Royal Marsden Study Day June 2026
Managing Anterior Mediastinal Masses and Thymic Epithelial Tumours: Update 2026
By Marrika Colvin, Trustee, Thymic UK and Lung & Thymic Cancer Clinical Nurse Specialist, Guy’s and St Thomas’ NHS Foundation Trust
On 10th June 2026, healthcare professionals from across the UK gathered at The Royal Marsden Education and Conference Centre for the Managing Anterior Mediastinal Masses and Thymic Epithelial Tumours: Update study day. The event brought together experts in surgery, oncology, radiology, pathology, neurology and specialist nursing to share the latest evidence and best practice in the management of thymic epithelial tumours (TETs).
The programme, sponsored by ThymicUK and led by Professor Sanjay Popat (Consultant Medical Oncologist, Royal Marsden NHS Foundation Trust) and a faculty of national experts, reinforced how multidisciplinary collaboration is essential in improving outcomes for patients with these rare cancers.
Session 1 – Diagnosis and Presentation
The morning opened with presentations focusing on diagnosis, pathology and the investigation of anterior mediastinal masses.
Dr Dennis Zhang (Consultant Pathologist, Royal Brompton Hospital) provided an excellent overview of the anatomy and pathology of thymic diseases, including an important update that the forthcoming 2027 ESMO guidelines are expected to recommend using both the TNM staging system and the Masaoka-Koga staging system when guiding treatment decisions. This reflects the increasing recognition that both systems provide valuable and complementary information.
Dr Carole Ridge (Consultant Radiologist, Royal Brompton Hospital) discussed the investigation of anterior mediastinal masses, highlighting the importance of selecting the most appropriate imaging for each patient.
Dr Jennifer Spillane (Consultant Neurologist, Guys and St Thomas’ NHS Foundation Trust) then explored the relationship between thymic tumours and autoimmune disease. Myasthenia gravis (MG) remains the most common autoimmune condition associated with thymoma and may develop before the tumour is diagnosed. One useful clinical reminder was to assess shoulder abduction repeatedly (10–20 repetitions) to identify fatigability, which may suggest underlying MG.
The session concluded with excellent MDT case discussions involving respiratory medicine, thoracic surgery, radiology, pathology, neurology and specialist nursing, demonstrating how collaborative decision-making leads to the best patient care.
Session 2 – Managing Locally Advanced Disease
The second session focused on the management of locally advanced thymic tumours.
Mr Simon Jordan (Consultant Thoracic Surgeon, Royal Brompton Hospital) reviewed the surgical management of complex thymic tumours and discussed the challenges associated with phrenic nerve involvement. Damage to a single phrenic nerve can reduce lung function (FEV1) by around 20–30%, while bilateral injury may reduce lung function by 50–60%. Where neuropraxia is suspected, recovery may continue for up to 18 months, meaning diaphragmatic plication should not be considered too early.
Dr Fiona McDonald (Consultant Clinical Oncologist, Royal Marsden NHS Trust) discussed the role of radiotherapy following surgery and for patients with unresectable disease. Post-operative radiotherapy (PORT) recommendations continue to be guided by Masaoka-Koga stage, completeness of surgical resection and individual patient factors.
The audience also heard about the increasing availability of proton beam therapy, which may reduce radiation exposure to the heart and lungs in carefully selected patients. Currently, proton therapy is available in two UK centres (Manchester and London) and may be considered particularly for younger patients or those requiring large radiation fields.
Dr Eleni Karapanagiotou (Consultant Medical Oncologist, Guys and St Thomas’ NHS Foundation Trust) explored the management of tumours initially considered unresectable. One memorable message was:
“Make unresectable disease resectable.”
Induction chemotherapy remains an important strategy to shrink tumours before surgery, aiming to achieve an R0 (complete) resection, which continues to offer the best long-term prognosis.
Important discussions also highlighted:
Session 3 – Relapsed Disease
The afternoon began with the management of recurrent thymic tumours.
Mr André Bille (Consultant Thoracic Surgeon, Guys and St Thomas’ NHS Foundation Trust) demonstrated that surgery remains an excellent treatment option for recurrent disease whenever technically feasible. Although pleural recurrence can be more difficult to clear completely, carefully selected patients may still achieve excellent outcomes with repeat surgery.
An important clinical reminder was that recurrence may sometimes present through the return or worsening of myasthenia gravis symptoms, rather than new radiological findings alone.
Dr John Conibear (Consultant Clinical Oncologist, Barts Health NHS Trust) discussed oncological management of recurrent disease, including the concept of oligometastatic recurrence. Current UK practice generally considers one to three metastatic sites as oligometastatic disease, although international definitions may differ.
With many patients surviving for prolonged periods, speakers emphasised the importance of considering the long-term consequences of treatment alongside effective disease control.
The CNS presentation by Lizzie Middleton (Lung CNS, Royal Marsden NHS Foundation Trust) highlighted the continuing importance of holistic support throughout surveillance, recurrence and further treatment, ensuring patients remain informed, supported and involved in decision-making.
Session 4 – Metastatic Thymic Tumours
The final session reviewed systemic treatment options for advanced disease.
Dr Eleni Josephides (Consultant Clinical Oncologist, University College London Hospital) discussed current cytotoxic chemotherapy options before Professor Sanjay Popat reviewed biological therapies.
Key messages included:
Dr David König Specialist in Medical Oncology (FDHA Switzerland) Royal Marsden NHS Foundation Trust concluded the scientific programme by reviewing promising new therapeutic agents currently being investigated, highlighting the exciting pace of research despite the rarity of these diseases.
Jo Vick (Lung CNS, Royal Marsden NHS Foundation Trust) then provided the Clinical Nurse Specialist perspective, emphasising the vital role CNSs play in supporting patients and families throughout diagnosis, treatment, surveillance and recurrence, while coordinating care across multiple specialist teams.
Reflections
One of the greatest strengths of the study day was seeing so many specialties working together. Every presentation reinforced that patients with thymic malignancies achieve the best outcomes when managed through experienced specialist multidisciplinary teams.
As both a Lung and Thymic Cancer Clinical Nurse Specialist and a Trustee of Thymic UK, I was proud to participate in the multidisciplinary panel discussions and to see continued collaboration between centres across the UK.
Events such as this ensure that knowledge continues to be shared, research translated into clinical practice and patients benefit from consistent, evidence-based care wherever they are treated.
Thymic UK is delighted to support education and collaboration that improves the lives of people affected by thymic epithelial tumours. We look forward to continuing to work alongside clinicians, researchers and patients to advance awareness, research and access to specialist care.
