What Are Thymic Carcinomas?
Thymic carcinomas are rare but highly aggressive, easily metastasizing cancer derived from thymic epithelial cells and have a very poor prognosis.
Unlike thymoma, associated with paraneoplastic syndrome, thymic carcinoma is almost always found at an advanced stage because patients often have atypical symptoms.
It causes symptoms when there is tumor compression and superior vena cava syndrome. Systemic findings such as fever and weight loss are also common. Consult your doctor if you have any of the following:
- A constant cough.
- chest pain.
- Difficulty breathing.
There is no known tumor marker for screening thymic carcinomas.
Pathology: The most common type is squamous cell carcinoma. It exhibits standard features with squamous cell carcinomas of other organs; It can be keratinized or non-keratinized
Treatment:Complete resection of the tumor leads to the best survival rate for patients.
Our first choice is to remove the tumor with Robotic surgery or the VATS method, that is, minimally invasive techniques. The general aim should be to complete resection without any residual tissue.
- Thoracoscopic /VATS; It is the most preferred method. It is a closed method with two or three incisions. Thymoma/thymic carcinoma is resected without cutting the sternum and through small incisions. It has many advantages, including aesthetics, less pain, and early discharge.
VATS; should not be preferred in tumors with a huge diameter to prevent the tumor's spreading.
- Robotic surgery; The surgeon makes small, precise movements with his hands, wrists, and fingers and converts these movements into real-time micro-movements. A surgeon standing at the patient's bedside during the operation helps the surgeon at the console. Like our eyes, the procedure is under a 3D image with a sense of depth on the console. The operation area is enlarged 10-12 times with cameras.
By magnifying the anatomical structures in deep and narrow areas with the camera, injuries that may occur during surgery are minimized. The surgeon gives commands using the camera and other tools with the help of his hands and feet.
Thanks to the system called 'endowrist,' these tooltips can rotate 540 degrees around their axis and imitate the wrist movements of the human hand. In robotic surgery, the possible hand tremor of the surgeon during the operation is not transmitted to the instruments in any way.
- Median Sternotomy. Median sternotomy should be the standard approach in locally advanced cases, especially if large vessels are involved, superior vena cava invasion, and the tumor diameter is huge.
- Thoracotomy: Sometimes, if the tumor's location is risky, we prefer to perform a thoracotomy.
Thymoma/Thymic carcinomas Since Myasthenia Gravis sometimes accompanies thymoma/thymic carcinomas, paying attention to the phrenic nerves is crucial. Phrenic nerve injury causes respiratory distress.
Neoadjuvant Therapy: In locally advanced cases, we can sometimes prefer surgery after Chemotherapy and Radiotherapy.Post-operative Radiotherapy and Chemotherapy are preferred in advanced cases.
Recurrent Thymoma and Thymic Carcinoma
Recurrent thymoma and thymic carcinomas recur (come back) after treatment. Cancer may recur in the thymus or other parts of the body. Thymic carcinomas often recur. Thymomas can recur after a long time. For these reasons, lifelong follow-up is necessary.