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Thymoma and thymic carcinomas are a type of cancer that affects the thymus, an organ located in between the breastbone and the heart. Thymus is a gland that functions to mature the T-cells which are the soldiers of the immune system and are very important to the body’s ability to adapt to and fight off new illnesses from various pathogens like bacteria, viruses and fungi. Thymus gland is relatively large during infancy and reaches its full maturity around puberty after which the gland slowly involutes (becomes smaller in size). In some people, the cells in the thymus gland can begin to grow abnormally and form tumours. These tumours can be a Thymoma or a Thymic Carcinoma.
Thymoma is a potentially malignant tumour of the thymus gland in which the cells bear resemblance to the original thymic cells. These grow slowly and rarely spread beyond the thymus gland. These tumours are further subdivided based on their cell characteristic ( which is known after biopsy or pathological examination of the removed tumour). So Thymoma can be further divided into Type A, AB, B1, B2 and B3 and C. Their aggressiveness increase in that order so Type A is least aggressive and Type C the most.
Thymic carcinoma on the other habd are composed of cells which are very different from thymic cells and are very aggressive and can spread to other body areas. In general thymic carcinoma is more difficult to treat than Thymoma.
Thymoma and thymic carcinoma may not cause early signs or symptoms.
After a detailed history and physical examination the doctor may suggest certain tests to detect or confirm the presence of thymoma
When a tumour of the Thymus gland that is Thymoma or Thymic Carcinoma is suspected a contrast enhanced CT scan of the Chest is usually the first investigation which will confirm the presence or absence of tumour.
Magnetic Resonance Imaging (MRI) of the chest may be required if there is doubt about the involvement of the underlying structures.
In some cases a whole body PET scan may be required to rule out distant spread of the thymoma or thymic carcinoma beyond the confines of Thymus gland.
Routine blood investigations may be required to asses the patient’s fitness for undergoing treatment.
Apart from the routine investigations AChR-Antibody test may be ordered to look for myasthenia gravis
Certain other tests may be required to rule out conditions that may be associated with Thymoma like:
Thymoma is categorized into different stages based on the extent of tumor spread. The Modified Masaoka-Koga staging system is commonly used to determine the appropriate treatment plan and prognosis. Here’s a detailed explanation of each stage:
Stage I: Encapsulated Thymoma
Description: The tumor is completely encapsulated and confined within the thymus. It has not spread to surrounding tissues or organs.
Treatment Options: Surgery is typically the preferred treatment option for Stage I thymomas. Complete surgical resection often results in excellent long-term outcomes. Most tumours in this stage can be managed by minimally invasive chest surgery like Robotic Thymectomy or VATS / Thoracoscopic Thymectomy.
Prognosis: Patients diagnosed at this stage generally have a favorable prognosis with high long term survival rates.
Stage IIA: Microscopic Invasion into Surrounding Fatty Tissue
Description: The tumor shows microscopic transcapsular invasion into the surrounding fatty tissue that is not appreciated grossly and is only visible under microscope.
Treatment Options: Surgery is still highly efficacious and the primary treatment. Complete surgery can still be achieved by Robotic surgery or Thoracoscopic surgery in many patients.
Prognosis: Prognosis remains good, with a high likelihood of successful treatment and long-term survival.
Stage IIB: Macroscopic Invasion into Surrounding Fatty Tissue or Pleura
Description: Description: The tumour exhibits macroscopic (grossly visible) invasion into the surrounding fatty tissue and may be touching the pleura but not invading through it.
Treatment Options: Surgical resection is the mainstay of treatment, often followed by radiotherapy to address any remaining cancer cells and prevent recurrence.
Prognosis: The prognosis is slightly less favourable than Stage I and IIA but still generally positive with appropriate treatment. Completeness of tumour removal plays a major role in the outcome, and hence, an experienced surgical team should address such cases. In experienced hands, a significant proportion of such patients can be managed by robotic thymectomy
Stage III: Invasion into Neighbouring Organs
Description: The thymoma has invaded neighbouring organs such as the pericardium (heart lining), lungs, or major blood vessels.
Treatment Options: Surgery is more complex and may involve removing parts of invaded organs. This is usually followed by radiotherapy and sometimes chemotherapy, especially if complete resection is not possible. Evaluation of such patients by a high-volume surgical team is very important as many of these cases can still be treated by surgery; however, the probability of robotic surgery is reduced. If the tumour is adherent to only the pericardium (lining of the heart) and/or a small portion of the adjacent lung, it can be managed by minimally invasive technique. Robotic surgery is better suited in such cases due to increased dexterity and precision.
Prognosis: Prognosis varies depending on the extent of invasion and the success of the surgical resection. Multimodal treatment improves outcomes.
Stage IVA: Pleural or Pericardial Dissemination
Description: The tumor has spread to the pleural or pericardial surfaces, leading to multiple tumor nodules in these areas.
Treatment Options: Treatment often involves a combination of
surgery,
chemotherapy, and radiotherapy. Many people think that surgery is not possible
in cases of Thymoma
that has spread to the pleura (lining of Lungs) of the pericardium (Lining of
the heart). However,
surgery is still very useful, where in the tumour is removed along with a
complete removal of all
nodules (achieved by total pleurectomy / pericardiectomy).in these cases some
form of additional
treatment in the form of adjuvant chemotherapy and radiation therapy is almost
always required.
A form of chemotherapy which is given during surgery may also be used in
selected patients. It is
known as HITHOC. Hyperthermic Intrathoracic Chemotherapy
(HITHOC) is an advanced
treatment option
for thymoma, especially in cases where the cancer has spread within the chest
cavity. After
surgical removal of the tumor, a heated chemotherapy solution is circulated
within the chest
cavity to eliminate any remaining cancer cells. The heat enhances the
effectiveness of the
chemotherapy, improving its ability to target and destroy cancer cells while
minimizing side
effects. HITHOC offers an innovative approach to reduce the risk of cancer
recurrence and improve
overall treatment outcomes. This innovative therapy is being done frequently by
our team.
Prognosis:Prognosis is more guarded, and aggressive multimodal treatment is necessary to manage the disease. However relatively long survival have been reported by surgery along with other therapies.
Stage IVB: Lymphogenous or Hematogenous Metastasis
Description: The thymoma has spread to distant lymph nodes or other organs via the bloodstream.
Treatment Options: Systemic chemotherapy is typically the primary treatment approach, often combined with radiotherapy. Surgery may be considered in select cases to alleviate symptoms or manage localized disease.
Prognosis: Stage IVB represents advanced disease with a more
challengBy
understanding the different stages of thymoma, patients can better comprehend
their diagnosis and
the rationale behind their treatment plan. If you or a loved one has been
diagnosed with thymoma,
our team of expert thoracic surgeons is here to provide comprehensive care and
support throughout
your treatment journey.ing
prognosis. Treatment focuses on controlling the spread and improving quality of
life.
Thymoma is a locally invasive tumour. By and large, the best treatment option for Thymic tumours is complete surgical excision / removal. However, when is surgery is not feasible other treatment options are considered.
Surgery is the primary treatment for thymoma, aiming to remove the tumor completely. Surgical removal offers the best chance for a cure, especially when the thymoma is detected early. Studies show that surgery provides higher survival rates compared to other treatments like radiation or chemotherapy.
Surgical Approaches for Thymoma Treatment We offer several surgical options for thymoma, tailored to each patient’s needs:
Our Expertise in Thymoma Surgery Our team has extensive experience in performing complex thymoma surgeries. We use the latest techniques to ensure the best outcomes for our patients. Read testimonials from our patients and explore our case studies to see our success stories.
The Role of Chemotherapy and Radiotherapy in Thymoma Treatment While surgery is often the best option for thymoma treatment, chemotherapy and radiotherapy also play crucial roles, especially for advanced cases or when surgery isn't feasible.
Frequently Asked Questions about Thymoma Surgery Have questions about thymoma surgery? Find answers to common questions about the procedure, recovery, and what to expect.
Contact Us for Thymoma Treatment Ready to discuss your treatment options? Contact us today to schedule a consultation with our expert team. Fill out the form below, call us, or visit our clinic.
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