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Thymoma is the slower-growing kind of thymic epithelial tumour, an indolent cancer of the thymus gland behind the breastbone that often announces itself through the autoimmune disease myasthenia gravis. Complete surgical removal cures most patients, radiotherapy is added when the tumour has grown through its capsule, and chemotherapy is used to shrink large tumours or control spread in the chest.
Thymomas are tumours of thymic epithelial cells mixed with non-neoplastic immature T lymphocytes, classified by the WHO into types A, AB, B1, B2 and B3 by the shape of the epithelial cells and the density of lymphocytes, with B3 the most aggressive and A and AB the most indolent. Type A and AB tumours nearly all carry the GTF2I L424H mutation, a finding unique to thymoma, while B thymomas have few recurrent mutations. Because the thymus educates T cells, thymomas are tied to autoimmunity: about a third of patients have myasthenia gravis, others have pure red cell aplasia, hypogammaglobulinaemia (Good syndrome) or other autoimmune conditions, and acetylcholine receptor antibodies are checked before any operation so that myasthenia can be controlled first. Stage, whether by the Masaoka-Koga system or the TNM system introduced in 2017, and completeness of resection matter more than histology for survival.
Surgery is the treatment. Encapsulated tumours are removed whole with the thymus, increasingly by video-assisted or robotic approaches, and the guidelines advise against preoperative biopsy of a resectable encapsulated mass. Postoperative radiotherapy is recommended for stage III disease and for incomplete resection and considered for stage II B2 to B3 tumours, and unresectable or bulky tumours are given induction chemotherapy with cisplatin, doxorubicin and cyclophosphamide (CAP) or a platinum-etoposide doublet before reassessment for surgery. Pleural spread is treated with repeated resection or, in some centres, pleurectomy. For recurrent disease not amenable to local treatment, chemotherapy is repeated, octreotide with prednisone helps octreotide-scan-positive tumours, everolimus produced disease control in a phase 2 trial, and sunitinib and lenvatinib have activity; PD-1 antibodies are used with great caution because thymoma patients develop severe myocarditis, myositis and other immune toxicity far more often than other cancer patients. Thymoma recurs late and slowly, so follow-up runs for at least ten years.
The commonest tumour of the anterior mediastinum in adults yet rare in absolute terms; most are found at stage I or II, and about a third of patients have myasthenia gravis.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Large cell neuroendocrine carcinoma of the lung, Thymic carcinoma
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
Contrast CT of the chest, acetylcholine receptor antibodies and neurology review; no biopsy of a resectable encapsulated mass; MRI to separate thymoma from cysts and hyperplasia.
Complete thymectomy with the tumour, by sternotomy or minimally invasive or robotic approaches for smaller tumours; en bloc resection of involved pericardium, lung or vessels for stage III.
Postoperative radiotherapy for stage III or incomplete resection; considered for stage II B2 to B3 tumours; observation for completely resected stage I and II type A to B1.
Induction chemotherapy with cisplatin, doxorubicin and cyclophosphamide (CAP) or a platinum doublet, then surgery or radiotherapy according to response.
Repeat resection of pleural recurrences where feasible; chemotherapy rechallenge; octreotide with prednisone for octreotide-scan-positive tumours; everolimus, sunitinib or lenvatinib; PD-1 antibodies avoided or given only in trials because of severe immune toxicity.
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The names on a thymic pathology report, and the sharp line between thymoma and thymic carcinoma that drives treatment, come from this classification.
The thymoma and thymic carcinoma pages follow this guideline for who gets surgery, radiotherapy and chemotherapy; its central message is that these rare tumours should be discussed in an expert network.
Whether a thymoma is called stage I or stage III, and hence whether radiotherapy follows surgery, still traces back to this scheme.
Query for this cancer: (TITLE:"Thymoma" OR ABSTRACT:"Thymoma" OR TITLE:"WHO types A, AB, B1, B2 and B3" OR ABSTRACT:"WHO types A, AB, B1, B2 and B3" OR TITLE:"Type A thymoma" OR ABSTRACT:"Type A thymoma" OR TITLE:"Type AB thymoma" OR ABSTRACT:"Type AB thymoma" OR TITLE:"Type B thymoma" OR ABSTRACT:"Type B thymoma" OR TITLE:"Thymoma with myasthenia gravis" OR ABSTRACT:"Thymoma with myasthenia gravis") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Thymoma (WHO types A, AB, B1, B2 and B3), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
QT: both Sunitinib and Lenvatinib prolong the QT interval (known and known risk).. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Avoid grapefruit. Live vaccines are contraindicated.
See all on the product pages:CarboplatinCisplatinCyclophosphamideDoxorubicinEverolimusLenvatinibPaclitaxel / nab-paclitaxelSunitinib·Printable cards in the navigator
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