Thymoma and Thymic Carcinoma are two types of rare cancers that can form in the cells that cover the outside surface of the thymus gland. The thymus gland is an organ present in the mediastinum (behind the breast bone) and functions until puberty and is responsible for the T-cell mediated immunity. The thymus gland then involutes and disappears.
If the gland persists, it can develop a tumour called “Thymoma”. It is associated with other diseases like Myasthenia Gravis, Rheumatoid Arthritis Sjogren’s Syndrome, and Hypogammaglobulinaemia. It is rare and accounts for less than 1% of all cancers.
90% of cancers that form in the thymus are Thymomas, while 10% of them can be Thymic Carcinoma, Lymphomas, or Carcinoid tumours. Thymoma surgery is a common surgical procedure of removing thymoma, which is a median sternotomy and performed by a cardiothoracic surgeon.
In about 25% of Thymoma & Thymic Carcinoma cases, patients are asymptomatic. They are typically detected when the patient is screened for other things or during a routine chest x-ray.
Some symptoms include chest pain, coughing, and upper airway condition. They can also be related to Myasthenia Gravis and the patient may have muscle weakness, fatigue or shortness of breath or difficulty in swallowing, as well as anaemia.
Most of the time for diagnosis is done with the aid of a CT scan and does not require a biopsy. But if it is inconclusive on a scan then a biopsy will be done if there is a suspicion of Thymic Carcinoma, if the tumour is large or if there is associated other diseases like a lymphoma.
These tumours can be found incidentally on a chest x-ray.
This is the most common investigation done to find the extent of the tumour and the association of it with the nearby structures.
If the cancer is confirmed then a PET CT scan is done to find out the extent of the disease, and the spread of the disease in other parts of the body if any. It is also done for finding out about lymph-node involvement.
Rarely done when involvements of nerves or blood vessels are in doubt.
Your surgeon will explain to you what are the investigations he needs to do in your case.
The treatment is usually based on the stage of the disease, but surgery has a universal role in this disease.
Surgical treatment can be in the form of a complete surgical excision or surgery to debulk the tumour.
Complete surgical excision of a thymoma is the goal of surgery. Here at ICTS, we provide minimally invasive access surgery in the form of robotic-assisted surgery where thymomas of a reasonable size are excised through a keyhole surgery without compromising on the cancer care. But when the thymomas are large or if they are thymic carcinoma then a complete surgical excision will involve a median sternotomy, hemi-clamshell or a Thoracotomy.
Your surgeon will explain to you the options available in your case and will discuss with you in detail about the surgical methods which are best suited in your case.
Radiotherapy is usually used as an adjuvant treatment in thymomas and thymic carcinoma after surgery to reduce the risk of recurrence. If the tumour is a large and the risk of local recurrence is highly then adjuvant radiotherapy will be offered to the patient after discussion with the radiation oncologist.
Chemotherapy is used in patients with thymic carcinoma or who have advanced stage for thymoma or recurrent cancers which are not resectable. Sometimes they can be used before surgery to shrink the tumour size.
This new form of treatment is still in the trial stage but can be used in certain cases of advanced cancer as the adjuvant or primary treatment to help get control over the disease. This conversation can be done with the medical oncologist and the treatment protocol can be decided between the surgeon, a medical oncologist and the patient. Details of this therapy will be discussed with the medical oncologist who will review your case.