Thymoma & Other Thymic Tumors: Diagnosis & Treatment at Memorial Sloan Kettering

Pictured: James Huang Thoracic surgeon James Huang works with medical oncologists and radiation oncologists to provide expert, multimodal care that is personalized to each patient.

Patients with thymoma, thymic carcinoma, and other tumors of the chest in the area between the lungs (known as the mediastinum) get the best care when surgeons, oncologists, and radiation oncologists collaborate in their treatment. Memorial Sloan Kettering's thymic tumor team focuses specifically on diagnosing and treating patients with these rare cancers. Our doctors, nurses, and other members of the healthcare team work together closely to develop and implement a treatment plan for each of our thymic tumor patients. Each year, our thymic tumor team evaluates and treats more than 50 new patients.

Diagnosis

If a thymoma or other thymic tumor is suspected, your doctor will first perform a number of imaging tests to determine the size, shape, and location of the tumor, and whether the disease has spread beyond the thymus. These tests may include chest x-rays, CT scans, MRI, and PET scans.

If a thymic carcinoid is suspected, the doctor also may perform an octreotide (somatostatin receptor scintigraphy) scan. Carcinoid tumors often have several receptors for somatostatin — a substance that suppresses the hormones involved in growth, metabolism, and digestion. Patients who undergo this test receive an injection of octreotide, a synthetic form of somatostatin that is attached to a radioactive substance. Radiation-sensitive imaging tests reveal how much octreotide has been absorbed, indicating the location and size of a tumor.

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Thymoma and other thymic tumors can only be diagnosed by examining a tissue sample (biopsy) taken from the tumor. A tissue sample can be obtained by a needle biopsy or a surgical biopsy. In a needle biopsy, a small sample of cells is removed with a thin needle and examined under a microscope. In a surgical biopsy (sometimes referred to as a Chamberlain procedure or a mediastinotomy), the doctor makes a small incision in the chest and removes a sample of the tumor for analysis. Sometimes, a surgeon may remove the tumor completely without performing a biopsy first. Our pathologists are specially trained to identify subtle clues that indicate whether a tumor is low grade (tumor cells resemble normal cells and grow slowly) or high grade (these tumor cells look very different from normal cells and grow rapidly). Understanding these differences can have an important influence on the type of treatment selected.

Treatment

Treatment of thymic tumors depends on the type of tumor, the stage of the disease, and the patient's overall health. Treatment options include surgery, radiation therapy, and chemotherapy.

Surgery

Surgery to remove the tumor is the most common treatment for thymoma and other thymic tumors. Tumors that are confined to the thymus (stage I) are usually treated with surgery alone. Surgeons also will remove tumors that have spread to the tissues immediately surrounding the thymus (stage II), to neighboring organs (stage III), or into the chest cavity (stages IV), including as much of the affected tissue as possible.

Chemotherapy & Radiation Therapy

Some patients with more advanced or recurrent cases of thymoma may receive a combination of chemotherapy drugs following surgery (in a treatment known as adjuvant chemotherapy). In some cases, chemotherapy may be given before surgery to shrink the tumor (known as neoadjuvant therapy). Patients with tumors that have spread beyond the thymus or chest may also receive radiation therapy following surgery.

Doctors treat thymic carcinoma by removing as much of the tumor as possible, followed by radiation and chemotherapy. They may also treat the patient with chemotherapy before surgery.

External-beam radiation therapy, which delivers radiation from a machine outside of the body, is used in selected cases. Radiation therapy is occasionally recommended following surgery to remove thymic tumors or to relieve symptoms in patients who are not candidates for surgery, particularly when the tumor has spread to the bone or brain.

Patients with carcinoid tumors may benefit from treatment with a synthetic hormone, octreotide, which controls hormone-related symptoms and may have the potential to slow tumor growth.

Investigational Approaches

Researchers at Memorial Sloan Kettering are investigating the potential effectiveness of new combinations of chemotherapy following surgery, as well as new drugs such as cetuximab — which inhibits a protein that promotes tumor growth — in patients with advanced tumors. They are also examining the genetic and molecular characteristics of thymomas and thymic carcinomas to better understand how these tumors begin, and to create more targeted therapies.

In addition, our thymic tumor team has established a thymoma database to track patient outcomes. Information from this database is also being used to develop more effective therapies for patients with thymoma and other thymic tumors.