Thymus cancer is a malignant tumor that develops in the cells of the thymus (thymus). The thymus is a part of the endocrine system, it synthesizes hormones that help cells function. He also - make up a segment of the lymphatic system, which produces cells to fight infections and diseases, maintaining the normal operation of immunity . Thymus cancer means that your body can not fully resisting tumor, since the immune system is not functioning properly. Cancer of the thymus is not the most common disease, but in any case it can be treated effectively if we turn for help in time to the clinic Assuta
Cancer Treatment in Israel is:
- Accurate diagnosis in a short time.
- Comprehensive and individual approach to diagnosis and treatment.
- Effective application methods in organ surgery.
- Application of the most recent protocols of chemotherapy and radiotherapy.
- The ability to use the latest developments in oncology due to the rapid implementation in practice.
Assuta - one of the largest medical centers in Israel, well-equipped with the latest medical technology. At work here are invited to the best doctors in Israel on a contract basis.
Let us consider the disease itself, and methods for its diagnosis and treatment in Assuta.
About cancer of the thymus gland and its types
The thymus gland is located behind the breastbone between the lungs. It is most active during childhood and adolescence. The thymus gland has two lobes, each of which has three layers. The outer layer is called a capsule, is located inside the crust, and the third layer is the bone marrow. Cortex and medulla are composed of epithelial cells and lymphocytes. Epithelial cells form a layer which covers the blood vessels and connective tissue in the thymus.
Most often, cancer of the thymus develops in epithelial cells in the cerebral cortex. Thymoma - the most common cancer of the thymus gland. In the past, thymoma were divided into benign and malignant. However, studies show that all thymoma have the potential to become cancerous. Non-invasive thymoma is within the thymus capsule, it is easily removed by surgery. Invasive tumor spread into the surrounding organs and structures gland, they are difficult to be removed by surgery.
Another type - cell carcinoma, a rare and aggressive. It mainly diagnosed in the later stages, it has a poor prognosis. Several distinct subtypes of carcinoma most frequently occurs - squamous subtype. All subtypes are treated equally - is removed surgically, if possible; with inoperable tumors treated to radiation, chemotherapy or chemoradiotherapy.
The rare species of thymic cancer include:
- Nehodzhikinskuyu lymphoma and Hodgkin's lymphoma. For their treatment used cytostatics, irradiation or chemoradiotherapy.
- Neuroendocrine tumors are treated with surgery, biological therapy, chemotherapy, irradiation or a combination of these methods.
- Germ cell tumors (germ cell tumor) cells develop into sperm in males and eggs in females. For their treatment involve surgery, cytotoxic drugs, radiation, or a combination of methods.
Reasons thymoma thymus
Most often, cancer of the thymus gland develops in people between 40 and 60 years, 50 years - the most common age.
Scientists refer to the possible risk factors that are associated with autoimmune diseases. This disorder in which the immune system attacks healthy tissue in the body.
- Myasthenia gravis is muscle weakness, can affect the eyes, face, neck, arms, legs or chest. About 30-65% of people with malignant thymoma have myasthenia.
- Red cell aplasia - a disease in which the body does not produce enough red blood cells, 5% of people suffer with thymoma aplasia.
- Hypogammaglobulinemia - a disease in which the body produces an insufficient amount of B-cells. This type of white blood cells, which protects the body against infection by creating antibodies or immunoglobulins. 5-10% of people with thymoma sick hypogammaglobulinemia.
- The following autoimmune diseases are also sometimes associated with thymoma: polymyositis, systemic lupus erythematosus, rheumatoid arthritis, thyroiditis, Sjogren's syndrome.
Symptoms thymoma (thymic cancer)
Signs of thymic tumors arise when it puts pressure on the surrounding structures. The symptoms of thymoma or thymic carcinoma may also be caused by other diseases.
The main symptoms of the disease:
- inconsistent breathing;
- chest pain;
- noise during breathing, swelling of the triggered pressure trachea;
- coughing, sometimes with blood;
- difficulty swallowing;
- loss of appetite;
- loss of body weight;
- compression of the superior vena cava syndrome;
- pleural effusion;
- Horner's syndrome.
This is a group of symptoms that develop when tumor cells release substances that affect the normal functioning of other body parts.
Thymoma and thymic carcinoma may provoke paraneoplastic autoimmune disorder where the immune system attacks its own body. The three most common syndrome: male, red cell aplasia and hypogammaglobulinemia.
Myasthenia gravis is most often associated with thymoma. Signs of it include:
- severe muscle weakness;
- drooping eyelids;
- double vision
- difficulty swallowing.
When red cell aplasia in the body can not produce sufficient red blood cells, causing anemia. Symptoms of the disease:
- inconsistent breathing;
When hypogammaglobulinemia in the body there is a lack of gamma globulin (proteins, infection-fighting), resulting in a higher risk of infection.
Diagnosis thymoma (thymic cancer) in Assuta
Diagnosis of thymoma in Israel may include the following types of surveys:
- Medical history, physical examination. The doctor collects information about the symptoms, risk factors and other diseases, family history. Physical examination is aimed at finding evidence of: the bottom part of the neck to the presence of any swelling; check for the presence of symptoms of myasthenia gravis (muscle weakness in the face and neck).
- Chest X-ray is used to search mediastinal tumors (space between the lungs, rib cage and spine). Often it is performed first, followed by a CT scan.
- CT is used to determine the location of the tumor, to assess its size, check out the invasion of tumor into the blood vessels or heart. Also it is used for diagnosis of rare tumors - thymic lymphomas.
- A biopsy involves taking a tissue sample. Used needle biopsy (under the guidance of CT) and fine needle aspiration.
- Mediastinoscopy is performed when a biopsy is not possible to collect a sufficient amount of tissue, or in the desired area can not be penetrated during the biopsy. This survey is also used to find out how far the tumor has spread.
- Thoracoscopy is operated for diagnosis of tumors in the chest when Mediastinoscopy can not access or stadirovat tumor thymus. Apply thoracoscopy for the study of structures in the thoracic cavity and sampling.
- Biochemical analysis of blood is used in cases when there is suspicion of myasthenia gravis, as well as a possible pathological process is not in the thymus, and from the thyroid gland.
- Measured levels of antibodies to acetylcholine receptor (Anti-AchR). People with myasthenia gravis may have abnormally high levels of antibodies and the high risk of breathing problems during surgery.
- Investigated the levels of thyroid hormone - TSH, T4 and T3 in the situations where the photographs tomography is difficult to recognize the difference between the enlarged thyroid gland and a tumor of the thymus gland.
- The test for the presence of tumor markers - alpha-fetoprotein and human chorionic gonadotropin - carried out for the diagnosis of germ cell tumors of the thymus, as well as to exclude carcinoma tumor.
- A complete blood count provides information on the general state of health.
- Pulmonary function tests determines how healthy people to undergo surgery.
- Echocardiography is aimed at finding pericarditis and check the heart.
Forecast thymoma thymus
Prediction of the thymus gland cancer depends on many factors:
- stage of the disease - a more favorable prognosis for stages 1 and 2;
- the type of tumor - cell carcinoma of the thymus has a poor prognosis;
- the possibility of operation - the complete removal of the tumor provides a more favorable prognosis.
There is relative, the overall statistics for all endocrine cancers - celebrated the 5-year survival rate to 63% of patients. Thymoma and thymic carcinoma how rare that is difficult to find accurate statistics on survival.
A concrete prognosis of malignant thymoma thymus is determined based have the following factors:
- medical history;
- type of tumor of the thymus;
- Step thymic cancer;
- characteristics of the disease;
- the response of the organism to therapy.
Only a doctor who owns all these factors, the information can be compared with the statistics of survival that come to a definite prediction.
Treatment of thymoma (cancer of the thymus gland) in Israel
Treatment of thymoma, thymic carcinoma in Assuta conducted by a team of highly qualified doctors - oncologists who specialize in surgery, radiotherapy, chemotherapy. a team of doctors helping a patient decide on a plan of therapy.
thymoma treatment program tailored to the stage of the disease, the general state of health. these therapies may be recommended.
Surgery for prostate thymoma fork in Assuta
Surgery is the main treatment of thymomas and thymic carcinomas. Choosing the type of operation is determined by the size of tumor, stage of the disease.
Total thymectomy is the primary means of treatment of thymoma in the very early stages of development. It involves the complete removal of the thymus gland. Thymectomy is performed using the following approaches:
- Median sternotomy involves an incision in the middle of the chest, creating a hole to reach thymus. This operation is carried out, if the tumor is located inside the capsule, it has not spread to surrounding tissues.
- Anterolateral sided thoracotomy with transverse strenotomiey - operation, during which the incision is made through the chest wall (thoracotomy) just under the breast, then the procedure transverse sternotomy.
Cytoreduction aims at removing the maximum amount of tumor, can be used in the later stages of the disease. Removed as much of the tumor as possible before will be used other methods - chemotherapy or radiotherapy. But studies have shown that this surgery improves survival.
Accommodation drainage tubes . During surgery to remove the tumor of the thymus surgeon places a drain tube extending from the thoracic cavity, through the ribs on the body surface. The tube is inserted into the bottle with sterile water and is connected with special equipment. It is attached to the body with tape. Drainage drained by the blood and other fluids removed from the air space around the lungs (the pleural cavity) after surgery.
Myasthenia operation and thymus cancer
Myasthenia gravis, a chronic autoimmune disease associated with thymoma. This condition causes muscle weakness. Require additional care during surgery. Muscle relaxants are commonly used in general anesthesia. They cause a partial or complete loss of sensation, feeling or consciousness. However mioreleksanty can cause breathing problems in infants. in the blood plasma of people with myasthenia contains antibodies that trigger muscle weakness. Before surgery, plasmapheresis (removal of blood plasma) may be conducted at thymoma.
Potential side effects of surgery thymus gland tumors:
- The pain often people have for several weeks after surgery, which may make it difficult to breath and the implementation of special breathing exercises to improve lung function and prevent complications. Effective pain medications used for pain management.
- Possible risk of bleeding, if there are problems with blood clotting, or has not been closed vessel during the operation.
- After thymectomy noted the likelihood of infection. For its prevention and treatment of antibiotic therapy is used.
- After extensive surgery for lung distributed two major problems - pneumonia (caused by infection of the lungs) and lung collapse (is caused air accumulation between lungs the pleura and the chest wall).
Radiotherapy, which uses high-energy rays to kill cancer cells, can be recommended for the treatment of thymomas and thymic carcinomas:
- after surgery and chemotherapy to destroy the remaining abnormal cells, to reduce the likelihood of a return of the disease;
- as the primary treatment with chemotherapy or separately.
The radiation dose is calculated for each case.
Thymoma or a thymic carcinoma are usually treated with external beam radiation therapy. Linear accelerator directs radiation to the tumor and some surrounding tissue.
Assuta Hospital doctors very carefully planned therapy to maximally protect located near organs - the heart and lungs, directing radiation to the affected area.
Malignant thymoma rarely spreads to the lymph nodes, thymus carcinoma contrary - often affects the lymph nodes near the tumor of the thymus gland, even at an early stage. Therefore, the treatment is considered to it with radiation therapy.
Potential side effects of radiation therapy for tumors of the thymus include:
- increased fatigue;
- skin reactions - darkening or scarring, redness, dryness, itching;
- difficulty swallowing, painful swallowing;
- lung problems - radiation pneumonitis (inflammation of the lungs caused by exposure of the chest), pulmonary fibrosis (lung tissue replaced by fibrous scar tissue);
- heart problems, if radiation therapy affects the region of the heart and mediastinum, especially when applied doxorubicin.
Treatment with cytotoxic drugs may be recommended along with radiation or separately at later stages of the disease. Chemotherapy is not applicable at an early stage thymoma located in the thymus capsule since studies have shown that this does not improve survival or reduce relapse.
Chemotherapy is recommended in all stages of thymic carcinoma, though the cancer does not respond well to therapy.
The main indications:
- as a basic treatment in conjunction with radiation or separately;
- before surgery with radiotherapy or separately to reduce the swelling of the thymus;
- after surgery to remove the body from potentially malignant cells remaining;
- to ease the pain, to control the symptoms of metastatic thymoma or thymic carcinoma of the thymus.
chemotherapy drugs for cancer of the thymus
Combination chemotherapy is most often used. The most common schemes:
- cisplatin (Platinol AQ), etoposide (VePesid), with or without ifosfamide (IFEX);
- doxorubicin (adriamycin), cisplatin and cyclophosphamide (Cytoxan, Procytox);
- vincristine (Oncovin), doxorubicin and cyclophosphamide;
- cyclophosphamide, doxorubicin, and cisplatin.
The following combinations are also prescribed for carcinoma of the thymus in Assuta:
- carboplatin (Paraplatin, Paraplatin AQ) and paclitaxel (Taxol);
- 5-fluorouracil (Adrucil, 5-FU) and leucovorin.
There is no standard treatment, if thymoma or thymic carcinoma of the thymus does not respond to chemotherapy, or if relapse occurs. Other drugs that can be used:
- pemetrexed (Alimta);
- gemcitabine (Gemzar);
- octreotide (sandostatin).
Possible side effects of chemotherapy, tumors of the thymus
- vomiting, nausea;
- inhibition of bone marrow: the lack of white blood cells, platelets, red blood cells;
- kidney problems - cisplatin can cause damage to the kidneys;
- disturbances in the heart - cardiotoxicity, its symptoms - shortness of breath, rapid or irregular heartbeat, cough, swelling of the hands or feet;
- lung injury often occurs during radiation therapy of the chest, requires identifying the early stages due to the irreversibility of engagement;
- disorders of the nervous system, especially when using cisplatin and paclitaxel - ringing in the ears, hearing loss, numbness or tingling in the hands and feet, muscle weakness;
- changes in skin - rash, or increased sensitivity to the sun;
- allergic reactions - shortness of breath, skin rash or hives, swelling of the face, tongue or throat.
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