of a specific
wavelength.?
?Electrosurgery Elecctrosurgery is surgery performed using a needle,
bulb, or disk electrode, Nd-YAG laser therapy (neodymium-yttrium/argon
laser that concentrates high-energy electromagnetic radiation to
destroy tissue), cryotherapy (destruction of tissue using extreme
cold), and brachytherapy (treatment with ionizing radiation) are
additional tumor debulking, or size-reducing, techniques that may be
performed during bronchoscopy.?
http://www.oncologychannel.com/lungcancer/treatment.shtml
?But because no treatment can eliminate advanced anaplastic cancer,
you may want to consider participating in a clinical trial. This is a
study that tests new forms of therapy ? typically new drugs or
surgical procedures, or novel treatments such as gene therapy. If the
therapy proves to be safer or more effective than current treatments,
it becomes the new standard of care. But treatments used in clinical
trials haven't been shown to be effective. They may have serious or
unexpected side effects, and there's no guarantee you'll benefit from
them. On the other hand, cancer clinical trials are closely monitored
to ensure that they're conducted as safely as possible. And they offer
access to treatments that wouldn't otherwise be available to you.
If you're interested in finding out more about clinical trials, talk
to your doctor. You can also call the National Cancer Institute's
Cancer Information Service at (800) 4-CANCER, or (800) 422-6237. The
call is free, and trained specialists are available to answer your
questions.?
http://www.cnn.com/HEALTH/library/DS/00492.html
?In recent years, the activation of the insulin-like growth factor
(IGF) system in cancer has emerged as a key factor for tumour
progression and resistance to apoptosis. Therefore, a variety of
strategies have been developed to block the type I IGF receptor
(IGF-I-R), which is thought to mediate the biological effects of both
IGF-I and IGF-II.?
http://mp.bmjjournals.com/cgi/content/abstract/54/3/121
?Aggressive local tumor control with surgery and external beam
radiotherapy may provide palliation and delay eventual death from
distant metastatic disease. This disease challenges clinicians and
researchers to develop new systemic therapies as well as to
aggressively treat differentiated thyroid cancers before they become
anaplastic tumors.?
http://www3.interscience.wiley.com/cgi-bin/abstract/30001306/ABSTRACT
?Our previous studies demonstrated that manumycin (a
farnesyltransferase inhibitor) enhanced the antineoplastic activity
and induction of apoptosis when combined with paclitaxel against
anaplastic thyroid cancer cells. We found that manumycin induces
endogenous expression of p21 Waf-1 in anaplastic thyroid cancer cells.
Manumycin increased the activity of the p21promoter, the level of
p21mRNA, and the amount of p21 protein.?
http://jcem.endojournals.org/cgi/content/abstract/88/2/763
?The treatment of metastases may require surgery or 131I therapy,
which is usually carried out after thyroid hormone withdrawal.
However, in selected cases, rhTSH preparation may be necessary, for
example when thyroid hormone withdrawal fails to evoke a sufficient
TSH response, or when the patient cannot tolerate hypothyroidism or
undergo withdrawal because of a concurrent medical illness. In other
cases patients simply become weary of undergoing repeated thyroid
hormone withdrawal. When this occurs, rhTSH is effective in preparing
patients for 131I therapy. The responses have generally been
approximately the same as those with thyroid hormone withdrawal,
although prospective comparative studies have not been performed.
?Although new treatment paradigms have had some impact on survival
rates, and a rare patient can be cured,many die within months of the
diagnosis, and the vast majority die within a year. A combination of
surgery, chemotherapy, and EBRT offer the best results, with
approximately 10% surviving more than two years.88 In one such
study,89 complete local response was observed in 19 patients.After a
median follow-up of 45 months (range 12 to 78 months), seven patients
survived and were in complete remission, of whom six had initially
undergone complete tumor resection.The overall survival rate at three
years was 27% and median survival was 10 months.?
http://www.touchbriefings.com/pdf/1479/ACF490.pdf
?These results suggest that growth inhibition of ATC cells by HDAIs
is due to the promotion of apoptosis through the activation of the
caspase cascade and the induction of cell cycle arrest via a reduction
in cdk2- and cdk1-associated kinase activities.? (Apoptosis means cell
death)
http://www.liebertonline.com/doi/abs/10.1089/10507250152039046?journalCode=thy
If you are interested in a clinical trial, check this page. In the
first line select Thyroid Cancer, then anaplastic, etc.
http://www.cancer.gov/Templates/doc.aspx?viewid=CF77634E-36E7-47C2-A88E-9E7B163D71F3&ReqUrl=%2Fsearch%2Fclinical_trials
Here?s another clinical trial
http://www.oxigene.com/trial.asp?sf=f
http://www.oxigene.com/trial.asp?sf=f#TrialThree
I hope this has helped you out some. I certainly empathize with you
and your husband. I wish him the best.
If anything is unclear, please request an Answer Clarification, before
you rate this answer.
Sincerely, Crabcakes
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Search Terms
ATC + pulmonary metastasis
ATC + lung cancer
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