Whether or not a thymus cancer is considered resectable (removable by surgery) is one of the most important factors in determining treatment options. The type of tumor is also important. Thymic carcinomas are more likely to grow and spread quickly than thymomas and often require more aggressive treatment.
For patients with resectable cancers (almost all stage I and II thymus cancers, most stage III cancers, and small number of stage IV cancers), surgery offers the best chance for long-term survival if it can be tolerated. This typically includes removal of the entire thymus and, depending on the extent of the disease, maybe parts of nearby organs or blood vessels as well.
Early stage thymomas (such as stage I and II) do not usually require further treatment after surgery as long as the tumor was removed completely. For early thymomas, radiation therapy may be considered if there is concern that any tumor was left behind.
Patients with more advanced stage thymomas (such as stages III and IV) may be treated with radiation after surgery, even if all of the tumor was removed. If the tumor couldn’t be removed completely, radiation therapy is usually given after surgery. Depending on how much cancer was left behind, chemotherapy (chemo) may be added as well.
Patients with thymic carcinomas, which are more likely to come back after treatment, are typically given radiation after surgery, even if the doctor feels the cancer was completely removed. Chemo is usually given as well, especially if some of the cancer is left behind after surgery.
This group includes cancers that are too close to vital structures or that have spread too far to be removed completely (which includes many stage III and most stage IV cancers), as well as cancers in people who are too ill for surgery.
In some cases, doctors may advise giving chemo, radiation therapy, or both first to try to make the tumor resectable. If it shrinks enough, surgery is done. This is then followed by further treatment with chemo or radiation therapy.
Surgery may be the first treatment for some unresectable cancers, to try to remove as much of the tumor as possible. This is known as debulking. Radiation therapy and/or chemo are then given. The hope is that the surgery may help the other treatments work better and may help people live longer, even if it doesn't cure the cancer. Studies of this approach have had mixed results.
For patients who can’t have surgery, either because the cancer has spread too far or because they are too sick from other serious medical conditions, chemo and radiation therapy are the main treatment options.
Because unresectable cancers can be hard to treat, taking part in a clinical trial of a newer form of treatment may be a reasonable option.
Recurrent thymus cancer
When cancer comes back after treatment it is called recurrent. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the liver or bone).
Treatment for thymus cancer that has recurred (come back) after initial treatment depends on the location of the recurrence and on what the original treatment was. If the recurrence is not too widespread, surgery may be an option and would offer the best chance for long-term survival. But in most cases, the treatment options may be limited to radiation therapy and/or chemo. These treatments can often be effective in controlling the cancer for a time, although they are very unlikely to result in a cure.
Because recurrent cancers can often be hard to treat, clinical trials of new types of treatment may be a good option.
What happens after treatment for thymus cancer?
For most people with thymus cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are leading full lives.
For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty.
When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.
There is no widely agreed upon follow-up schedule for people with thymus cancer. Your doctor will most likely want to see you fairly frequently (every couple of months or so) at first. The time between visits may be extended if there are no problems. Most patients get a chest CT every year, at least for a while.
It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
Another concern is the possibility of developing a second type of cancer later on. Several studies have found that a person who has had thymoma is more prone than the average person to develop other cancers, particularly lymphoma. The reasons for this are not clear.
If treatment for thymus cancer stops working
If cancer keeps growing or comes back after one kind of treatment, it is possible that another treatment plan might still cure the cancer, or at least shrink it enough to help you live longer and feel better. But when a person has tried many different treatments and the cancer has not gotten any better, the cancer tends to become resistant to all treatment. If this happens, it's important to weigh the possible limited benefits of a new treatment against the possible downsides. Everyone has their own way of looking at this.
This is likely to be the hardest part of your battle with cancer− when you have been through many medical treatments and nothing's working anymore. Your doctor may offer you new options, but at some point you may need to consider that treatment is not likely to improve your health or change your outcome or survival.
If you want to continue to get treatment for as long as you can, you need to think about the odds of treatment having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to treatment you are considering. For instance, the doctor may say that more chemo or radiation might have about a 1% chance of working. Some people are still tempted to try this. But it is important to think about and understand your reasons for choosing this plan.
No matter what you decide to do, you need to feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.
Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose - the main purpose of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer.
At some point, you might benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it is given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn't mean you can't have treatment for the problems caused by your cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. You can learn more about hospice in our document called Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends − times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.
What`s new in research and treatment for thymus cancer?
There is always research going on in the area of thymic tumors. Scientists are looking for causes of thymic tumors, and doctors are working to improve treatments.
Because thymic tumors are relatively rare, more information from clinical trials is needed to decide which treatments are best for each type and stage. For example, the role of chemotherapy in treating thymomas is still being explored. In addition, new treatments are being developed and tested.
Researchers are looking for more accurate ways of predicting the aggressiveness of each tumor so that treatment can be more appropriately selected for each patient.
Some studies are looking to see if giving treatment with chemotherapy (chemo) and/or radiation before surgery can help patients with thymus cancer.
Removing or destroying all of the cancer cells is not the only consideration in treating patients with thymomas. Some paraneoplastic syndromes may persist even after the tumor has been treated. Researchers are studying the causes of these syndromes and the best ways to treat them.
While chemotherapy can often help shrink thymus cancers, it is not always effective and can have serious side effects. Chemo drugs work by attacking rapidly growing cells, which is the main cause of their side effects. As researchers have learned more about what makes cancer cells different from normal cells, they have begun to develop drugs that target these differences. Studies are now testing targeted therapies against cancers of the thymus. These targeted therapies include anti-angiogenesis drugs (which affect tumors by limiting their blood supply) and anti-growth factor drugs (which interfere with substances some cancer cells make to stimulate their own growth). Some of these drugs are already being used to treat other cancers, and are being studied for use against thymus cancers. These include cetuximab, erlotinib, and bevacizumab. Others being studied, such as milciclib and saracatinib are not yet approved to treat any type of cancer.