indiacancer.org - Malignant Thymoma

	Malignant Thymoma

		What is the Thymus?
		What is Malignant Thymoma?
		How does Malignant Thymoma present?
		How is Malignant Thymoma detected?
		What is staging and grading?
		How is Malignant Thymoma treated?
		What are the side effects of Malignant Thymoma treatment?
		What is the importance of follow up?

What is the Thymus?

The thymus is a small gland nestling under the breastbone. Prominent during the younger years, it fades into insignificance functionally with maturity. It's function is to make white blood cells called T-lymphocytes, which circulate in the body and fight infection.

What is Malignant Thymoma?

Malignant Thymoma is a cancer arising from the thymus.

How does Malignant Thymoma present?

	Usually, these patients also have some other forms of immune disorders such as a condition called myasthenia gravis, in which all the muscles of the body tire out easily. Usually, the presentation is as follows:
		A cough that won't subside.
		A pain in the upper chest, especially in the region of the breast bone, which may be continuous or intermittently exacerbated.
		The patient gets easily tired out, even upon performing the simplest of activities.
		Difficulty in swallowing or breathing, which keeps getting worse as the days pass.

How is Malignant Thymoma detected?

There are several steps to establishing the presence of a malignant thymoma:
	The doctor takes a history of the patient's symptoms.
	The doctor examines the patient physically.
	A series of investigations are requested for, including:
		X-ray of the chest, to look for a mass like shadow in the central part of the chest cavity (the mediastinum).
		A CT scan of the chest,in which the X-ray machine is linked to a computer. The X-ray machine is shaped like a large doughnut (Vada) with a hole. The patient lies on a bed which passes through this hole. As the patients body goes through it, the machine takes X-rays of different parts of the body. The computer then puts the X-ray pictures together to produce detailed, three dimensional pictures.
		A bronchoscopy, in which a special, fiberoptic, flexible tube will be introduced through the nose and passed into the patient's airways. This 'scope has a self illuminating system and a biopsy port as well. Thus, the doctor can visualize any tumors present and also biopsy them, in case there is invasion into the airways.. The procedure is done with the patient awake, with local anesthesia to the main windpipe or trachea, to prevent him coughing.
		A series of blood tests and possibly challenge tests. The latter help in the diagnosis of myasthenia, by provoking the condition temporarily, in case it is not always visualized.

What is staging and grading?

These are terms with which you must become familiar, if you are dealing with any form of cancer.

When we stage a cancer, we try to establish carefully degree of spread of the cancer and if indeed there is spread, to what extent and involving which organs. The grading of a cancer is a microscopic issue, in which the pathologist lets you know how aggressive this particular type of cancer is ; well differentiated means less aggressive, moderately differentiated intermediately aggressive and poorly differentiated more aggressive.

Both grading and staging help your clinician to establish the prognosis or how serious your disease is and what is going to be the likely outcome.

Staging may require additional imaging tests such as MRI, Sonography, or Bone scan .

The staging for malignant thymoma is as follows:

Stage 1. Cancer only in the thymus and it's capsule. (Non invasive malignant thymoma).

Stage 2.The cancer has invaded into the surrounding fat or the pleura, which is the lining of the lungs.

Stage 3. Cancer has invaded the adjacent organs.

Stage 4a. Deeper spread into the pericardium, which is the sac containing the heart, or into the lungs.

Stage 4b. Spread to distant tissues and organs. (All stages after stage 1 are labeled as invasive malignant thymoma).

Recurrent malignant thymoma. That disease which has come back, either in the same locus or in a different one after primary treatment has been completed.

How is Malignant Thymoma treated?

	A lot depends on the patient's constitution, the grade of his disease and its staging. Patients are usually treated by a team of specialists which utilizes a multipronged approach. This includes a cardiothoracic or oncosurgeon and a radiotherapist. The plan of treatment is tailored to fit a patient's requirements. If necessary, hormonal therapy may become an add on. Treatment strategies. The bastion of thymoma cancer treatment is surgery. The doctor tries to remove the complete thymus with it's capsule along with some surrounding fatty tissues and adjacent lymph nodes. (Lymph nodes are small bean-shaped structures, which act as stations for drainage of lymph, a clear watery fluid, which courses through out the body in transparent, thin tubes called lymph channels or lymphatics,from various organs). The alternative local therapy to surgery is radiation therapy. This involves the use of high energy, penetrative rays to destroy cancer cells. It also affects cancer cells only in the zone treated. Radiation therapy is also employed for palliation i.e. control of symptoms alone in an advanced thymoma. Radiation therapy can also be used in adjunct to surgery or chemotherapy, either before or after. Teletherapy or external radiation is given via a machine remote from the body while brachytherapy or internal radiation is given by implanting a radioactive source within the involved tissues. Patients may or may not require both modalities of radiation. Radiotherapy, after initial planning, usually takes just 5 to 10 minutes per day, 5 days a week for about 6 weeks. This time period is flexible depending upon the modality of radiation used. Hormonal therapy is a form of systemic therapy, in which hormones like steroids are given in order to prevent thymic cancer cells from further propagation and replication. Besides local therapy, the best attempt to control cancer cells circulating in the body and lodged at places other than the thymus is by using systemic therapy (therapy which affects the entire systems of the body) which is in the form of injections or oral drugs. This form of treatment is called chemotherapy. This form of treatment is given in a cyclical manner (each set of drugs is repeated usually after every 3-4 weeks). Chemotherapy can also be used in combination with surgery, radiotherapy or both, either before or after. For non invasive malignant thymoma, one of the following options may be entertained:
		Surgery.
		Radiation (rarely).
	For invasive malignant thymoma, one of the following options may be entertained:
		Surgery followed by radiation.
		Radiation alone, if the cancer cannot be removed by surgery.
		Chemotherapy (results are not too encouraging).
		Chemotherapy followed by surgery.
		Combination of chemotherapy and radiation ( still experimental), if surgery is not feasible, or does not succeed in removing the tumor.
	For recurrent malignant thymoma, one of the following options may be entertained:
		Surgery , perhaps followed by radiation.
		Radiation alone, if the cancer cannot be removed by surgery.
		Hormonal therapy using steroids.
		Chemotherapy (results are not too encouraging).

What are the side effects of Malignant Thymoma treatment?

	Unfortunately treatment for cancer does cause damage to the healthy tissues. Please ask the clinician about any possible side effects before any form of treatment commences. The effects of radiation depend upon the dose of radiation, the size of the area radiated, and the number and size of each fraction. The commonest side effect is extreme fatigue. Although bed rest is good, most radiotherapists advise the patient to be as mobile as possible. Another common problem is that of radiation dermatitis in which the skin covering the radiated area becomes red, dry, itchy, and may show signs of scaling off. This will slowly settle down after radiation ceases, but there may be a permanent 'bronzing' of the skin. It is important to note here that this skin problem is associated only with teletherapy or external radiation therapy. Radiation also may cause nausea and vomiting, diarrhea, urinary discomfort. There may also be a fall in the white blood cells, which are needed by humans to fight infection. Usually the radiotherapist can suggest the drugs and diet necessary to alleviate such problems. The various drugs in chemotherapy cause a varied spectrum of side effects. The severity and variability of these symptoms are very individualistic, changing from patient to patient. Some of the common side effects are:
		Skin rashes.
		Loss of hair.
		Diarrhea.
		Vomiting.
		Tingling and numbness in the fingers and toes.
		Hearing loss.
	Most are temporary and recede after therapy is over. Hair growth gradually starts after cessation of chemotherapy. The medical oncologist will usually be able to reduce the severity and spectrum of these side effects. The psychology of the patient is very important during therapy. Better psychologically prepared the patient is, better are his chances of having decreased side effects. The patient should drink large quantities of water while the therapy is in progress, and preferably avoid uncooked or raw food. Water should be filtered or boiled. Any relative or person who has any sort of infection such as common cold should be asked to desist from coming close to the patient. Steroids in high doses for hormonal therapy can also cause problems, including acidity, bone pains, even conditions like diabetes or glaucoma (a condition in which the pressure inside the eyes increases, eventually causing loss of vision if not treated promptly).

What is the importance of follow up?

The importance of followup cannot be overemphasized. It is a fatal fallacy to assume on the patient's part that once the primary or the first phase of treatment is over, then he or she is cured. It must be stressed here that cancer has a notorious proclivity of coming back again and again. The only way to fight this is to pick up any problem when it is still early, so that it can be nipped in the bud. And the only way to do this is to follow up when the doctor calls you for the next visit. Each such visit will include a detailed history, a physical examination (including an internal i.e. a rectal or vaginal examination), a chest x-ray, an ultrasonography or a CT scan, and various other blood studies as indicated.