Ashok R Shaha Introduction

Approximately 16,000 new patients with thyroid cancer are expected to be seen in the United States in 2000. There appears to be a steady increase in the incidence of thyroid cancer in the United States, but the mortality from thyroid cancer (1,200) has essentially remained unchanged in the past twenty years. The overall incidence of anaplastic thyroid cancer in various series ranges between 4-6%.1-3 It appears that there is a decrease in the incidence of anaplastic thyroid cancer in the United States, however there appears to be a higher incidence in areas of iodine-deficiency and regions of endemic goiters. Anaplastic thyroid cancer forms one of the most deadly tumors among all human neoplasms. It is interesting that in the same human organ there exists one of the best cancers (papillary) and one of the worst cancers (anaplas-tic thyroid). The average survival in anaplastic thyroid cancer is approximately 6-12 months. The majority of patients die of advanced local disease, distant metastases, airway problems or cachexia. In approximately half of the patients with anaplastic thyroid cancer, the presence of pre-existent papillary or follicular cancer is noted pathologically. This leads to the belief that early diagnosis and treatment of malignant thyroid tumors is essential to decrease the overall incidence of anaplastic thyroid cancer. It is also extremely important to make a definitive diagnosis of anaplas-tic thyroid cancer and not to confuse poorly-differentiated, medullary or small-cell anaplastic thyroid cancer with giant and spindle cell thyroid cancer. The small cell anaplastic thyroid cancer needs to be distinguished further from thyroid lymphoma, where the outcome is much better and definitive treatment is available. Recent review of the National Cancer Data Base, published by Hundahl et al, reported 893 patients with anaplastic thyroid cancer in a series of 53,856 thyroid cancer patients (2%).4

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