TN 48 (09-21)

DI 23022.340 Anaplastic Thyroid Cancer

COMPASSIONATE ALLOWANCES INFORMATION

ANAPLASTIC THYROID CANCER

ALTERNATE NAMES

Anaplastic Thyroid Carcinoma; ATC

DESCRIPTION

Anaplastic Thyroid Cancer (ATC) is a rare and aggressive form of cancer of the thyroid gland, a hormone-producing organ at the base of the throat that helps control heart rate, blood pressure, body temperature, and weight.

Women are more likely to be affected than men. ATC generally occurs in individuals with a history of goiter or thyroid cancer. A history of head and neck radiation or exposure to radioactive materials may also increase the risk for ATC. Metastasis is present in more than half of individuals at the time of diagnosis.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The diagnosis of ATC is made by:

  • A history and physical exam to detect growths or swelling in the lymph nodes;

  • Thyroid scan and/or ultrasound scan to detect thyroid nodules; and

  • Biopsy.

A biopsy is the only sure way to diagnose ATC.

Physical findings: Individuals with ATC generally present with:

  • A rapidly-growing neck mass which may cause trouble swallowing (dysphagia);

  • Coughing;

  • Hoarseness or voice changes;

  • Swollen lymph nodes in the neck;

  • Trouble breathing (dyspnea); and

  • Pain in the throat or neck that does not go away.

Firm cervical masses are highly suggestive of regional lymph node metastasis. Vocal fold paralysis implies involvement of the recurrent laryngeal nerve.

Individuals with metastases may also present with:

  • Bone pain;

  • Lymph node enlargement;

  • Weakness; and

  • Neurological deficits.

ICD-9: 193.0

ICD-10: C73

PROGRESSION

ATC is an invasive type of thyroid cancer that grows very rapidly. It occurs most often in people over age 60. ATC makes up about 2% of all thyroid cancers. Median survival is usually 4-5 months from the time of diagnosis.

TREATMENT

Treatment of ATC is mostly palliative. In some cases, surgery with radiation and chemotherapy may prolong survival. However, this type of cancer generally cannot be cured by surgery. Surgery to place a tube in the throat to help with breathing (tracheostomy) or in the stomach to help with eating (gastrostomy) may be needed during treatment. For some patients, enrolling in a clinical trial may be an option. There is no effective treatment for metastatic ATC.

SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
  • Clinical history and examination that describes that diagnostic features of the impairment; and

  • Pathology report from a thyroid biopsy specimen.

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.09 A ATC currently meets the criteria in 13.09 A.
Equals
* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested evaluating the claim. However, the decision to allow or deny the claim rests with the adjudicator.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022340
DI 23022.340 - Anaplastic Thyroid Cancer - 09/09/2021
Batch run: 10/12/2021
Rev:09/09/2021