Thymus cancer

Symptoms of thymus cancer may include:

• chest pain
• a cough that does not go away
• coughing up blood
• becoming breathless or wheezy
• difficulty swallowing
• a hoarse voice
• swelling of the face, neck, or arm.

These symptoms can be caused by other conditions, but it is important to have them checked by your doctor.

Sometimes thymus cancer has no symptoms but is found when people are having tests for something else. For example, it might show up when someone has a routine chest x-ray. Or it may show up when you have a CT scan for another reason. For example, in someone who has myasthenia gravis.

If you have symptoms of thymus cancer, your GP will refer you to a hospital specialist if they:

• are unsure what the problem is
• think your symptoms may be caused by cancer.

At the hospital, the specialist doctor will ask you about your symptoms and general health before examining you. You may have the following tests:

Blood tests are not used to diagnose thymus cancer, but they can be helpful to look at your overall health. If you have symptoms of thymus cancer, then you may have a blood test to look for antibodies in your blood. These are sometimes found if you have myasthenia gravis or other autoimmune diseases linked to thymus cancer.

A doctor may be able to diagnose thymus cancer using the tests above. But sometimes they need to collect a sample of tissue or cells (biopsy) from your thymus. If you have a small thymoma found early on a CT scan you can usually have surgery straight away without a biopsy.

Biopsy

There are different ways of taking a biopsy. After the cells or tissue samples are removed they are examined under a microscope by a doctor (called a pathologist). They check for cancer cells. The results of the biopsy tell your doctor:

• the type of thymus cancer you have
• how the cells look compared with normal cells (the grade of the cancer).

A biopsy can be done during the following tests:

Waiting for test results can be a difficult time. We have more information that may help.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.

You may have some treatments as part of a clinical trial.

Your treatment will depend on:

• the type of tumour
• the stage and grade of tumour
• your general health.

Usually the aim of treatment is to remove or destroy the cancer and reduce the chance of it coming back. The main treatments for thymus cancer are explained below.

Surgery is the main treatment for thymus cancer. The surgeon removes the thymus, or as much of it as possible. This operation is called a thymectomy. Removing the thymus gland usually has no effect on your immune system.

The type of operation you have depends on the stage of cancer.

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. If all of the tumour can be removed with surgery, you may not need radiotherapy. Most people with thymic carcinoma need radiotherapy after surgery. You will not start radiotherapy until your surgery wounds have fully healed.

You may have radiotherapy:

• if it was not possible to remove all of the cancer after surgery
• if there were cancer cells close to the edges (margin) of the removed tissue
• as your main treatment if the cancer cannot be removed with surgery
• with chemotherapy (chemoradiation). This can cause more severe side effects, so you need to be well enough to cope with it.

You may have treatment in short sessions from Monday to Friday over 4 to 6 weeks. Side effects may include:

• feeling tired
• mild skin reactions
• difficulty swallowing
• feeling sick
• poor appetite.

Side effects usually disappear a few weeks or months after treatment has finished. There are other side effects of radiotherapy and it is important to be aware of these. We have more information about the side effects of radiotherapy.

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given:

• before surgery, to shrink the cancer and make surgery easier
• after surgery, to reduce the risk of cancer coming back
• with radiotherapy (called chemoradiation) if surgery is not possible
• to help control symptoms if the cancer has spread (palliative chemotherapy).

You will usually have a combination of drugs. The most common chemotherapy drugs for treating thymus cancer are:

• carboplatin
• cisplatin
• cyclophosphamide
• doxorubicin
• etoposide

You may have a combination of cisplatin, doxorubicin and cyclophosphamide drugs (called CAP). Your cancer doctor or nurse will talk to you about your treatment. They will explain the possible side effects and how they can be managed or controlled.

Doctors are trying to find out how helpful targeted therapies and immunotherapy drugs are in treating thymus cancers. These are not currently standard treatments for thymus cancer so they may not be widely available throughout the UK. Sometimes they may be given in a clinical trial.

If a treatment drug is not available on the NHS, there may be other ways you can access it. Your doctor can talk to you more about this.

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