The first 60 days: Thymoma (WHO types A, AB, B1, B2 and B3)
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. Below, week by week, is what OnCo's record of Thymoma (WHO types A, AB, B1, B2 and B3) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
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.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Diagnosis and staging.
- RadiologistNamed in the standard of care for: Diagnosis and staging, Recurrent or metastatic disease.
- SurgeonNamed in the standard of care for: Diagnosis and staging, Resectable (stage I to III), After surgery, Unresectable or bulky disease and 1 more.
- Medical oncologistNamed in the standard of care for: Diagnosis and staging, After surgery, Unresectable or bulky disease, Recurrent or metastatic disease.
- Clinical oncologist (radiotherapy)Named in the standard of care for: After surgery, Unresectable or bulky disease.
- Transplant and cell therapy teamNamed in the standard of care for: Unresectable or bulky disease.
- Palliative and supportive care teamNamed in the standard of care for: Unresectable or bulky disease.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example WHO histotype, Masaoka-Koga and TNM stage, Completeness of resection, Acetylcholine receptor antibodies, GTF2I L424H mutation), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Type A thymoma, Type AB thymoma, Type B1 thymoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Diagnosis and staging
- For my situation (diagnosis and staging), which of the standard options do you recommend and why?Guideline options include: 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.
Resectable (stage I to III)
- For my situation (resectable (stage i to iii)), which of the standard options do you recommend and why?Guideline options include: 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.
After surgery
- For my situation (after surgery), which of the standard options do you recommend and why?Guideline options include: 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.
Unresectable or bulky disease
- For my situation (unresectable or bulky disease), which of the standard options do you recommend and why?Guideline options include: Induction chemotherapy with cisplatin, doxorubicin and cyclophosphamide (CAP) or a platinum doublet, then surgery or radiotherapy according to response.
- Am I a candidate for Cisplatin, Doxorubicin, Cyclophosphamide or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic disease
- For my situation (recurrent or metastatic disease), which of the standard options do you recommend and why?Guideline options include: 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.
- Am I a candidate for Somatostatin analogues (octreotide, lanreotide), Everolimus, Sunitinib or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Study of KC1036 in Patients with Advanced Thymic Tumors and Target-Selected CAR-NK Cells (CD30, CD5, or Mesothelin) for Relapsed/Refractory B2 Thymoma or Thymic Carcinoma apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Everolimus, Sunitinib, Lenvatinib, A Study of KC1036 in Patients with Advanced Thymic Tumors?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Randomised trials are almost absent; postoperative radiotherapy for stage II disease rests on registry data”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “No systemic therapy is approved specifically for thymoma”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- A Study of KC1036 in Patients with Advanced Thymic TumorsPhase 2 · recruiting · NCT05683886A Single-arm, Open, Multicenter, Phase II Study to Evaluate the Efficacy and Safety of KC1036 in the Patients with Advanced Recurrent or Metastatic Thymic Tumors
- Target-Selected CAR-NK Cells (CD30, CD5, or Mesothelin) for Relapsed/Refractory B2 Thymoma or Thymic CarcinomaPhase 1/2 · recruiting · NCT07598955A Phase 1/2, Open-Label, Target-Selected Study of Allogeneic CAR-NK Cells Directed to CD30, CD5, or Mesothelin in Patients With Relapsed/Refractory B2 Thymoma or Thymic Carcinoma
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Thymoma (WHO types A, AB, B1, B2 and B3): the full pageThymoma 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Disease-specific staging and risk systems (FIGO, Ann Arbor, IPI, R-ISS, ELN, IMDC): Beyond the generic TNM system, gynaecological cancers (FIGO), lymphoma (Ann Arbor, IPI), myeloma (R-ISS), AML (ELN), kidney cancer (IMDC), neuroblastoma (INRG) and CLL (Rai, Binet) each have their own system that combines stage, blood tests, genetics and fitness into risk groups.
- Immune-related adverse events (irAEs): Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
Every term links to the glossary.