Treatment for Thymus Gland Cancers

The cornerstones of treatment are surgery, chemotherapy and radiotherapy. There are no ‘official’ NHS or NICE guidelines in the UK for the treatment of thymus gland cancers. However, it is accepted that the gold standard treatment is to remove the tumour by surgery. If it is not possible to remove the tumour surgically (for example because of the proximity of the tumour to other major organs or blood vessels or has spread to other areas) then you might have chemotherapy in order to shrink the tumour such that surgery is possible. Radiotherapy is sometimes used post-surgery to ensure that any remaining cancer cells have been eliminated. If the tumour is inoperable you may have palliative chemotherapy and/or radiotherapy to control the growth of the tumour and manage any symptoms. The treatment your medical team suggests to you will depend on the stage and type of cancer and your general health.

 

You can find a good overview of the available treatments on the Macmillan website (link below) and we suggest you read the information that is provided. We have not repeated that information here.

www.macmillan.org.uk/information-and-support/thymus-cancer

Below, you will find some key, additional information based on our experiences as patients and our interactions with the medical profession.

What type of surgery will I have?

It will depend on how extensive the surgery needs to be in order to remove the tumour and any surrounding tissue that has been invaded by the tumour. If a tumour is small and has not spread widely (i.e. is at an early stage) it may be possible to remove the tumour by video-assisted thoracic surgery (VATS). If the tumour is larger and the cancer is at a later stage you may need to have open surgery typically a sternotomy in which the sternum is broken to expose the chest and/or a clamshell thoracotomy which is a technique to provide complete exposure of the heart and lungs.  Recovery from a sternotomy and/or a clamshell thoracotomy procedure typically takes longer than from VATS.

How long will I be in hospital following surgery?

It will depend on what type of surgery you have, your fitness level and general health going into the surgery. Generally, if you have VATS you can expect to be in hospital for just a few days. If you have a sternotomy and/or clamshell thoracotomy you may be in hospital for several days. Prior to surgery, if you can increase your fitness level it will aid your recovery. That doesn’t mean you have to train for a marathon!  Walking at a speed and/or gradient to increase your lung capacity and exercises to strengthen your core (e.g. pilates) and your legs/quads (e.g. squats) will help you post surgery as you may not be able to weight bear (pushing and pulling) using your arms for a period of time whilst your body heals which can take several weeks/months. Once you are back home from hospital, you will need help with household tasks (cooking, cleaning, laundry etc), so plan that in advance.

Ask your surgeon to advise you on what you can do to help yourself given the procedure he or she is recommending.

Is the surgery painful?

The sensation of pain is such a personal experience. Typically, the more extensive the surgical procedure the more pronounced the pain and for a longer period of time. However, there is an array of different pain medications that are available and your medical team will tailor the pain medication to your needs. In our experience pain is well managed and turns out not to be a major issue.

What chemotherapy will I have?

If the tumour can be removed surgically then there may be no need to have chemotherapy at all. If it is not possible to remove the tumour surgically (for example because of the proximity of the tumour to other major organs or blood vessels) then you might have chemotherapy in order to shrink the tumour such that surgery is possible. If the tumour is inoperable you may have palliative chemotherapy to control growth. There are several chemotherapy regimens that are used in the UK. One known as CAP (which is a combination of Cisplatin, Adriamycin (also known as doxorubicin) and Cyclophosphamide) is often used as first line chemotherapy. Your oncologist may recommend an alternative to CAP if CAP is not suitable for you.

How will the side effects of chemotherapy affect me?

When you read about the chemotherapy drugs you will inevitably read a long list of possible side effects that you might experience and that can feel quite daunting. However, it is unlikely you will have every side effect listed. It is also unlikely that you will have no side effects. Everyone responds differently and will have a different experience even with the same drugs. Most side effects are usually transient and there are other medications that you can take to help manage the worst effects.
Some patients also find complementary therapies such as acupuncture and/or reflexology helpful in managing side effects and anxiety.
Asking other patients how they managed is a good way to get helpful tips and to give you confidence that you will cope.

Will I need Radiotherapy?

If all of the tumour can be removed surgically (referred to as a complete resection with clear margins) then there may be no need to have radiotherapy at all. If it has not been possible to remove all of the tumour (referred to as an incomplete resection or without clear margins) then you may require radiotherapy to ensure that any remaining cancer cells are killed. Your oncologist will work with the radiologist to define what specific area needs to be targeted. The radiotherapy treatment will be done over several weeks (usually 4 to 6 weeks) every day with rest days at the weekend.
If the tumour is inoperable then you may have a short course of radiotherapy to control growth and to alleviate any symptoms.

How will the side effects of radiotherapy affect me?

The side effects from radiotherapy that you may experience will depend on the length of your radiotherapy course, the dose of radiation and the precise location that is targeted in your chest. Some people experience quite pronounced side effects, others very little. Any side effects usually disappear several weeks or months after radiotherapy treatment has finished.

What follow-up should I expect?

The follow-up that you can expect to receive will depend on the risk of the cancer recurring, which in turn depends on the type, stage and the completeness of the surgery. In our experience, if your medical team considers there is a significant risk of a recurrence you should expect follow-up for several years post-surgery. The follow-up may involve regular (every 6 months for the first year and annually thereafter) CT scans or possibly MRI scans.

How can I find out about trials taking place?

Thymic cancer trials are generally posted to online registers when they are recruiting.  Some trials may be in the UK, and some are abroad.  You can search for the latest trial opportunities at the following websites:

EU Clinical Trials Register

Cancer Research Trials Search

Clinicaltrials.gov

 

Where can I find out more about treatment options?

Ask your medical team to explain all the treatment options that are available to you and the risks/benefits of each.

Below are two documents (one from Europe and one from the US) which provide comprehensive details of the different treatment options that are currently available.

ESMO Guidelines (Europe)

NCNN Guidelines 2019 (US)

Further information may also be found here:

https://www.itmig.org