Whether or not a thymus cancer is considered resectable (removable by surgery) is one of the most important factors in determining treatment options. The type of tumor is also important. Thymic carcinomas are more likely to grow and spread quickly than thymomas and often require more aggressive treatment.
Resectable cancers
For patients with resectable cancers (almost all stage I and II thymus cancers, most stage III cancers, and small number of stage IV cancers), surgery offers the best chance for long-term survival if it can be tolerated. This typically includes removal of the entire thymus and, depending on the extent of the disease, maybe parts of nearby organs or blood vessels as well.
Stage I thymomas, which are contained within the thymus, do not usually require further treatment after surgery. Patients with more advanced stage thymomas (such as stages III and IV) may be treated with radiation after surgery, even if all of the tumor was removed. If the tumor couldn’t be removed completely, radiation therapy is usually given after surgery. Depending on how much cancer was left behind, chemotherapy may be added as well.
Patients with thymic carcinomas, which are more likely to come back after treatment, are typically given radiation after surgery, even if the doctor feels the cancer was completely removed. Chemotherapy is usually given as well, especially if some of the cancer is left behind after surgery.
Unresectable cancers
This group includes cancers that are too close to vital structures or that have spread too far to be removed completely (which includes many stage III and most stage IV cancers), as well as cancers in people who are too ill for surgery.
In some cases, doctors may advise giving chemotherapy, radiation therapy, or both first to try to make the tumor resectable. If it shrinks enough, surgery is done. This is then followed by further treatment with chemotherapy or radiation therapy.
Surgery may be the first treatment for some unresectable cancers, to try to remove as much of the tumor as possible. This is known as debulking surgery. Radiation therapy and/or chemotherapy are then given. The hope is that the surgery may help the other treatments work better and may help people live longer, even if it doesn't cure the cancer. Studies of this approach have had mixed results.
For cancers that have spread too extensively for surgery and for people with other serious medical conditions who are unable to have surgery, chemotherapy and radiation therapy are the main treatment options.
Because unresectable cancers can be hard to treat, taking part in a clinical trial of a newer form of treatment may be a reasonable option.
Recurrent thymus cancer
When cancer comes back after treatment it is called recurrent. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the liver or bone). Treatment for thymus cancer that has recurred (come back) after initial treatment depends on the location of the recurrence and on what the original treatment was. If the recurrence is not too widespread, surgery may be an option and would offer the best chance for long-term survival. But in most cases, the treatment options may be limited to radiation therapy and/or chemotherapy. These treatments can often be effective in controlling the cancer for a time, although they are very unlikely to result in a cure.
Because recurrent cancers can often be hard to treat, clinical trials of new types of treatment may be a good option.
Feedback
