Treatment of Thymus Cancer in Germany
Best hospitals and doctors for thymus cancer treatment in Germany
Leading hospitals
Cost for treatment
Thymus cancer is a rare neoplasm that develops in the mediastinum. In Germany, it is treated with surgical interventions: not only open but also minimally invasive ones. After surgery, most patients receive radiation therapy. In the advanced stages of cancer, chemotherapy is used, and sometimes targeted therapy and immunotherapy can also be used.
Content
- What is thymus cancer
- Thymus cancer symptoms
- Diagnostics
- Principles of treatment
- Surgical treatment
- Radiation therapy
- Chemotherapy
- Targeted therapy and immunotherapy
- Why is it worth undergoing thymus cancer treatment in Germany
What is thymus cancer
Thymic tumors are epithelial neoplasms that belong to one of three types.
- thymoma;
- thymus cancer;
- neuroendocrine tumor of the thymus gland.
These are rare tumors that account for up to 0.5% of all cancers.
There are different types of thymoma: benign, intermediate, and malignant tumors. Malignant neoplasms are referred to as thymus cancer. This is a severe oncological disease with a five-year patient survival rate of about 55%. However, if detected at stage 1, this figure is 90%, and at stage 2, the survival rate reaches 70%.
Thymoma can develop at any age, and thymic carcinoma occurs predominantly in people over 70. The causes of malignant neoplasms of the thymus are unknown. Risk factors have not been established.
Thymus cancer symptoms
The main symptoms of the disease are associated with tumor growth and compression of the surrounding organs:
- dyspnea;
- cough;
- bloody sputum;
- hemoptysis;
- chest pain;
- dysphagia (difficulty swallowing);
- loss of appetite;
- weight loss.
Since the thymus gland is located next to the superior vena cava, with the growth of the tumor, its compression is possible. In this case, additional symptoms may develop:
- facial swelling;
- bulging neck veins;
- bluish color to the neck and upper chest;
- headache;
- dizziness.
With thymoma, half of the patients develop myasthenia gravis. This is an autoimmune inflammation that blocks neuromuscular transmission. Patients easily get tired, suffer from muscle weakness, have difficulty climbing stairs, and cannot walk long distances. These patients often have droopy eyelids, double vision, difficulty swallowing, and may also experience shortness of breath due to respiratory muscle weakness.
Diagnostics
The diagnostics involve the use of instrumental methods. Some patients undergo a tumor biopsy.
Chest X-ray is often the first examination that a doctor prescribes to patients complaining of pain, shortness of breath, dysphagia, and other symptoms. The doctor can see a mediastinal tumor on the X-ray image. In addition, small growths are sometimes detected incidentally when the X-ray scan is taken for another disease (for example, pneumonia).
Computed tomography is a more accurate method of examining chest organs. It allows doctors to assess the size, shape of the tumor, spread to the adjacent tissues, and the presence of metastases in the regional lymph nodes. Whenever required, a CT-guided biopsy is performed.
A biopsy is not required for all patients. It is not performed if the doctor is sure that the mediastinal tumor is not lymphoma and cancer treatment is planned to begin with surgery. Nonetheless, a biopsy is required in some cases to rule out lymphoma and is also performed for patients for whom chemotherapy is the first treatment. The drug treatment scheme depends on the histological type and grade of cancer.
MRI is infrequently used for thymic carcinoma. It is an alternative to CT scanning for people whom this test is contraindicated. But MRI is a less accurate method of chest scanning.
PET is a radionuclide test to detect distant metastases if any. This diagnostic test allows scanning the entire body and identifying metastatic foci in the lymph nodes and distant organs. This diagnostic test is required in cases where the doctor suspects the presence of distant metastases but does not know where they developed.
Principles of treatment
The patients with stage 1 are candidates for surgery. The treatment for patients with stage 2 may be different: surgery or radiation therapy. The issue is resolved individually.
Histological verification of the tumor before surgery is not mandatory, so the biopsy is not performed. The neoplasm is removed, and only after that, the surgical material is examined in the laboratory.
If there is suspicion that the formation found in the mediastinum may not be thymus cancer but lymphoma, then a biopsy is performed. Lymphoma is treated with chemotherapy, but not surgery, so the doctor needs to know what kind of tumor they are dealing with before starting treatment.
Whether the patient needs treatment after surgery depends on:
- type of thymus cancer;
- stages;
- grade;
- the radicalness of the operation performed (whether the doctor managed to remove cancer completely).
An unequivocal indication for radiation therapy to treat thymus carcinoma is incomplete resection. The residual tumor is destroyed by radiation. The therapy is carried out no later than three months after surgery.
In some patients, the tumor is recognised as unresectable at the time of detection of thymus cancer. In this case, it can be converted to a resectable state and then removed. In stage 3, the treatment usually begins with chemotherapy. If the neoplasm decreases in size, the operation is performed. The next step is radiation therapy.
10-15% of patients after the surgical treatment of thymus cancer develop relapses. In such situations, the second operation is under consideration.
In metastatic thymus cancer (stage 4), the main treatment method is chemotherapy. Not all patients get good results. In case of response to therapy, the tumor may shrink. A doctor can remove it completely along with metastases. Therefore, after successful chemotherapy for cancer of any stage, the issue of surgical treatment and adjuvant radiation therapy is discussed.
After the initial treatment, patients are monitored. They are periodically examined to timely detect cancer recurrence. The diagnostic examination is carried out once in six months in the first two years, then one time per year. The follow-up period for the thymus gland cancer is five years. For thymoma, it is ten years.
Surgical treatment
The goal of radical surgery is to remove the entire tumor mass and the thymus gland. The resection of the adjacent structures may be required: pericardium, pleura, lung, phrenic nerve, and great vessels. During the removal of the thymus gland, pleural revision is performed. The doctors always remove the cellular tissue surrounding the thymus gland with lymph nodes.
If the doctor has doubts that cancer has been completely removed, he marks the resection margins with surgical clips. They are necessary for subsequent radiation therapy.
There are two types of surgery to remove thymus cancer:
- median sternotomy is a classic surgical intervention through a large incision in the center of the chest;
- Thoracoscopy is a minimally invasive intervention through short incisions, with long thin instruments, under the control of a video camera.
The minimally invasive version of the operation is not considered the standard treatment method since the intervention is technically complex. It is performed only in specialized centers. In Germany, such operations for thymus carcinoma are performed on patients with stage 1 or 2 diseases.
Radiation therapy
Radiation therapy for cancer can be used in the following cases:
- after surgery to remove thymus cancer – at any stage;
- after surgery to remove thymoma of any stage, except for the first one;
- to curb the growth of the inoperable tumor;
- at the advanced stage, with a palliative purpose (to relieve symptoms: pain, shortness of breath, bleeding, dysphagia).
Hospitals in Germany use advanced radiation therapy options: IMRT and VMAT, which can reduce radiation exposure to critical organs. The scope of irradiation includes the area of the primary tumor, anterior, superior, and middle mediastinum. Lymph nodes and pleura are not irradiated for prophylactic purposes. Nonetheless, they can be included in the radiation zone with the signs of metastasis detected.
Vital organs surround the thymus gland. It is important to direct the radiation to the tumor very precisely to avoid complications. Therefore, doctors use 3D or 4D respiratory-gated planning. The dose of radiation and the number of fractions are selected individually, depending on the presence and volume of the residual tumor.
Chemotherapy
Chemotherapy for thymus cancer can be conducted in the following cases:
- after surgery to reduce the risk of recurrence;
- before surgery to shrink the tumor and destroy metastases;
- with the presence of medical contraindications to surgery – alone or in combination with radiation therapy;
- in the advanced stages of cancer.
For thymoma chemotherapy, doctors use CAP, ADOC, and EP regimens. In the case of thymus cancer, TC and GEM-CAP schemes are used, and monotherapy with one drug is possible. 4 to 6 cycles are usually required. If chemotherapy is started before surgery, patients receive 2-4 cycles. The remaining cycles of chemotherapy are completed after cancer removal.
In the advanced stages of cancer, chemotherapy is used as the main treatment method. It does not cure the disease but relieves symptoms and increases the life expectancy of patients. Approximately one-third of patients respond to first-line chemotherapy, and one in five respond to second-line chemotherapy. If, after successful first-line therapy, a relapse occurs more than six months later, this regimen is likely to work again. But if the relapse occurs earlier, or the patient does not respond to first-line chemotherapy, doctors switch to the second-line regimen.
Hospitals in Germany conduct not only systemic but also topical chemotherapy. It is not yet part of the standard treatments but is already used in some specialized hospitals. Hyperthermic intrathoracic chemotherapy (HITHOC) is used for advanced cancer. It is performed immediately after tumor removal surgery. Doctors wash the chest cavity with a heated solution of chemotherapy drugs to kill any remaining cancer cells and reduce the risk of cancer recurrence.
Targeted therapy and immunotherapy
Targeted therapy and immunotherapy are rarely used. In 10% of cases, thymus carcinoma has a mutation in the c-KIT gene. Such patients can be treated with tyrosine kinase inhibitors. Tumors disappear or decrease in 26% of cases, stabilize in 41% of patients.
Immunotherapy with checkpoint inhibitors is also used as the second-line therapy for thymus cancer. The objective response rate (disappearance or reduction of tumors by more than 30%) is 22.5%. 15% of treated patients develop autoimmune complications.
For patients with thymoma, mTOR inhibitors may be prescribed as well. Objective response is achieved only in 11% of cases, but stabilization of the oncological process is ensured in 88% of patients. With this tumor, analogues of the hormone somatostatin can also be used.
Why is it worth undergoing thymus cancer treatment in Germany
Thymus cancer is a rare type of cancer. But Germany offers specialized centers with extensive experience in treating such patients. You can get medical care in one of the hospitals specializing in mediastinal tumors. There are several reasons for you to undergo cancer treatment in Germany:
- minimally invasive thoracoscopic surgery to remove stage 1-2 cancer (less traumatic compared to a large incision in the center of the sternum);
- experienced surgeons, in most cases, remove cancer completely, which ensures a low risk of recurrence and a smaller volume of postoperative radiation therapy;
- resectable thymus tumors are cured with a probability of up to 90%;
- successful surgical treatment for cancer, even at stages 3-4, is possible if the patient responds to chemotherapy;
- radical surgical operations are performed even for recurrent tumors;
- for postoperative irradiation, doctors use new types of radiation therapy, which can reduce the risk of side effects from the organs surrounding the thymus (including the heart, lungs);
- in addition to chemotherapy, drug treatment for advanced stages of cancer is carried out using targeted therapy and immunotherapy.
To undergo treatment for thymus cancer in a hospital in Germany, you are welcome to use the Booking Health service. On our website, you can get up-to-date and accurate information about the cost of treatment in Germany, compare prices in different German hospitals and book a medical care program at a favorable price. The treatment will be easier and faster for you, and the cost of treatment in Germany will be lower.
Please leave your request on the website of the Booking Health medical tourism facilitator. Our employee will contact you, consult, and answer all your questions. We will take care of the organization of your trip abroad. We will provide the following benefits for you:
- We will select the German hospital whose doctors specialize in thymus cancer treatment and achieve the best results.
- We will help you overcome the language barrier and communicate with the doctor from the German hospital.
- The waiting period for medical diagnosis and treatment for you will be reduced, and you will receive medical care on the most suitable dates.
- We will reduce the price. The cost of treatment in Germany will be lower than usual due to eliminating overpricing and additional coefficients for foreign patients.
- Our specialists will solve any organizational issues: paperwork, transfer from the airport to the German hospital and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You will not have to undergo the previously performed diagnostic procedures.
- We will keep in touch with the German hospital after the completion of treatment.
- We will arrange additional medical examinations and treatment if required.
- We will buy medicines in another country and forward them to your native country.
While the best specialists in the world take care of your health, the Booking Health staff will help reduce the cost of treatment in Germany and take care of all the travel arrangements.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources: