Thymoma

A thymoma is a tumour of the thymus, a small gland behind the breastbone that trains immune cells in childhood and then shrinks. Thymomas are rare, usually grow slowly and are most often found between the ages of 40 and 70. Thymic carcinoma is a more aggressive relative.

Around a third of people with a thymoma have myasthenia gravis, an autoimmune muscle weakness, and other immune conditions can occur as well. Complete surgical removal is the central treatment, and for early-stage tumours it is often all that is required. Because the tumours can recur after many years, follow-up is long.

Symptoms

• No symptoms, with the tumour found on a chest scan done for another reason
• A persistent cough, chest pain or pressure
• Breathlessness
• A hoarse voice
• Swelling of the face, neck and arms caused by pressure on the large vein in the chest
• Drooping eyelids, double vision, difficulty chewing or swallowing, and weakness that worsens with use
• Repeated infections or severe anaemia caused by associated immune disorders

Causes and risk factors

The cause is unknown. No lifestyle, environmental or inherited risk factors have been established. The tumour arises from the epithelial cells of the thymus and is classified by the WHO as types A, AB, B1, B2 and B3, with thymic carcinoma as a separate entity. Behaviour depends less on the microscopic type than on the stage, that is, whether the tumour remains within its capsule or has invaded the surrounding fat, the lung, the pericardium or the pleura. Because the thymus regulates immune tolerance, the tumours can trigger autoimmune diseases, which may appear before surgery or even after it.

How it is diagnosed

• Contrast CT of the chest: Shows a mass in the front of the mediastinum and its relation to the major vessels. MRI helps to distinguish cysts and to assess invasion.
• Blood tests: Acetylcholine receptor antibodies in all patients, even those without weakness, since unrecognised myasthenia makes anaesthesia risky. AFP and beta-hCG, to exclude germ cell tumours, and blood count and immunoglobulins are also checked.
• PET-CT: Used selectively for larger or more aggressive-looking tumours.
• Biopsy: Not needed when a small, well-defined tumour is going to be removed anyway. A core needle biopsy is done when lymphoma is a possibility or when treatment before surgery is planned.
• Staging: By the Masaoka-Koga or TNM system, completed after the operation.

Treatment options

• Complete thymectomy: Removal of the tumour together with the whole thymus and the surrounding fat. Keyhole (VATS) or robotic surgery is used for small tumours, and an incision through the breastbone for large or invasive ones.
• Optimisation of myasthenia before surgery: Pyridostigmine, steroids, immunoglobulin or plasma exchange to make the anaesthetic safe.
• Radiotherapy after surgery: For tumours that were incompletely removed or had invaded, and for thymic carcinoma.
• Chemotherapy: Platinum-based combinations are given before surgery to shrink tumours that cannot initially be removed, and for advanced disease.
• Surgery for pleural recurrence: Deposits on the lining of the lung that are removed can give long periods of control.
• Follow-up: Chest CT every year for at least 10 to 15 years.

When it is urgent

Increasing difficulty with breathing, swallowing or holding up the head may signal a myasthenic crisis and needs an emergency department immediately. Rapid swelling of the face and neck with breathlessness, which indicates obstruction of the superior vena cava, is also an emergency to be managed where you are.

Travelling to Türkiye for treatment

A thymoma is rarely an emergency, so there is time to choose a thoracic surgical team with experience, and travelling for a planned thymectomy is reasonable. A robotic or keyhole operation needs about 7 to 10 days on site, and open surgery about 2 to 3 weeks. If you have myasthenia, it has to be well controlled before the operation and before flying, which your neurologist should confirm. Annual CT follow-up can take place at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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