Q&A with Dr Yvonne Summers, Medical Oncologist at the Christie

Q&A with Dr Yvonne Summers, Medical Oncologist at the Christie

On the 26th October 2022, we were very grateful to have guest speaker Dr Summers, consultant in medical oncology at the Christie hospital in Manchester, England.Dr Summers answered questions from ThymicUK members in our 60 minute online webinar, hosted on Zoom.You can listen to an audio summary of the Q&A below:

Positive comments about the meeting:
Thank you to the group and Dr Summers.
A very helpful and informative meeting which helps us share our rare cases and the professional support out there
I am my oncologist first case but he has had support from Dr Popat at RM and Simon Jordan at Brompton who will be my surgeon once my thymona has shrunk
It has shrunk by over 50% in mass from just 2 heavy chemo sessions so plenty to be positive about at this stage
Thank you all again 

– P B (Facebook)

Thanks so much for organising, it was so interesting. Dr Summers is wonderful, how lucky her patients are.

– A D (Facebook)

Text transcription of the video:

Reading Time: 25 minutes

Summary of Questions Answered

You can click on the link to jump to that question

Q. Does Dr. Summers think that chemotherapy alone is the best treatment for thymic cancer?

So when we’re making treatment decisions for patients that have been diagnosed with a thymic tumour, it depends a lot on the details of that individual patient and their cancer. For many people that are diagnosed with a Thymoma, actually they will not have any chemotherapy at all. So many patients will have an operation and may not need any other treatment at all. Some patients will have chemotherapy followed by an operation and sometimes followed by radiotherapy as well. And then there will be some patients where chemotherapy is the primary treatment and is the atmosphere any sort of treatment that we would do initially. It depends a lot on the details, is a lot to do with the extent of disease. And also, of course, when we’re thinking of a chemotherapy, you have to be well enough to be able to put up with chemotherapy. So there are some patients for whom even although we might want to do chemotherapy, it’s not the right thing for them.  

Q. Is it possible to give a 5 year prognosis or a 5 year life expectancy with thymic cancer?

Thymic tumours are quite unusual and often very different to other sorts of cancer. Often thymic tumours can be quite indolent, slow growing and be there for a long period of time before they’re picked up and often then picked up incidentally. So a patient might have an x ray or a CT scan for some other completely unconnected reason, and all of a sudden we’ll see that there’s something abnormal in this place in the front of the chest called the anterior mediastinum. And then when the diagnosis is made after that. So actually it’s, it’s not unusual for tumours to have been there for quite a long time before an individual will come to medical attention. And the amount of time that it kind of can have been there for depends to some degree on the nature of that tumour. So for slow growing tumours, as I’ve said, they can sometimes be there for years and occasionally we’ll be in a situation where somebody has had a CT scan done two or three years before for other reasons. And when we look back, actually, yes, it was there that time again, sometimes not even all that different. And if I go back even further to the times when Thymic tumours were often regarded as benign tumours, often these things were watched and so sometimes thymic tumours which have been watched for years with not a lot happening to them. Sometimes things can be really quite slow growing. Then for those that are removed, obviously the aim of an operation is to try and get rid of the tumour and hopefully it’s not going to come back. But depending on the type of tumour, those tumours can come back and even the ones that we think have the least aggressive potential, they can come back, which is why we say actually they should come out once we think that was a seismic tumour in that area. Even for the most slow growing of those tumours, there is a risk that they may come back at some point. But Thymic tumours are also very different in that their natural history. So if we do nothing they can be very slow growing. And even people who have advanced disease, sometimes people present and they will have a cancer that’s already spread and sometimes those patients will have even quite advanced disease at the time of diagnosis and not be suitable for any treatment because they’re not well enough for chemotherapy or the kidney function is not good enough. And sometimes even those individuals are still here five years later. So even with advanced disease, there are people who do very well and some people would do very well even without treatment. So there’s a great spectrum. So I think I guess what I’m trying to say is that there’s a quite a lot of variation. And even for someone who has stage four disease, that is not very poor prognosis. There are some people that don’t do well, but equally even with stage four tumours, there are people who do well with treatment and are still here five years and more after the time of diagnosis. Some case studies follow a three year treatment regime of chemotherapy, ketogenic diet, i.e. high protein, low carbon plus seven times a day fasting to begin, followed by twice a day fasts. Though high risks have enabled the patients to live a normal life despite Thymomas enlarging, then shrinking and the patient have admittance to intensive care.  

Q. Can Dr. Summers substantiate these studies, which I think would be very difficult to predict?

So I think that’s within the context of what I’ve just said. So some people with thymic tumours do very well and sometimes do very well without any treatment. And actually the other thing that I have said is also if we look at the natural history of thymic tumours, they’re not like other cancers. So other cancers will grow and if we do a treatment they may respond. And if we don’t do treatment you would expect them to continue to, to grow. Thymic tumours are not entirely like that. So the immune system can have influence with thymic tumours and occasionally we see thymic tumours shrinking when there’s been no treatment. So that is the background on which I would then answer the question about diet. So we’re obviously very much driven by evidence and clinical trials, and we try to be as objective as we can, whether it’s about what happens naturally with the cancer or whether we’re looking at new treatments, we always try to be as objective in the scientific data as we possibly can. Doing so to do a trial, a randomised trial of one treatment versus another treatment or one treatment versus no treatment is always the best way of us getting clear evidence. And I think it’s fair to say that there is no randomised trial evidence of a ketogenic diet in thymic tumours or indeed actually of any other tumour demonstrating a benefit. So there’s enough. But one of the problems with evidence is in this day of the internet, all sorts of things can be published on the Internet. All sorts of opinions can be published on the Internet without any necessary scrutiny or peer review or assessment of the quality of whatever is written there. So it’s very difficult and you have to be when you’re reading things on the Internet, you have to be quite critical with the source of that data is and try to glean from it how valuable it is. I would always say that with regard to any cancer, looking at reliable websites. So websites like CRUK , ThymicUK, or ITMIG, those are the sorts of places which have relatively safe data which, you know, can be trusted. But once you start to go outside of some of those websites, the data can be quite difficult to understand how reliable it is. But I think it’s fair to say that we certainly don’t have any data in that area. And if I always think to myself when I’m asked questions about these sorts of things, if it was something that was very straightforward and of a very substantial benefit, my goodness, we do want that rather than the drugs which have side effects, radiotherapy, that had side effects, operations that clearly can be risky. So I think, unfortunately, the answer to that is no.  

Q. They have a proton therapy machine at the Christie. Has this been found to be effective in treating Thymoma? Could it be used to prevent recurrence?

Okay, so one of the problems that we have with any kind of new treatment is we’re always very excited about it. And that excitement translates often through the media about, you know, a great new treatment for cancer. And we think from that that it’s A it’s going to cure things and B, that’s going to be better than whatever we have. So with Proton Beam, there is there are some clear advantages to it in certain groups of people that are related to the way it works. So the real advantage of proton beam therapy is it’s essentially a radiation treatment. And so what it does to the cancer is, is essentially what radiation does. So in the way that you we would use radiation therapy for thymic tumours or for other tumours and in theory proton beam can be helpful. But actually the advantage of proton beam is it is much easier for the radiation to store and therefore not go into the normal tissues, which is why it is so important in paediatric oncology. So for children we really don’t want to be giving any normal tissues radiation because of course children are growing and if you irradiate growing tissue, then that can cause long term damage and developmental damage. And of course particularly in brain tumours with children where you really don’t want to be radiating any normal brain if you can avoid that, because of those issues of development and radiation causing damage. So in terms of the proton beam for other sorts of cancers really with other sorts of cancers, it’s very much still a tool for research, it’s still a radiation treatment. And so in theory has evolved but it hasn’t got any advantage in terms of how effective it is in the tumour compared to other radiation techniques, much less so. It’s more to do with it not causing damage to the surrounding tissue. So have we got any experience with it and seismic disease? The answer is no. Technically it would be possible to do. Theoretically it would have the same advantages of standard radiation treatment. But there’s not any additional advantages because of course, with the best will in the world, I suspect all of us around this meeting room this evening have stopped growing. And and so those concerns about development are much less in an adult population. So the proton beam is really a fundamental importance for paediatric patients. The role of it in adult oncology is much less clear.  

Q. This is such a rare cancer. Do you have any thoughts on what causes it?

I suppose all cancers are genetic in a sense in that the immune system is very efficient at preventing cancers and all of us have cells turning over the whole time; we are producing blood cells the whole time; we have a skin, that skin that is sloughs off and we all have skin cells that are regenerating the whole time and the same for many other tissues. So cells are regenerating the whole time. And every time we have a cell that copies and it grows, there are there are DNA components of that that have to be copied and there can be mistakes in that. And so there has to be a genetic change that is not repaired for a tumour of any sort to occur, which is why we see cancers becoming more common in the elderly. So with an ageing population we see more cancers of all sorts and with Thymic disease, interestingly that doesn’t seem to be the same sort of age distribution as there is with other tumours. So I see a lot of young patients and in fact looking around the virtual room this evening, there’s quite a lot of young faces that I see here. So we don’t have the same propensity for the majority of patients; like, for example, with lung cancer, the average age of our patients is is 71, 72. And although we do have younger patients, there are much fewer of them. With Thymic disease it’s not particularly a disease of the elderly. So do we have any clear reasons for thymic tumours arising? The answer to that is essentially no. We haven’t identified a particular cause. There’s not one thing that we can point the finger at and say this is why you have developed a thymic tumour. We do know that the immune system is important and of course with thymic tumours there are subtle changes in the immune system. And we also know that for patients with thymic disease there’s probably a slightly increased risk of other cancers. And so one of the things that’s so important for people when they’ve been diagnosed with a tumour and that’s been treated, is for us to be keeping a very careful eye on them, making sure that they have a healthy life as possible, making sure that they’re not increasing the risk of other cancers. So obviously avoiding smoking, making sure that your weight is relatively well controlled, keeping an eye on other health factors, diet, those sorts of things. So really important that people stay healthy because there’s something about the thymic tumours that cause some modulation of the immune system. That means you’re slightly at risk of other cancers. So we must be very careful. Part of the follow up and surveillance we do is all about trying to pick up any other problems that might be occurring. So I’ve gone off on a tangent again there, but I guess that was a that was a long answer to how we got a cause for finding tumours there.  

Q. Is there a direct link between Thymoma and Mylopathy affecting only the lower limbs?

Okay. So, thymic tumours often have other things associated with them, and there’s a whole range so traditionally we have associations that you may well already know about and some of you may have experienced this as a condition called myasthenia gravis, which is not uncommon to be associated with some tumours. There are other rarer conditions such as aplastic anaemia, and then there’s other conditions which can cause changes in the body’s immune system and make you more susceptible to infections. There’s also other associated conditions which are not a direct consequence of the thymic tumour, so it’s not a direct effect, but it is being caused indirectly by the thymic tumour. So yes, it is possible to have both neurological conditions, muscular conditions and conditions affect the nerves because there can be or antibodies that the tumour generates that then cause the body to have problems with some of those other tissues. So yes, it is possible to have myopathy or neuropathies that are associated with silent tumours. They’re uncommon, but they certainly are well documented and strangely enough it doesn’t have to be generalised. Sometimes conditions can can pick off one particular area of the body, and of course for things like myasthenia it causes weakness and we often see weakness affecting particular muscles. Sometimes we see people who have weakness of their shoulders and their neck muscles because of myasthenia. And I think there was a question about somebody being admitted to critical care previously. So. So, again, that can often happen with myasthenia. Well, not often, but it can occasionally, very occasionally happen with myasthenia. If that myasthenia affects the respiratory muscles and so affects an individual’s breathing, if they need some help to to breathe, essentially while we’re getting on-top of the Myasthenia. So yes, absolutely thymic disease can affect a number of muscles and nerves, but not necessarily directly, but as an indirect consequence of the things that the tumour is doing.  

Q. Would the removal of the Thymoma reinstate my full mobility? Is the removal of the Thymoma always recommended?

So again it goes back to how we manage thymic tumours. So how we manage them and whether or not we do an operation relates to a lot of technical factors to do with whether they will prevail. So of course you’re probably all aware that the thymus gland is in the middle part of the chest at the front. But there’s, of course, lots of other really important structures in that area. There’s heart just a bit lower down, there’s blood vessels, nerves, lymph nodes, there’s all sorts of really important things, not to mention the lungs on either side. So technically, sometimes it’s not possible to do an operation. But if we can do an operation, if it’s resectable and we think that’s going to clear the tumour, then often we will do an operation. And if for example, someone has oe of the conditions that we’ve talked about and an operation is done because it’s technically possible to get rid of it, then that can sometimes result in the condition improving, whether that is myasthenia gravis or aplastic anaemia or one of these other conditions that we see. Not always, but sometimes. But it needs to be the right thing to be able to remove all of the tumour, to put somebody through an operation in the first place. Because of course, operations are not straightforward in this area and there can be substantial risks associated with the surgery itself. So we have to be quite convinced that there’s a good chance that we’re going to have a successful operation in order to put somebody through that sort of procedure.  

Q. Can one live with a Thymoma that is stable and what other treatments other than surgery are available?

Okay. So yes, thymic tumours can stay there for a long period of time sometimes and they don’t always change. Sometimes thymic tumours can be there for a number of years and change very little. In terms of what are the main stages of treatment. So of course we’ve talked about surgery, we’ve talked briefly about chemotherapy, we’ve talked a little about radiotherapy. And those are well-established means of treating, thymic tumours Sometimes only one of those treatment types is used. Sometimes they are all used and sometimes two of them in combination. And it all depends on each individual case, what the right decision is and what sort of treatment we use. And then of course we haven’t talked about clinical trials and of course in a disease where there has not been a lot of change over the recent past, I think it’s very important that we also, whenever we have got clinical trials, try and encourage individuals to be aware of those and participate in them if it if it’s appropriate. And sometimes those trials are of other sorts of anti-cancer therapy. Sometimes they are still chemotherapy based. But we do have early phase, early phase clinical trials here in Manchester and many of the other centres have early-phase clinical trials for which we would consider thymic tumour patients if that was possible. I suppose one of the things that I would pray to see in that conversation is that often clinical trials of very new agents are restricted to those with the most aggressive types of tumours, so that’s often Thymic Carcinoma rather than Thymomas and also there’s a lot of screening that goes into clinical trials so patients have to be really quite fit before they go into a clinical trial. And depending on the type of drugs that are being tested, sometimes there are particular exclusions. So sometimes, for example, people who have active myasthenia are not allowed into clinical trials.  

Q. How can patients find an oncology department with particular experience/expertise in treating thymic cancer patients?

Yes. And it’s a difficult area and it’s a similar problem for any type of rare disease, actually. There are a number of other tumours which are also rare. So oncologists when they are training, doctors go through usually about six years of medical school and will then do general training in medicine and surgery, in a hospital for a number of years. They’ll both have to sit for various exams to make sure that they know enough about medicine before they start to specialise. Usually after four or five years, they’ll then specialise in a particular area, and somebody at that point will say, well actually I’m very interested in cancer. They may have had some experience with cancer prior to that, and I at that point they want to may enter specialist training in oncology. And during that period of time they have to do training in all sorts of tumours and all sorts of cancers. And one of the aspects of that training is in thoracic oncology. So thoracic oncology, the “thorax” is the chest and of course that covers essentially the things that are in there. So things that affect the lungs, the pleura and this area here, the mediastinum. So most thoracic oncologists will have had some experience of lung cancer, both non-small cell and small cell mesothelioma. And most of us oncologists will have had some experience with silent tumours whilst they have been training. But it is fair to say because thymic tumours are rare, the amount of exposure that oncologists will have had to the thymic tumours during their training very substantially. So if you if you train in an area where there’s a very large population of patients and there is a specialist centre, then you may have had more exposure and experience of, of thymic tumours when you were in training than in some other areas. So there is a great deal of variation across the UK, and in fact in other parts of the world also. And then once the doctor takes up a position as a consultant, they often specialise in one or two areas and then as time goes by, they may find that they have a lot of patients of one sort and have developed a special interest in that area. So all oncologists will have training in thoracic oncology, but how much thymic tumour training they’ll have had during that period as a trainee before they become a consultant does vary because they are rare diseases; and in a part of the northwest where the population is about 3.4 million, we would expect to see about ten thymic cases a year and that population would perhaps see a little more than that. And of course, we do have patients that come in for some specialist opinion and often, often if we have any trials up and running, but that’s the sort of degrees. So most GP’s will not have another patient or each one of your GPs is probably quite, quite interested in the fact that you have that they have a patient with Thymic disease because they probably wouldn’t have another Thymic patient in their entire career.   Thank you very much. And actually, I’d just like to add that the British thoracic oncology group, which Dr. Summers is a member of, they have developed a specialist interest group for oncologists, radiologists, pathologists that have an interest in Thymomas. And at the moment, they’re working on developing an MDT so possibly it’s going to be regional, but at the moment that’s all still being discussed and worked on. So there are things happening in the background with regards to the health care professionals that do have a special interest and experience with Thymic malignancies. There are things happening and yes, at the moment in the UK, we had our awareness month in May and there was a whole day of learning for healthcare professionals which was again hosted by BTOG, the British Thoracic Oncology Group. That’s very important to mention. And the other thing that I would also say is, of course, there are guidelines, there are European Medical Oncology guidelines, and there is the International Thoracic Thymic Society as well. So there are there are guidelines and sources of information for people to look to with regard to how we should be treating thymic tumours. And the other thing that I would say is that there is quite a network of oncologists in the UK and it’s not unusual at all for myself or one of the other oncologists to have a phone call or an email from consultants from elsewhere saying, I’ve got this case, we’ve been doing X, Y and Z; Can you just have a look and scan the case and offer any advice about anything else that we should be doing? That’s very commonplace. People do reach out to colleagues and we and we like to share experience and knowledge, particularly with diseases such as this.  

Q. What would be the criteria be for an oncology department experienced in trying to treat a patient or what would deter them from treating the patient?

Okay. So. As I have said earlier, what guides us in terms of making decisions about treatment is a combination of patient factors, if you want to put it like that. So how well an individual is, what their other organ function is, are the kidneys working well? Is the heart working well? Are the lungs working well? Because that has an influence in terms of what sort of treatment we can do. And clearly, if someone is very unwell than actually sometimes the treatment is more risky than the underlying tumour. So there are some situations where there are factors to do with the patient’s condition that mean the treatment is not the right thing for them. And a lot of that, a lot of that judgement call is, is actually more general oncology than necessarily being very specific to thymic tumours, because a lot of the factors that will make us say that chemotherapy is right or wrong are very similar in one type of cancer versus another. The skills needed to make those decisions and have those discussions are quite generic. So being experienced in other types of thoracic cancer often gives an individual the same skillset, to be able to answer some of those questions about general fitness for treatment. So in terms of of radiotherapy, chemotherapy, surgery, obviously as we talked about before, whether an individual is suitable for a surgery has a lot of technical factors and that as well to do with tumour verities, whether it’s technically feasible to be able to get rid of it with an operation and whether the individual’s fit enough for it. In terms of waiting to see an expert, I would almost say that a lot of local doctors can give you a quite good idea about whether, for example, a tumour is in a position where it can be operated upon or whether an individual is generally fit enough to be able to tolerate a chemotherapy and radiotherapy treatment. Where the intricacies of the specialism is, is partly to do with combinations of treatments and particular types of drugs, rather than the sort of general discussion. So I would always say that I completely appreciate that when you have a rare disease, you want somebody who knows what they’re talking about to give you an opinion. But I think it’s also important to say that a lot of local doctors will have a lot of the skills that you need to be able to to manage this sort of problem, and also be able to manage some of the side effects that often come with treatment.  

Q. Do you give seconds opinions?

Okay. So that can be quite distressing for people. If they know that they’re oncologist is not somebody who has seen a lot of this in the past. And absolutely so many oncologists will reach out to colleagues in their area or further afield if if they’re not used to looking after Thymic patients. As I was saying before, it’s really common for people to pick up the phone, send an email or do a formal second opinion. And, you know, that’s what the network is here for. And that’s what the British Thoracic Oncology Group, the special interest group in Thymoma is really trying to foster and make sure that people are aware that there are people that have more experience that are more than happy to help out with advice.  

Q. Are Thymic carcinomas treated differently than Thymomas?

Thymic Carcinoma seems to be treated differently from Thymoma, i.e. not operable. So Thymic Carcinoma; there’s obviously a spectrum of thymic tumours. Thymic carcinoma is often slightly more aggressive, and so it’s more common for Thymic Carcinoma to be more advanced than some of the other types of tumour. So it’s fair to say that Thymic Carcinomas are sometimes not treated with surgery and can be treated with chemotherapy upfront. But that’s not to say that if it was technically possible to do an operation, that’s exactly what we would do. So it’s more to do with the whole picture, not just the histology.  

Q. Could there be a viable trigger?

So again, there’s all sorts of things to do with tumours and some tumours, not necessarily thymic tumours, but some tumours are triggered by virus. I don’t think we have any clear evidence that thymic tumours are viably triggered. But as I said, we don’t know at this point in time exactly what does cause thymic tumours. So I think that the jury is out, we don’t have any clear evidence in terms of particular positive antibodies to particular viruses that we see with some other types of cancer. But I guess we don’t know at the moment exactly what causes thymic tumours.  

Q. Are there any clinical trials that are specific to or potentially open to thymic cancer patients?

Absolutely. There are very few clinical trials, with thymic disease. At the moment we have only one trial that’s actively recruiting in England for patients with Thymic disease, but specifically for patients with thymic disease that’s looking at immunotherapy for patients with thymic disease. But there are often, as I was perhaps touching on earlier, phase clinical trials, which are at an earlier phase of development, where we have some indication, often from preclinical studies, either in test tubes or sometimes in other sorts of studies, where we think that a particular new type of drug might be active in patients with thymic disease. And then actually those studies will allow enrollment of patients with thymic tumours in addition to other types of tumours. So it’s not uncommon for us to be looking in those sorts of areas for clinical trials as well.  

Q.  What about Immunotherapy?

So there have been a number of there’ve been a number of phase one and phase two clinical trials looking at immunotherapy in Thymic disease. And to summarise a number of clinical trials, there’s certainly evidence of activity of immunotherapy in patients with thymic tumours after other types of chemotherapy. And we certainly have seen response rates very similar to the sort of response rates that we have seen with immunotherapy in other thoracic tumours, like for example, lung cancer. So overall response rates of probably about 20% in some of those early phase clinical trials, small numbers of patients. So we certainly have seen clear evidence that immunotherapy can be helpful in some patients. But I guess the caution that I would have with immunotherapy in patients who have a thymic tumour, particularly with Thymoma is we have seen a slightly higher incidence of some of the side effects with immunotherapy. So there’s a number of trials ongoing. We certainly do see patients responding, but we haven’t got final results from those yet. I would be surprised in the future if immunotherapy does not form part of the treatment we have for looking after patients with thymic tumours.  

Q. How can a patient get enrolled in a clinical trial?

Always through your oncologist. And just a word about clinical trials. So clinical trials, are usually at the point when things are changing so people don’t go into clinical trials if their tumour is stable. So we never want to upset the apple cart. So if things are stable and scans are looking good and you’re well and not having any change in symptoms. We would never want to interfere by doing any sort of treatment because of course a treatment can carry side effects and risks with it. So clinical trials are at the point when things start to change. And clinical trials depend partly on what treatment you’ve had before and also some other factors to do with what trials available, and other things. So, I’d love to say was a trial for everyone, but in this rare disease, there’s often not a trial available. But we are certainly very happy to discuss with oncologists what trials may be available and whether people would like to be considered for those.  

Q. If I were to get a recurrence, would it be encapsulated or will it only ever be encapsulated the first time? Is it much more dangerous the second time around because it’s no longer encapsulated?

Okay. So the encapsulated bit is a little bit of a red herring. So if a tumour comes back, then we will always reassess it at that time and treat it on its merits at that time. Now what does that mean? If we can get rid of it completely, surgically, if it comes back, we will try to. So sometimes thymic tumours don’t come back in this area of the chest. They may come back somewhere else. They may come back, for example, in the lining of the lung. And if there’s one area of spread in the lining of the lung and everything else is clear, we will quite often say, particularly if there’s been four or five years between that and the original surgery, we quite often say, actually, can the surgeons take this out? So the encapsulated bit is not important. And also the other factor she asked about is does the histology change essentially? Does it come back? If it was originally a Thymoma, does it come back as a Thymic Carcinoma? No, they’re usually the same. Things can change over time and tumours can change to some degree histologically over time and of course not all parts of the tumour are exactly the same under the microscope, but generally speaking it’s the same sort of tumour, if it comes back in another area. But we would often want to know, for example, if we’re in that situation where a tumour has come back in the lining of the lung and we’ve taken out, we’ll look under the microscope and we’ll look at exactly what it looks like now compared to the original tumour.  

Q. Can Lymphoma be erroneously diagnosed as Thymoma if seen in the same area of the Thymoma. What are the links between Thymoma and Lymphoma?

Yes. So it can be tricky for some types of thymic tumours which have lymphocytes which can look similar to the cells that we see in lymphoma. It can be tricky. So not always, it depends again on the precise appearances under the microscope, but there are some types of thymic tumours that it can be difficult to distinguish between a Thymoma and a Lymphoma. Particularly if we have small sample size, if it’s a small biopsy, it can be more difficult for a pathologist if they’ve not got a reasonable sized biopsy to be able to see exactly the characteristics of the cells and the architecture, etc.. So it would be uncommon for that mistake to be made, but it can be made and it can be understandable because they can look very similar. And if the biopsy is very small, it can be tricky.  

Q. Six months on from radiotherapy and chemotherapy, my Thymic Carcinoma has been labelled stable. Is that good or can it grow back quicker and quicker tomorrow?

Ok, stable is always good. I am always delighted when things are stable. Stable means it’s not doing anything. And as I was saying before, when things are stable, we don’t want to rock the boat. So we don’t tend to do anything else. We just keep an eye on things. And there are many people and I’m sure there will be a number of you in this room this evening who have been in this situation, have had treatment, have had perhaps chemotherapy, radiotherapy, a combination of them, and are stable, not just six months after that period of time, sometimes a number of years, sometimes many years after that. So absolutely, of course, with any kind of tumour, it can come back, it can grow again. But equally it’s stable at the moment. And you just have to some degree, go between scans and if you’re well on the scan and stable, that is quite lovely.  

Q. If Thymic Carcinoma is partially resected, would this expose the rates of growth? Also, what is the best practise for treatment of Thymic Carcinoma? Can we only proceed with radiotherapy due to fitness?

Okay. So, again in terms of treatment, it depends on a lot of the characteristics of the tumour and symptoms. So if we can’t get rid of a tumour, if we can’t get rid of a cancer, then often our treatments, and if there’s some treatments that we can’t do because of fitness, then often with every treatment decision, there’s always the balance of how much good are we going to do with the treatment versus how much harm might be caused. So often in a situation of that sort, we’ll be looking at what symptoms have been caused by the tumour and therefore what can we do to help that; is it sufficiently localised that radiotherapy will help? Or is it more generalised? And what is the extent of the area that is affected? Can that all be treated with radiotherapy? So again, it is really difficult to be specific because there are so many factors that you have to look at for each individual case in terms of what is possible. But I would encourage you all and with Marrika and Marie in the virtual room, I would encourage you to be asking questions, to be asking questions of your oncologist, of your of your specialist nurses. Now, I know you’re not all lucky enough to have a Marie or a Marrika, but you will have at least a specialist nurse who’s experienced in thoracic cancer; and those nurses will be able to again answer a lot of those questions about radiotherapy. What will radiotherapy do for me, what’s it likely to help? What problems might there be?  

Q. How long after a Thymoma resection is the patient usually followed up for?

That is a very good question. And of course, as you’ve heard me saying early on, that we have many of our patients who do very well for five years, six years, seven years, more than that. So traditionally with most tumours, after five years after a curative treatment, we would traditionally discharge people after five years. But actually you just heard me saying thymic tumours are not like many other tumours. And so actually the follow-up of patients with Thymic tumours for me is not the same as those other tumours. And so I need to look after my patients for a bit longer, I need to keep an eye on them for longer. So we would routinely in my practise, follow patients up to ten years and sometimes more than that depending on the individual situation. But it is tricky and there’s no hard and fast rules about it. I think what is important, particularly if an individual has been discharged from follow-up after an earlier period of time, that you’re just very aware that if there are any problems, you don’t sit on them, you speak to your doctor, if there’s anything that you’re concerned about. And it’s perfectly okay to say, if you’ve been discharged from specialist follow-up and you’re in that period of time afterwards, it’s perfectly okay to say to your doctor, I am worried about this, I have had a tumour in the past; is there anything that we need to be doing, any tests that we need to be doing in those situations? It’s really difficult when you’ve been diagnosed with a cancer of any description because you wouldn’t be normal and natural if you didn’t automatically presume that almost everything that happened to you could possibly be related to that cancer. So it is difficult, but I think you just need to make sure that you’re seeking attention when you have a problem for whatever route you have whether that is with your specialist nurses, your consultant oncologists, your GP; you should you be seeking attention to make sure things are checked out appropriately? Thank you very much, Dr. Summers. It’s just a massive thank you. You went through an amazing 20 questions. So thank you so much. We really appreciate you giving up your time today. Also to Marrika and Marie. Thank you very much also for attending. And this has been such a useful meeting. I really can’t thank you enough and thank you to everyone that’s attended and put some great questions. `
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