Whether or not a thymus cancer is considered resectable (able to be removed with 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.
For people 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. Surgery includes removing the entire thymus and, depending on the extent of the disease, maybe parts of nearby organs or blood vessels, too.
Early stage thymomas (such as stage I and II) don't usually need more treatment after surgery as long as the tumor was removed completely. In some cases, radiation therapy may be considered if there is concern that any tumor was left behind.
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 (chemo) may be added as well.
Thymic carcinomas are more likely than thymomas to come back after treatment. Patients with stage I tumors may not need further treatment if the tumor was removed completely. If the tumor is more advanced, or some might have been left behind, patients are typically treated with radiation after surgery. The radiation may be given along with chemo, especially if some of the cancer is left behind after surgery.
Unresectable cancers are those that cannot be removed with surgery. This group includes cancers that are too close to vital structures (like nerves and blood vessels) or that have spread too far to be removed completely (which includes many stage III and most stage IV cancers). It also includes people who are too ill for surgery.
In some cases, doctors may advise giving chemo first to try to make the tumor resectable. If it shrinks enough, surgery is done. This is then followed by further treatment with chemo 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 called debulking. Radiation therapy and/or chemo 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 patients who can’t have surgery, either because the cancer has spread too far or because they're too sick from other serious medical conditions, chemo 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.
When cancer comes back after treatment it's called recurrent. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs, liver, or bone).
Thymomas most often come back locally. Thymic carcinomas can also come back locally and in nearby lymph nodes, but they may also spread to liver, lungs, and 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 are limited to radiation therapy and/or chemo. These treatments can often help control the cancer for a time, but they are very unlikely to result in a cure.
Because recurrent cancers can be hard to treat, clinical trials of new types of treatment may be a good option.
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Last Revised: October 4, 2017