THYMOMA

ABOUT THE CANCER:

What is thymus?

The thymus is a lymphoid organ situated in the neck of vertebrates; it becomes smaller as we approach puberty.

The thymus is a small gland in the lymphatic system that trains special white blood cells called T-cells.

What are T-cells?

Ans- T-cells are a type of white blood cell called lymphocytes. They help our immune systems to fight germs and foreign invaders and in turn protects us from diseases.

These are of two types:

1. Cytotoxic T cells which destroy infected cells.
2. Helper T cells, which send signals that direct other immune systems to fight infection.

What is thymoma?

Thymomas and thymic carcinomas are rare cancers that form on thymus. It develops in the cells that cover the outer surface of the thymus (epthelial cells)

thymoma and thymic cancers act differently, even though they form in the same kinds of cells.

Thymoma: The cancer cells look a lot like the normal cells of the thymus, grow slowly, and rarely spread beyond the thymus.

Thymic carcinoma: these cancer cells do not look like the normal cells of the thymus, grow and spread more quickly to other body parts.

Thymic carcinomas are more difficult to treat than thymomas.

STATISTICS:

• Thymomas are rare malignancies which represents only 0.2 – 1.5% of all malignancies.
• It has an estimated incidence of between 0.13 and 0.40/100,000/year.
• Sex has no influence on the development of this cancer. Survival rate is around 78-90℅.
• Thymoma rarely occurs in young adults. It occurs highly in middle age people (45–55-year-olds).

TYPES OF THYMOMA:

The types of thymoma are classified by the kinds of cells which make up the tumors. It is determined by taking a look at a small section of the tumor underneath a microscope.

The main types of thymomas are as follows:

• Type A thymoma, also known as medullary thymoma, spindle cell thymoma or predominantly epithelia thymoma. Composed of bland spindle cells and few scattered lymphocytes
• Type AB thymoma, also known as mixed thymoma or small polygonal type thymoma. It is composed of intermixed or distinct components.
• Type B1 thymoma, also known as lymphocyte-rich thymoma, lymphocytic thymoma, organoid thymoma or predominantly cortical thymoma. Composed of predominantly lymphocytes with scattered epithelial cells, not in clusters.
• Type B2 thymoma, also known as cortical thymoma or mixed lymphocytic and epithelial thymoma. Composed of mostly epithelial cells forming clusters and medullary islands may be present.
• Type B3 thymoma, also known as atypical thymoma, epithelial thymoma, squamoid thymoma or well-differentiated thymic carcinoma. Composed predominantly of large, polygonal cells with increased atypia and few scattered lymphocytes.
• Metaplastic thymoma, also known as biphasic thymoma, low-grade metaplastic carcinoma or thymoma with pseudosarcomatous stroma
• Micronodular thymoma with lymphoid stroma, or micronodular thymoma with lymphoid B cell hyperplasia

LOCATION OF THYMOMA CANCER:

• A thymoma is a cancer which originates from the thymus gland, located in the upper chest between lungs.
• Thymomas originate from the epithelial cells of the thymus within the anterior mediastinum.
• There are two kinds of thymomas – primary and secondary.
• Primary tumours develop in the thymus gland
• Secondary tumours originate and develop from somewhere else in the body, and spread or metastasize to the thymus gland.

STAGES OF THYMOMA:

Thymus cancer ranges from stages I through IV. This is done based on how much the cancer has spread.

• Stage I: the tumour has not spread outside the thymus. The cancer has not spread to nearby lymph nodes or to distant body parts. It may have grown into nearby fatty tissues or into the mediastinal pleura.
• Stage II: the tumour has spread in to the pericardium of the heart, the lungs, or into the phrenic nerve. The cancer hasn’t spread to nearby lymph nodes or distant body parts.
• Stage IIIA: The tumour has grown into other nearby tissues, including the chest wall, the vessels carrying blood into or out of the lungs, or the superior vena cava.
• Stage IIIB: The tumour has grown to nearby tissues or organs, including the trachea, oesophagus, or the main blood vessels pumping blood away from the heart. The cancer has not spread to nearby lymph nodes or to distant parts of the body.
• Stage IV A: the cancer may or may not have spread to nearby tissues or organs, but it has spread to nearby lymph nodes in the front chest cavity. It hasn’t spread to distant body parts.

The cancer may or may not have spread to the pleura or the pericardium.

• Stage IV B: the cancer might or might not have spread to nearby tissues or organs, but it has spread to the lymph nodes deep in the chest or neck. It might or might not have spread to the pleura or the pericardium.

Or

The tumour might or might not have grown into nearby tissues or organs. The cancer might or might not have spread to nearby lymph nodes in the chest cavity or neck, but it has spread to the inside of the lungs or to other distant organs.

SYMPTOMS OF THYMOMA:

• Chest pain- a feeling of pressure on the chest
• persistent cough
• Dyspnoea (shortness of breath)
• Difficulty in swallowing
• Fatigue
• Dizziness
• Headaches
• Swelling of neck, face, arms, and hands
• Voice becomes hoarse
• Muscle weakness
• Anemia
• Frequent infections
• Massive weight loss

CAUSES AND RISK FACTORS OF THYMOMA:

• Age: the risk of thymoma greatly affects middle aged to older adults, people around 40-70 years.
• Autoimmune disorders: people with autoimmune diseases like myasthenia gravis, pure red cell aplasia, good syndrome, lupus are likely to get thymoma.
• Gender: studies show thymoma greatly affects men. -Radiation exposure: Some studies suggest that previous radiation therapy to the upper chest area may increase the risk of developing a thymoma.
• Heavy smoking
• High consumption of spirits

There are no known genetic or environmental risk factors for thymoma. Research is ongoing to look for links to viruses, heredity and other cancers.

HOW TO PREVENT THYMOMA?

• Regular health checkups
• Avoid smoking
• Maintain a healthy immune system through a balanced diet.
• Regular exercising
• Adequate sleep
• Avoidance to radiation exposure
• Early treatment of autoimmune disease
• Genetic counselling
• Early diagnosis and treatment-if you see any symptoms of thymoma, like persistent cough or chest pain, go for a medical checkup.

DIAGNOSIS OF THYMOMA:

A physical exam, medical history of the patient and symptoms shown are essential to make a diagnosis.

Physical exams include:

• Chest X-ray: an x-ray can display the masses inside the body of the patient. It can provide useful data, for example, how well-defined the tumour’s edges are.
• CT scan: a chest CT scan is done by injecting dye in the vein, called a contrast medium, to make the tumour be prominent on imaging.
• MRI: An MRI (magnetic resonance imaging) scan is a test that creates clear images of the structures inside your body using a large magnet, radio waves and a computer. It can provide a comprehensive image of your tumour, allowing to tell it apart from other potential growths.
• PET scan: Positron emission tomography (PET) scans detect early signs of cancer, heart disease and brain conditions. It involves an injection of a benign radioactive tracer (radioactive sugar) that helps detect diseased cells.
• Biopsy: it involves removing the tumour cells and analysing them under microscope.
• Blood Tests: Used to evaluate for associated conditions like autoimmune disorders and to assess general health.

TREATMENT FOR THYMOMA:

• Surgery: A thoracic surgeon will perform surgery to remove the tumour. If the cancer spreads further, the surgeon may have to remove the lymph nodes, thymus, or the lung lining. Many times, it is difficult to remove the entire tumour, hence the surgeon removes as much as possible to relieve the symptoms.
• Radiation: a radiation oncologist delivers radiation at the cancer site using external beam radiation therapy (a common cancer treatment that sends fixated radiation rays to shrink or destroy tumours, by killing cancer cells).
• Chemotherapy: chemotherapy drugs are used to kill cancer cells to shrink or destroy it, if surgery is not an option. It may be paired with other cancer treatments such as radiation therapy or surgery. Chemotherapy is usually given intravenously.
• Targeted therapy:  Targeted therapies are intended to target specific gene mutations, which turn healthy cells to cancer cells, to destroy cancer cells, without hurting healthy cells.
• Immunotherapy: It uses your body’s immune system to find and destroy cancerous cells. This maybe an option if chemotherapy hasn’t worked out.
• Clinical trial: It is a study that trials the effectiveness and safety of diverse or new cancer treatments.
• Palliative care: it provides symptom relief and support to people living with chronic conditions. It can improve overall wellbeing of the patient. It includes nurses, doctors, and other specialists who can help you manage cancer symptoms and treatment side effects.

SIDE EFFECTS OF TREATMENT:

Effects after radiation for thymoma:

• Throat and swallowing problems
• Lung problems
• Heart problems
• Damage to the bones
• Spinal cord damage
• Risk of breast cancer
• Skin cancer
• Mouth sore (short term)
• Neuropathy
• Scar tissue forming
• Fatigue
• Breathing issues
• Exacerbation of autoimmune conditions
• Nerve damage due to surgery
• Kidney toxicity
• Hair loss
• Nausea
• Low blood counts
• Hypothyroidism

MAINTENANCE AFTER TREATMENT:

• Physical therapy is included in early and structured rehabilitation. This is required to regain strength and flexibility after surgery.
• Regular and scheduled check-ups, with imaging and monitoring to detect any recurrence.
• Intake of a balanced and nutritious diet
• Emotional support is necessary to manage psychological impacts and strengthen mental health. -Immunoregulatory medications are crucial to be taken by the patient for at least a year; some may require them for longer periods of time.

FAQs:

1. What is thymoma?

Ans-Thymomas and thymic carcinomas are rare cancers that form on thymus. It develops in the cells that cover the outer surface of the thymus.

For thymoma, the cancer cells look a lot like the normal cells of the thymus, grow slowly, and rarely spread beyond the thymus.

2. Can a thymoma go undetected?

• Ans- Yes, thymoma can go undetected for long periods because these tumours are typically slow-growing and often do not cause symptoms in their early stages. Roughly one-third to one-half of all people with thymoma have no symptoms at the time of diagnosis. Small thymomas may not be visible on standard imaging, such as a basic chest X-ray.

3. What should I expect after thymoma surgery?

Ans- After a thymectomy, you’ll be in a recovery room after a provider takes out the breathing tube in the operating room. You’ll need oxygen, fluids, and pain medicines initially. Recovery is quick, and pain significantly reduces in a few weeks. You may have breathing issues.

4. Is thymoma curable at its early stages?

Ans- Yes, at early stages thymoma can be cured, as it is slow growing. It can be done by surgery to remove the tumour and the small margin of infected tissue surrounding it.

5. Do certain foods fight thymoma?

Ans- There is no specific food that can fight or cure thymoma on its own. However, a healthy, balanced, nutritious diet can support the immune system and manage the side effects. The following food items may help the patient:

• Berries
• Dark leafy vegetables
• Allium veggies
• Tomatoes
• Carrots
• Whole grains
• Lean protein
• Healthy fats
• Hydration
• Cruciferous vegetables

6. How long is the recovery after surgery?

Ans- Recovery period fluctuates from person to person. It may also be contingent on whether a person has open or laparoscopic surgery. The typical time period is 2 to 6 weeks. Most patients return to light, daily activities within 2-3 weeks. Pain, numbness, or soreness in the chest, back, or neck is common and usually lessens within 2 weeks. Fatigue is common for several weeks after surgery.

7. What are the symptoms for thymoma?

• Ans- Chest pain- a feeling of pressure on the chest
• persistent cough
• Dyspnoea
• Difficulty in swallowing
• Fatigue
• Dizziness
• Headaches
• Swelling of neck, face, arms, and hands
• Voice becomes hoarse
• Muscle weakness
• Anemia
• Frequent infections
• Massive weight loss

8. Should we panic if we have thymoma?

Ans- DO NOT PANIC. Thymoma is a rare, generally slow-growing tumour of the thymus gland, and many cases are treatable and manageable. A greater percentage of patients have good outcomes. Consult a doctor to determine the stage of the cancer and decide on the treatment plan. Trust your medical team and spend quality time with your loved ones. Join rehabilitation centres to meet and interact with more people facing similar problems. This way you will feel lighter and stronger. Rapid medical consultation is the key.