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Treatment of Thymus Cancers by Extent and Type of Tumor

Whether or not a thymus tumor (thymoma or thymic carcinoma) 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 they often require more aggressive treatment.

 

Resectable cancers

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.

Treatment after surgery

Early stage thymomas (such as stage I and II) usually don't 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.

People with more advanced stage thymomas (such as stages III and IV) who have had surgery may be treated with radiation afterward, 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. People 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

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.

These people will often have a biopsy before treatment to confirm the diagnosis.

In some cases, doctors may advise giving chemo as the first treatment to try to make the tumor resectable. If it shrinks enough, surgery is done. This is then followed by further treatment, usually with radiation therapy.

For people who can’t have surgery, either because the cancer has spread too far or because they're they're not healthy enough because of other serious medical conditions, chemo and radiation therapy are the main treatment options. If chemo is no longer helpful, other drugs that work in different ways might be 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's called a recurrence. A recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs, liver, or bones).

Thymomas most often come back locally. Thymic carcinomas can also come back locally and in nearby lymph nodes, but they may also spread to other parts of the body, such as the liver, lungs, and bones.

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 isn't too widespread, surgery may be an option and would offer the best chance for long-term survival. But most often, the main treatment options are 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. If chemo is no longer helpful, other drugs that work in different ways might be options.

Because recurrent cancers can be hard to treat, clinical trials of new types of treatment may be a good option.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

 

Meneshian A, Oliver KR, Molina JR. Clinical presentation and management of thymoma and thymic carcinoma. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/clinical-presentation-and-management-of-thymoma-and-thymic-carcinoma on May 14, 2024.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Thymomas and Thymic Carcinomas. Version 1.2024. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf on May 14, 2024.

 

Last Revised: May 15, 2024

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