DIAGNOSIS AND TREATMENT METHODS FOR THYMOMA
Written By: Prof. Dr. Semih Halezeroglu
What is Thymoma?
Thymoma is a tumor originating within the thymus gland located behind the sternum, in the area called ‘anterior mediastinum’.
The thymus gland is the production place of the T lymphocytes, which exist in the body’s immune system until puberty. After puberty the thymus gland loses its function and shrinks..
Tumors that appear in the thymus gland are called THYMOMA.
What are the Symptoms of Thymoma?
Thymomas may give no symptoms. If they keep growing, they may cause bronchitis-like cough by creating a pressure on the trachea. If they grow further, they may cause swelling and redness in the face by creating a pressure on their surrounding blood vessels (superior vena cava syndrome). And at more advanced stages, they may cause shortness of breath when they spread in the lung.
Approximately 15% of patients with myasthenia have a neural transmission disorder called Myasthenia Gravis. In Myasthenia Gravis, patients have a visual impairment (as a result of droopy eyelid) and difficulties in swallowing and sometimes in breathing. However, the most distinctive complaint in patients with Myasthenil is the fatigue in the entire muscular system that appears during the later hours of the day.
In patients with thymoma, many disease conditions may appear, which are sometimes not related to thymoma itself, such as anemia, skin rashes, and Kaposi’s sarcoma etc. These conditions called para-neoplastic syndrome are recovered with the treatment of thymoma.
The following photo shows the skin rashes caused by Kaposi’s sarcoma that appeared in our patient with thymoma.
Stages of Thymoma?
There are 4 stages of Thymomas
Stage 1 Thymoma
At this stage, the tumor is limited within a capsule.
The adjacent photo shows the computed tomography image of the thymoma that appeared in our 67-year-old female patient. The red arrow shows the thymoma located behind the breastbone and in front of the heart. Because the tumor is observed not to spread to its surrounding blood vessels, it can be understood based on the image that this is a Stage 1 or Stage 2 thymoma. Definitive diagnosis is made according to the result of the pathological examination.
Stage 2 Thymoma
At this stage, the tumor invades its capsule.
Distinguishing between stage 1 and stage 2 may not always be possible by means of computed tomography images.
This distinction is made as a result of the pathological examination of the removed tumor.
The adjacent photo shows the thymoma that we removed from our 41 year-old male patient.
Because the tumor invaded its capsule according to the result of its pathological examination, it was ascertained to be a Stage 2 Thymoma. The tumor’s diameter is 7cm.
Stage 3 Thymoma
At this stage, thymoma exceeds beyond the capsule, and progresses towards the surrounding structures such as the lung, trachea, arteries and pericardium.
Stage 4 Thymoma
At this stage, thymoma spreads to other organs (such as the lungs, the liver, and the suprarenal gland).
Diagnosis of Thymomas
Plain chest X-rays do not have an important role in the diagnosis of thymomas. A plain chest X-ray result that seems to be normal does not eliminate the possibility of the presence of a thymoma.
Computed tomography images gives very detailed information in this regard.
In some cases, MRI images may be needed, as well.
In suspicious cases, PET-CT may be required. But this is not always a necessity.
Under the conditions that allow for a surgery (Stage 1 and Stage 2), needle biopsy is not needed for regular-bounded tumors but is a necessity for the diagnosis of Stage 3 and Stage 4 thymomas.
Treatment of Thymoma
If the patients have Myasthenia Gravis, first it needs to be cured with suitable medications. The treatment is applied by the neurology clinic. When Myasthenia Gravis is taken under control to a certain extent, thymoma treatment can be initiated.
Thymoma treatment is based on the stage of the thymoma.
IMPORTANT: Thymoma is an extremely serious tumor. It leads to extremely serious outcomes.
if it is not treated properly as a result of being considered as a simple and benign tumor.
Treatment of Stage 1 and Stage 2 Thymoma
Thymoma needs to be surgically removed.
Any other postoperative treatment such as chemotherapy or radiotherapy is not needed.
It would be suitable to follow up patients once every 6 months for a period of 5 years. Then, they are controlled once a year.
Treatment of Stage 3 Thymoma
First chemotherapy (drug therapy) and radiotherapy (radiation therapy) are applied, whereby regression of the spread of the tumors to the nearby tissues is ensured, and then patients are operated.
Chemotherapy may need to be continued after the surgery. Whether chemotherapy is needed or not is determined by the hospital’s Tumor Council.
After the treatment, patients are followed up with controls to be made once every 3 months for a period of 2 years, and then once every 6 months for the subsequent period of 3 years. Then, the controls are made once a year.
The adjacent photo shows the computed tomography image of our female patient with Stage 3 thymoma. First chemotherapy and radiotherapy were applied to our patient, and when the spread to the blood vessels were eliminated, the tumor was surgically removed.
Treatment of Stage 4 Thymoma
Because the disease has spread to other organs, surgery is not performed in this stage.
Only chemotherapy and sometimes radiotherapy is applied when needed.
Surgical Methods for Thymoma
Open-Surgery Method for Thymoma
It is the process of removing the tumor (thymoma) located under the chest bone with an open-surgery.
The tumor should be completely removed, and also the surrounding fatty tissues should be removed during the surgery.
The average hospitalization period is 4 nights.
Open-surgery method is preferred for the surgery of a Stage 3 thymoma, after chemotherapy and radiotherapy.
The complication rate of the operation is 2-5% in experienced medical centers.
The adjacent photo shows the removal of the thymoma with the open-surgery method, from our 43-year-old male patient.
Closed-Surgery Method for Thymoma – Single Port Thoracoscopic Surgery (VATS)
In the closed-surgery method that we call VATS, an incision of 3 cm is made, through which a camera is pushed forward at the side of the chest to get images, and then the thymoma and surrounding fatty tissues are pulled out into a special bag (endo-bag).
It is an operation that requires specific experience.
It is the most harmless method for patients.
The hospitalization period is 2 nights.
It requires a shorter time of period for returning to normal life, compared to the open-surgery method. Its complication rate is 2%.
Robotics Method for Thymoma
4 separate small incisions are made for the robotic method (while thoracoscopy requires only a single incision) with intent to remove the tumor. Its complication rate is higher compared to thoracoscopy (5%).
Note: All the visual materials on this page belong to the individual patient archive of Prof.Dr. Semih Halezeroglu. Please do not copy without referring to the source.