Thymus Cancer. This reference summary will help you better understand what thymus cancer is and what treatment options are available.

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1 Thymus Cancer Introduction Thymus cancer is a rare cancer. It starts in the small organ that lies in the upper chest under the breastbone. The thymus makes white blood cells that protect the body against infections. There are different types of thymus cancers. But the most common types are thymomas and thymic carcinomas. This program focuses on these two types. Thymus This reference summary will help you better understand what thymus cancer is and what treatment options are available. The Thymus The thymus is a small organ. It is made of 2 parts called lobes. It lies in the upper chest, just in front of and above the heart. The thymus is part of the lymph system. The lymph system makes, stores and carries white blood cells throughout the body. White blood cells are a type of immune cell. These cells help the body fight infections and other diseases. Before birth and during childhood, the thymus helps the body make a type of white blood cell. These cells are called lymphocytes.from the thymus, lymphocytes travel to bean-shaped structures called lymph nodes. Lymph nodes are found throughout the body. Here the lymphocytes help fight infection and disease. The thymus is largest in size during puberty. Puberty is the time in life when a boy or girl becomes sexually mature. It usually happens between ages 10 and 14 for girls. For boys, puberty usually happens between ages 12 and 16. The thymus slowly gets smaller through adulthood. Over time, the thymus is replaced by fat tissue. 1

2 Thymus Cancer The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way. This causes an abnormal growth called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor. It is also called a non-cancerous growth. Benign tumors are usually not life threatening. If the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer. Cancer cells spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes. Cancer that moves from one tissue to other body parts is known as metastatic cancer. For example, a thymus tumor may grow through the sac that surrounds the thymus. It can then spread to nearby tissues over time. Cancers in the body are given names depending on where the cancer started. Cancer that begins in the thymus will always be called thymus cancer, even if it spreads to other places. There are different types of tumors of the thymus. Thymomas and thymic carcinomas are rare tumors. They start in the cells on the outside surface of the thymus. The tumor cells in a thymoma look similar to the normal cells of the thymus. These tumors grow slowly. They rarely spread beyond the thymus. The tumor cells in a thymic carcinoma look very different from the normal cells of the thymus. These tumors grow more quickly. They often have spread to other parts of the body when the cancer is found. Thymic carcinoma is more difficult to treat than thymoma. Risk Factors It is usually impossible to specify the cause of cancer in an individual. But we do know what causes cancer in general. Health care providers also know factors that can increase the chances of getting cancer. These are known as risk factors. 2

3 Age is one risk factor for thymus cancer. The risk increases with age. Thymus cancer is most common in people aged 70 years or older. Having certain autoimmune diseases also raises the risk of some types of thymus cancer. These diseases cause the immune system to attack healthy tissue and organs. Those most commonly associated with thymus cancer are: Myasthenia gravis. Acquired pure red cell aplasia. Hypogammaglobulinemia. Myasthenia gravis is a disease. It causes the antibodies made by a person s immune system to not work correctly. The antibodies prevent certain nerve-muscle interactions. This can cause weakness in the arms and legs, vision problems and paralysis. Acquired pure red cell aplasia is a rare disorder. It happens when the bone marrow makes almost no red blood cells. Hypogammaglobulinemia is a condition that raises the risk for infection. The level of immunoglobulins, or antibodies, in the body is low. Antibodies help protect the body from infection and disease. Other autoimmune diseases that also raise the risk of thymus cancer are: Lupus. Polymyositis. Rheumatoid arthritis. Sjögren syndrome. Thyroiditis. Lupus is an inflammatory disease. It affects the joints and many organs, including the skin, heart, lungs, kidneys and nervous system. It can cause many different symptoms. Polymyositis is an inflammatory disease. It affects the muscles closest to the center of the body. It causes weakness, inability to stand, muscle pain and difficulty swallowing. Rheumatoid arthritis, or RA, is an autoimmune disease. This means the body s immune system mistakenly attacks the body s own tissues. RA causes pain, swelling and stiffness in the joints. Sjögren syndrome is an autoimmune disease. This means the body s immune system mistakenly attacks the body s own tissues. Sjögren syndrome affects the tear and salivary glands, causing dry eyes and mouth. It can also affect other glands in the body. Thyroiditis is inflammation of the thyroid gland. 3

4 Not everyone who has risk factors for thymus cancer develops thymus cancer. People who have no risk factors for thymus cancer can still get it. Symptoms Sometimes thymus cancer does not cause any symptoms. It may be found during a routine chest x-ray. When symptoms of thymus cancer do appear, they may include: A cough that does not go away. Chest pain. Trouble breathing. Symptoms of thymus cancer can also include: Difficulty swallowing. Feeling lightheaded. Headaches. Loss of appetite. Swelling in the face, neck or upper chest. Weight loss. These symptoms may not be caused by thymus cancer. Make sure to see a health care provider to find out what is causing your symptoms. Diagnosis The best way to treat thymus cancer is by finding it very early. It is sometimes possible to find this type of cancer even before it causes any symptoms. Your health care provider will ask you about your medical history. He or she will perform a physical exam. Imaging tests can be used to create pictures of areas inside your body. These pictures can show if a tumor is present on the thymus. Imaging tests that may be done include: Chest x-ray. CT scan. MRI. PET scan. 4

5 A CT scan is an x-ray machine linked to a computer. A CT scan takes a series of detailed pictures of your organs. You may be given contrast material by mouth or injection. This will make abnormal areas easier to see. An MRI uses strong magnets to create images of the inside of the body. You may receive contrast material by injection. This will make abnormal areas easier to see. A PET scan can show if the cancer has spread. For this test, you are injected with a small and safe amount of radioactive sugar. The PET scanner makes a picture of the places in your body where the sugar is taken up. Cancer cells show up brighter because they use sugar faster than normal cells. A biopsy of the tumor is done to diagnose thymus cancer. A biopsy is a removal of a sample of cells or tissue. It may be done before or during surgery, using a needle to remove a sample of cells. A pathologist will then examine the biopsy sample. He or she will use a microscope to look for cancer cells. A biopsy is the only sure way to know if a person has thymus cancer. Staging If you have thymus cancer, your health care provider will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. There is no single staging system that all doctors use for thymus cancer. But stages are usually described using the numbers 1-4. A lower number indicates an earlier stage. Staging is helpful in deciding the best course of treatment. When staging thymus cancer, health care providers want to find out: Whether the tumor has invaded tissues outside the thymus. Whether the tumor has spread and, if so, to which parts of the body. If thymus cancer has spread to nearby lymph nodes, it can spread to other areas of the body. Thymomas rarely spread beyond the thymus. Thymic carcinoma usually spreads to other parts of the body. It can spread to the lungs or to the sac around the heart. The imaging tests used to diagnose thymus cancer may also be used to stage it. The staging of thymus cancer may not be complete until after surgery. 5

6 Treatment and Supportive Care The type of treatment used depends on the: Size and location of the tumor. Stage of the disease. General health of the patient. Treatment for thymus cancer may involve: Surgery. Radiation therapy. Chemotherapy. Hormone therapy. Some combination of these treatments may be used. Surgery to remove the tumor is the most common treatment of thymoma. Radiation therapy may be given afterwards, even if the surgeon removes all of the cancer seen at the time of surgery. Radiation therapy kills any cancer cells that are left. It also lowers the risk that the cancer will come back. Radiation therapy uses high energy rays to kill cancer cells. It also stops cancer cells from growing and spreading. External radiation comes from a machine. It aims the rays at a specific area of the body. Internal radiation uses a radioactive substance. It is sealed in needles, seeds, wires or catheters. These objects are placed directly in or near the cancer. The way radiation therapy is given depends on the type and stage of cancer being treated. Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is usually given in the blood stream through an IV or taken by mouth. Chemotherapy and radiation therapy may be done together to treat thymus cancer. But these treatments may also be used on their own, before surgery or after surgery. Hormone therapy is treatment that adds, blocks or removes certain hormones. This can slow or stop the growth of some types of cancer. Hormone therapy with drugs called corticosteroids may be used to treat thymus cancer. 6

7 There may be clinical trials available for people with thymus cancer. Clinical trials test new medical approaches and treatments. Thymus cancer and its treatment can lead to other health problems. It is important to have supportive care before, during and after cancer treatment. Supportive care is treatment to: Control symptoms. Relieve the side effects of therapy. Help you cope with emotions. Supportive care also deals with the pain associated with cancer and its treatments. Your health care provider or a pain control specialist can suggest ways to relieve or reduce pain. Summary Thymus cancer is a rare cancer. It starts in the small organ that lies in the upper chest under the breastbone. The thymus makes white blood cells that protect the body against infections. There are different types of thymus cancers. But the most common types are thymomas and thymic carcinomas. These cancers start in the outer layers of the thymus. Treatment for thymus cancer may involve: Surgery. Radiation therapy. Chemotherapy. Hormone therapy. Some combination of these treatments may be used. Sometimes thymus cancer can be found before it causes any symptoms. The earlier it is found and treated, the more likely that treatment will be successful. Research already has led to advances that have helped people live longer. It continues to find better ways to care for people with thymus cancer. 7

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