What is Thymus Gland Cancer? Symptoms | Prof. Dr. Levent Alpay

Ingredients

What is Thymus Gland Cancer? Types and Characteristics
Thymoma: Slowly Progressing Thymus Tumors
Thymic carcinoma: Thymus cancer with an aggressive course
Causes and Risk Factors of Thymus Gland Cancer
What are the Symptoms of Thymus Gland Cancer?
Pressure and Pain in the Rib Cage
Upper Vena Cava Syndrome (Swelling in the Face and Neck)
Myasthenia Gravis (Muscle Weakness) Symptoms
Thymus Gland Cancer Diagnosis and Staging Process
Radiological Imaging: CT, MRI, and PET-CT
Evaluation with Masaoka-Koga Staging System
Thymus Gland Cancer Treatment Methods
Surgical Treatment (Thymectomy Surgery)
Closed Thymus Surgery (Robotic and VATS Techniques)
Multidisciplinary Approach: Chemotherapy and Radiotherapy
Preoperative Preparation and Postoperative Recovery Process
Survival and Follow-up Protocols for Thymus Gland Cancer
Frequently Asked Questions
Can Thymus Gland Cancer Be Completely Cured?
Will There Be Hoarseness After Surgery?
Does the Immune System Collapse When the Thymus Gland is Removed?

Thymus gland cancer is a rare but clinically critical form of cancer that originates in the thymus tissue, which is located in the center of the chest cavity, just behind the sternum.

The thymus gland is a center where “T cells”, which play a key role in the development of the immune system, mature, especially during childhood.

Although in adulthood this gland shrinks and turns into adipose tissue, in some individuals these tissue cells can multiply uncontrollably and form tumoral structures.

Cancers that develop in this region require early detection and precise surgical intervention due to their proximity to the heart and major vessels.

Today, thymus gland cancers can be treated with high success rates thanks to developing oncological surgery techniques and multidisciplinary approaches.

What is Thymus Gland Cancer? Types and Characteristics

Thymus gland cancer is divided into two main groups according to the biological behavior of the cells from which it originates.

This distinction is vital for planning treatment and predicting the patient’s recovery potential.

Thymoma: Slowly Progressing Thymus Tumors

Thymoma is the most common type of thymus tumor that originates from the epithelial cells covering the thymus gland.

These tumors usually tend to grow slowly and may remain confined within the capsule of the thymus gland for a long time.

However, their classification as “benign” can be misleading; Because they carry the risk of spreading (invasion) to the surrounding tissues over time.

Thymomas tend to co-occur with autoimmune diseases such as Myasthenia Gravis, which usually progresses with muscle weakness in the patient.

Thymic carcinoma: Thymus cancer with an aggressive course

Thymic carcinoma is a type of cancer that is much rarer than thymoma but is more biologically aggressive.

These cells look very differentiated from thymus tissue when viewed under the microscope and multiply rapidly.

At the stage of diagnosis, they are usually likely to have spread to surrounding tissues, lymph nodes or distant organs.

Surgery alone may not be sufficient in the treatment process; Due to its aggressive nature, chemotherapy and radiotherapy support is often required.

Causes and Risk Factors of Thymus Gland Cancer

The exact cause of thymus gland cancer is still not fully clarified in the medical world.

Unlike other types of cancer, there is no direct link to smoking, dietary habits or environmental factors.

Although studies on genetic predisposition are ongoing, most cases occur without showing a familial transmission.

The disease usually occurs in adults between the ages of 40 and 70 and there is no significant difference in distribution between the sexes.

What are the Symptoms of Thymus Gland Cancer?

Thymus gland cancers usually progress without any symptoms in the early stages and are detected incidentally during routine check-ups.

However, as the mass grows or begins to put pressure on surrounding organs, significant clinical findings occur.

Pressure and Pain in the Rib Cage

Since the tumor is located just behind the breastbone (sternum), the most common symptom is a feeling of pressure in this area.

Patients often complain of blunt pain in the middle of the chest that does not go away or a tightness that is felt when breathing.

This pain can sometimes radiate to the back or shoulders.

Upper Vena Cava Syndrome (Swelling in the Face and Neck)

A thymus tumor can put pressure on the main vein (Vena Cava Superior) that carries dirty blood from the upper body to the heart.

As a result of this pressure, it becomes difficult for blood to return to the heart and the following symptoms develop:

Significant swelling (edema) on the face, neck and arms.
Prominence and enlargement of the neck vessels.
Dizziness and persistent headaches.
Bruising or redness of the skin.

Myasthenia Gravis (Muscle Weakness) Symptoms

About half of patients with thymus gland cancer have Myasthenia Gravis, in which the immune system attacks the body’s own muscles.

This condition is caused by the thymus tissue working abnormally and producing faulty antibodies.

The most characteristic symptoms are:

Increased eyelid drooping (ptosis), especially towards the end of the day.
Complaints of double vision or blurred vision.
Fatigue quickly when chewing and swallowing.
Muscle weakness felt when climbing stairs or raising arms.

Prof. Dr. Levent Alpay: Silence of symptoms in thymus gland cancer may cause the tumor to grow at the time of diagnosis. However, the presence of neurological findings such as Myasthenia Gravis sometimes acts as an “early warning system” that allows the tumor to be caught when it is at a very small stage. It is a life-saving step for patients experiencing these symptoms to consult a thoracic surgeon without wasting time.

Thymus Gland Cancer Diagnosis and Staging Process

Making an accurate diagnosis of thymus gland cancer begins with understanding the tumor’s relationship with surrounding tissues in millimeters.

The diagnostic process is usually triggered by a chest X-ray taken upon complaints or incidentally.

However, advanced imaging techniques are needed for definitive diagnosis and surgical planning.

Radiological Imaging: CT, MRI, and PET-CT

Computed Tomography (CT) is the gold standard for diagnosing thymus tumors, showing the tumor’s size, shape, and proximity to the vessels.

Magnetic Resonance (MRI) offers more detailed tissue contrast, especially to understand whether the tumor has entered the heart or large vessels (invasion).

PET-CT is used to detect whether there is a spread in the rest of the body and to measure the biological activity of the mass.

Evaluation with Masaoka-Koga Staging System

Thymus gland cancers are staged with the globally accepted Masaoka-Koga system.

This system focuses on whether the tumor has exceeded the outer capsule of the thymus gland and has spread to surrounding organs.

In Stage 1, the tumor is completely encapsulated, while in Stage 4, there is spread to distant organs or the pleura.

Thymus Gland Cancer Treatment Methods

The treatment plan is personalized based on the staging results and the patient’s overall health.

The most effective and primary treatment method for thymus gland cancers is complete surgical removal of the tumor.

Surgical Treatment (Thymectomy Surgery)

Thymectomy is the surgical removal of the thymus gland and surrounding fat tissues with potential risk.

The success of the surgery depends on the removal of the tumor without leaving any tissue behind (R0 resection).

If the tumor is attached to the pleura or vessels, the surgeon may plan an extended surgery to include these areas.

Closed Thymus Surgery (Robotic and VATS Techniques)

Today, closed methods called “minimally invasive” are preferred in appropriate cases.

VATS (Video-Assisted Thoracoscopic Surgery) is performed with a camera through small holes opened on the side of the chest.

Robotic Surgery, on the other hand, provides the surgeon with high-resolution 3D images and precise movement in the narrow anterior mediastinum region.

Multidisciplinary Approach: Chemotherapy and Radiotherapy

Additional treatments are added to surgery, especially in aggressive thymic carcinomas or advanced thymomas.

Chemotherapy may be administered to shrink the tumor before surgery (neoadjuvant) or to reduce the risk of recurrence after surgery (adjuvant).

Radiotherapy, on the other hand, is used to provide local control in cases where the surgical margins are close to the tumor or complete cleaning is difficult.

Thymus Gland Cancer Treatment Comparison Table

Method	Application Purpose	Recovery Time	Oncological Impact
Closed Surgery (VATS/Robotics)	Complete removal of the tumor	3 – 5 Days	High (Early Stage)
Open Surgery (Sternotomy)	Cleaning of large and adherent tumors	1 – 2 Weeks	Maximum Vision
Radiotherapy	Regional cell control	Session-based	Local protection
Chemotherapy	Systemic cell control	Cure-based	Spread prevention

Preoperative Preparation and Postoperative Recovery Process

Before the surgery, the patient’s pulmonary function tests and cardiological evaluations are meticulously performed.

Especially in patients with Myasthenia Gravis, a coordinated preparation is carried out with the neurologist to prevent a respiratory crisis after surgery.

Patients treated with the closed method after surgery are usually discharged within 48 hours.

Patients should avoid heavy lifting for the first few weeks and continue breathing exercises, which speeds up recovery.

Survival and Follow-up Protocols for Thymus Gland Cancer

Since thymus cancers can progress slowly, the postoperative follow-up process should be spread over years.

10-year survival rates are over 90% in tumors caught at an early stage (Stage 1 and 2) and completely removed.

In the follow-up protocol, computed tomography checks are recommended every 6 months for the first 2 years and annually in the following years.

Prof. Dr. Levent Alpay: The most critical point in thymus cancer surgery is to remove not only the visible tumor, but also the entire thymus gland and surrounding fatty tissues in “blocks”. An incomplete thymectomy carries the risk of recurrence years later. For this reason, it is vital to perform the operation with a team that has a good command of the anatomy and oncological surgery principles of this region.

Case Experience (Anonymous):

A 45-year-old male patient who was found to have a 5 cm mass in the anterior mediastinum during a routine health screening underwent robotic thymectomy. The pathology result was reported as Stage 2 thymoma and all surgical margins were clear. The patient was discharged on the 2nd day of surgery and no signs of recurrence were found in the 5-year follow-up.

For detailed information and oncological surgical evaluation, you can consult an expert and make an appointment with our clinic.

Frequently Asked Questions

Can Thymus Gland Cancer Be Completely Cured?

The complete cure rate is quite high in thymus cancers diagnosed at an early stage and completely removed by surgery.

Will There Be Hoarseness After Surgery?

If the tumor is too close to the nerves that control the vocal cords, there is a risk of temporary or permanent hoarseness, but this risk is minimized with modern techniques.

Does the Immune System Collapse When the Thymus Gland is Removed?

No, removal of the thymus gland does not adversely affect immunity in adults, as the immune system delegates its function to other organs and the lymphatic system.

Scientific Bibliography