Thymoma Health Article

Definition

Thymomas are the most common tumor of the thymus.

Description

The thymus is located in the upper chest just below the neck. It is a small organ that produces certain white blood cells before birth and during childhood. These white blood cells are called lymphocytes and are an important part of the body's immune system. Once released from the thymus, lymphocytes travel to lymph nodes where they help to fight infections. The thymus gland becomes smaller in adulthood and is gradually taken over by fat tissue.

Although rare, thymomas are the most common type of thymic tumor. The term thymoma traditionally refers to a non-invasive, localized (only in the thymus) type of thymic tumor. Thymomas arise from thymic epithelial cells, which make up the covering of the thymus. Thymomas frequently contain lymphocytes, which are non-cancerous. Thymomas are classified as either noninvasive (previously called benign) or invasive (previously called malignant). Noninvasive thymomas are those in which the tumor is encapsulated and easy to remove. Invasive thymomas have spread to nearby structures (such as the lungs) and are difficult to remove. Approximately 30% to 40% of thymomas are of the invasive type.

Demographics

Thymoma affects men and women equally. It is usually diagnosed between the ages of 40 and 60 years. Thymomas are uncommon in children.

Causes and symptoms

The cause of thymoma is unknown. Cancer is caused when the normal mechanisms that control cell growth become disturbed, causing the cells to grow continually without stopping. This is caused by damage to the DNA in the cell.

Approximately 40% of the patients diagnosed with thymoma have no symptoms. The symptoms in the remaining 60% of patients are caused by pressure from the enlarged thymus on the windpipe (trachea) or blood vessels or by paraneoplastic syndromes. Paraneoplastic syndromes are collections of symptoms in cancer patients that cannot be explained by the tumor. Seventy-one percent of thymomas are associated with paraneo-plastic syndromes. The most common syndromes related to thymoma are pure red cell aplasia (having abnormally low levels of red blood cells), myasthenia gravis (a muscular disorder), and hypogammaglobulinemia (having abnormally low levels of antibodies). These conditions are autoimmune diseases, those in which the body mounts an attack against certain normal cells of the body. Regarding myasthenia gravis, 15% of patients with this syndrome have thymomas. Alternately, 50% of patients with thymomas have myasthenia gravis. The relationship between the two entities is not clearly understood, though it is believed that the thymus may give incorrect instructions about the production of acetypcholine receptor antibodies, thus setting the state for faulty neuromuscular transmission. The confirmed presence of either thymomas or myasthenia gravis should prompt investigation for the other condition.

Symptoms of thymoma may include:

• shortness of breath
• swelling of the face
• coughing
• chest pain
• muscle weakness (especially in the eyes, neck, and chest, causing problems with vision, swallowing, and breathing)
• weakness
• dizziness
• shortness of breath
• fatigue

Diagnosis

The physician will conduct a complete physical exam. He or she may be able to feel a fullness in the lower neck region. Routine blood tests may be performed. Imaging studies are necessary because the symptoms of thymoma can be caused by many other diseases. Thymomas can be identified by chest x ray, magnetic resonance imaging (MRI), and computed tomography (CT).

A biopsy may be performed, in which a small sample of the tumor is removed and examined under the microscope. However, because of the risk of "seeding" cancerous cells, biopsies are not routinely performed. There are a few different methods to biopsy a thymoma. For a mediastinoscopy, a wand-like lighted camera (endoscope) and special instruments are passed through a small cut in the lower neck. The surgeon can see the tumor on a monitor and can cut off small samples for microscopic analysis. Mediastinoscopy is performed under general anesthesia. Alternatively, a needle biopsy will be taken in which a long needle is passed through the skin and into the tumor. Fine needle biopsy uses a thin needle and larger-core needle biopsy uses a wider needle. Needle biopsies may be performed in conjunction with computed tomography imaging.

Patients who are having difficulty breathing may have a bronchoscopy performed to examine the wind pipe. An endoscope, in this case a bronchoscope, is inserted through the mouth and into the windpipe. The physician will look for tumors and may perform biopsies.

Treatment team

The treatment team for thymoma may include a hematologist, pulmonologist, immunologist, oncologist, thoracic surgeon, cardiologist, radiation oncologist, nurse oncologist, psychiatrist, psychological counselor, and social worker.