Centers of Excellence

The Lung Center

Thymoma and Thymic Cancer

Thymoma and thymic cancer are rare diseases in which malignant cancer cells form within the thymus gland, a small organ that is part of the lymphatic system and lies in the anterior mediastinum under the breastbone. They occur at a rate of only 1.5 cases for every million people each year in the United States.

The thymus makes infection-fighting white blood cells called lymphocytes. Tumor cells in a thymoma look similar to normal cells of the thymus, grow slowly, and rarely spread beyond the thymus. Thymomas are often cured by surgery or surgery followed by radiation. Tumor cells in a thymic carcinoma, however, look very different from normal thymus cells, grow more quickly, and have the potential to spread to other parts of the body. Thymic carcinoma is more difficult to treat than thymoma and can require a combination of surgery, chemotherapy and radiation.

The specialists at The Lung Center at Brigham and Women’s Hospital (BWH) use the most advanced diagnostic methods and proven treatments for patients with thymoma and thymic cancer, including minimally invasive surgical techniques aided by video and robotic technology. We are the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.

Thymoma and Thymic Cancer Topics

Risk Factors for Thymoma and Thymic Cancer

People with thymoma often have autoimmune diseases which cause the immune system to attack healthy tissue and organs. They include:

  • Myasthenia gravis
  • Acquired pure red cell aplasia
  • Hypogammaglobulinemia
  • Polymyositis
  • Lupus erythematosus
  • Rheumatoid arthritis
  • Thyroiditis
  • Sjögren syndrome
Symptoms of Thymoma and Thymic Cancer

Sometimes thymoma and thymic cancer do not cause symptoms and are found during a routine chest X-ray. When tumors in the thymus press on nearby structures they may cause:

  • A cough that doesn't go away
  • Chest pain
  • Trouble breathing
  • Trouble swallowing
  • Loss of appetite
  • Weight loss
Diagnosis of Thymoma and Thymic Cancer

Your BWH thoracic surgeon may conduct the following tests and procedures to diagnose thymoma or thymic cancer:

  • Physical exam and medical history
  • Chest X-ray, a type of energy beam that goes through the body and onto film, making a picture of areas inside the body.
  • CT-scan, a series of detailed pictures inside the body, taken from different angles. by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
  • Position Emission Tomography (PET) uses a small amount of radioactive glucose injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Metabolically active tumor cells can show up brighter in the picture because they take up more glucose than normal cells do. This may indicate malignancy, although infection or inflammation may the cause as well.
  • Magnetic Resonance Imaging (MRI) is a diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. It is particularly useful to show the borders between the tumor and blood vessels or nerves in preparation for surgery.
  • Biopsy, removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The type of biopsy depends on where the extragonadal germ cell tumor is found. 
    • Excisional biopsy: The removal of an entire lump of tissue.
    • Incisional biopsy: The removal of part of a lump or sample of tissue.
    • Core biopsy: The removal of tissue using a wide needle, often using CT-scan guidance.
  • Median sternotomy is an incision made into or through the sternum to gain access to the lungs for diagnostic purposes.
  • Mediastinoscopy, a small incision is made in the neck above the top of the sternum or between the ribs anteriorly in the upper chest and a mediastinoscope is inserted to see into the chest cavity and obtain tissue samples of mediastinal lymph nodes. 
  • Pulmonary Function Tests (PFT) Pulmonary function tests (PFTs) are noninvasive diagnostic tests that provide measurable feedback about the function of the lungs.
Stages of Thymoma and Thymic Cancer

Staging helps in treatment planning by determining where cancer is in the body and how much it has spread from the original site. Staging is determined through tests and procedures.

  • Stage I Cancer is found only within the thymus. All cancer cells are inside the capsule (sac) that surrounds the thymus.
  • Stage II Cancer has spread through the capsule and into the fat around the thymus or into the lining of the chest cavity.
  • Stage III Cancer has spread to nearby organs in the chest, including the lung, the sac around the heart (pericardium), or large blood vessels that carry blood to the heart or lungs.
  • Stage IV is divided into stage IVA and stage IVB, depending on where the cancer has spread.
    • In stage IVA, cancer has spread widely around the lungs and heart.
    • In stage IVB, cancer has spread to the blood, lymphatic system or pleural space (around the lungs).
Treatment for Thymoma and Thymic Cancer

Options vary depending upon the size and location of the tumor, but surgery is often the recommended treatment for thymoma. In both advanced thymoma and in thymic cancer, surgery may be performed before or after chemotherapy, radiation and clinical trials of chemotherapy and radiation.

Surgery

Although a traditional surgical approach is still needed for many complex thoracic cases, an increasing number of diagnostic and surgical procedures now can be approached through smaller incisions and by using less invasive techniques aided by video and robotic technology. These procedures have been found to be accurate, efficient, cost-effective, and safe through years of technological development and experience. They are specifically indicated for small tumors which are less than 5 cm or 2 inches in size. Bigger tumors still require open surgery to reduce the risk of spread.

  • Mediastinal tumor resection removes part or all of a tumor in the mediastinum.
  • Thymectomy, surgical removal of the thymus gland.
  • Median sternotomy, the sternum is accessed and separated through a large midline incision in the chest.
  • Thoracotomy or thoracoscopy: the chest cavity is accessed through an incision on the side, back or between the ribs.
  • Video-Assisted Thoracic Surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (a tiny camera) and surgical instruments into small incisions in the chest. VATS uses small incisions without any spreading of the ribs. A camera is used to assist the dissection of sensitive blood vessels and mediastinum masses. Less pain and quicker recovery are the goals.
  • Robotic-assisted mediastinal tumor resection uses a computer-controlled device that moves, positions, and manipulates surgical tools based on the surgeon's movements. BWH uses the da Vinci®Surgical System to remove masses in the mediastinum with better maneuverability, visualization and control, and the tiny incisions result in less post-operative pain and scarring.
  • Pleurectomy and Extra pleural pneumonectomy:  Surgeons at BWH specialize in operating on patients who develop recurrence of thymic cancers. Usually such recurrent tumors occur in the pleura,the lining of the chest, and require resection of the entire tumor often with surrounding tissues to reduce the risk of recurrence. On occasion, intra-pleural heated chemotherapy is added to kill any tumor cells that might have spread but cannot be visualized with the naked eye. 

Non-Surgical Cancer Treatments

  • Radiation therapy uses high-energy rays to kill or shrink cancer cells. Radiation is often used in conjunction with chemotherapy before surgery to shrink the tumor or after to treat the margin of the resection bed. The Radiation Oncology service at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) uses the most advanced equipment and techniques to deliver radiation to cancerous areas, while minimizing exposure to normal tissues.           
  • Chemotherapy Chemotherapy at DF/BWCC uses anticancer drugs to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery or alone in the most advanced cases. When used before surgery, the purpose is to shrink the tumor so it can be surgically removed.

Hormone Therapy

  • Hormone therapy removes hormones or blocks their action and stops cancer cells from growing.
  • Corticosteroid drugs may be used
What You Should Expect

You will receive a thorough diagnostic examination and receive clinically-proven treatment by a board-certified surgeon with expertise in thymoma and thymic cancer. Our goal is to alleviate or eliminate symptoms so patients can confidently resume everyday activities. Thymic carcinomas commonly recur and thymomas may recur after a long time. There is also an increased risk of having another type of cancer after having a thymoma. For these reasons, lifelong follow-up is needed.

Multidisciplinary Care

Thymoma and thymic cancer patients benefit from the wide range of specialists at The Lung Center. Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. Our DF/BWCC treatment team includes thoracic surgeons, medical and radiation oncologists, and pulmonologists. If your thoracic surgeon discovers an underlying illness or concern, you will be referred to a BWH physician for an expert evaluation.

Resources

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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