Thymic Tumors

Posted by anotherfinemass @anotherfinemass, Jan 16, 2019

As the owner of a fairly large thymic tumor, I have been trying to and understand the condition, currently acceptable treatments, and the various risks associated with those treatments (and non-treatment). The basics of my initial understanding are:

(1) Thymic tumors are relatively rare.
(2) Except in the case of thymic hyperplasia, thymic tumors are cancerous.
(3) Thymic hyperplasia is extremely rare in adults.
(4) The cancerous thymic tumors are thymomas, thymic carcinomas, and neuroendocrine tumors.
(5) The most dangerous and least understood of those are neuroendocrine tumors.
(6) In almost all instances, surgical removal of the thymic tumor is the standard treatment.
(7) The most common and most desired goal of surgery is a full resection of the tumor.
(8) Full resection of the tumor is important to achieve satisfactory long-term survival.
(9) Biopsies of thymic tumors are usually performed at the time the tumor is being surgically removed.

Some of the most common conditions that are associated with thymic tumors and the operations conducted to remove them are:

(1) Phrenic Nerve damage;
(2) Sympathetic Chain damage;
(3) Sternal wound infections;
(4) Damage to the superior vena cava and/or other nearby veins;
(5) Recurrent laryngeal Nerve damage;
(6) Horner Syndrome, and;
(7) Myasthenia gravis.

Of greatest concern in considering the above is that just as the tumors are relatively rare, so are surgeons that specialize in resecting the tumors. And not being independently wealthy, resources for consults and second or third opinions are limited. This has given rise to the question of what is the proper or commonly recognized protocol to engage surgeons.

More specifically, many thoracic surgeons do not work with thymic tumors. That being the case, I have tried to get answers to the following questions before making an appointment for a consult:

(1) How many thymic tumors (approximately) have you removed or debulked in your career?
(2) Of those, in how many cases was the tumor completely removed and how many debulked?
(3) Of all those procedures how many (approximately) were for which of the four types of tumor?
(4) What were your best and worst results?
(5) The mass in my chest now measures ## cm x ## cm x ##.# cm in craniocaudal, mediolateral and anteroposterior dimensions. Have you ever operated on a mediastinal mass this size?
(6) Have any of the several conditions listed above have been common (occurring in more than 50%) in your patients, and if so, which conditions?

My limited experience in this pursuit of these answers is that the surgeon's assistant says I need to schedule an appointment to discuss those matters with the surgeon. However, that leaves you in a "chicken or the egg" situation where you need a referral to see a surgeon, but without the answers, you aren't sure if you want to use the referral for that surgeon! And sending unsolicited emails has not been productive.

Has anyone else dealt with this? What was your process? What's the process at Mayo? (I am not located near a Mayo Clinic.) Also, please feel free to supplement the information above or correct any misinformation (provided unknowingly).

Thanks in advance.

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@anotherfinemass checking in. How are you doing?

REPLY

@colleenyoung - In a nutshell, I'm wearing down.

I finally got the authorization to go to an out-of-state expert for the operation that was originally going to be done locally. But after an awful trip (rerouted, delayed, unscheduled overnight stay, and finally a rental car because the plane had to land an hour and a half away from the airport where my car was parked) I learned that the expert is requiring me to first have chemotherapy there before he will do the operation. Thus I would have to relocate for some months, which currently seems financially/logistically impossible for me.

Meanwhile, my tumor has compressed several nerves, one of which has caused a paralyzed vocal cord, so no one can hear me unless there is total silence when I speak, and my appetite is totally destroyed. Of course, sleeping is almost impossible because some other nerve coming from my chest going behind my shoulder blade and up into my neck will not stop hurting for three minutes. And if I do somehow fall asleep there's a 50/50 chance that I will turn the wrong way and the pressure from the tumor will lean on my lung and constrict my breathing so that I wake up in a gasping panic.

Today, after 48 hours of solid do-nothing rest, I am just now semi-recovered enough from the trip to try and contemplate what to do.

On the bright side, I'm still alive and able to write.

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@anotherfinemass

I am sorry to hear that you were not able to get more help from the specialist. Did he indicate that he would be willing to work with a local doctor to coordinate your treatment closer to home?

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@anotherfinemass

@colleenyoung - In a nutshell, I'm wearing down.

I finally got the authorization to go to an out-of-state expert for the operation that was originally going to be done locally. But after an awful trip (rerouted, delayed, unscheduled overnight stay, and finally a rental car because the plane had to land an hour and a half away from the airport where my car was parked) I learned that the expert is requiring me to first have chemotherapy there before he will do the operation. Thus I would have to relocate for some months, which currently seems financially/logistically impossible for me.

Meanwhile, my tumor has compressed several nerves, one of which has caused a paralyzed vocal cord, so no one can hear me unless there is total silence when I speak, and my appetite is totally destroyed. Of course, sleeping is almost impossible because some other nerve coming from my chest going behind my shoulder blade and up into my neck will not stop hurting for three minutes. And if I do somehow fall asleep there's a 50/50 chance that I will turn the wrong way and the pressure from the tumor will lean on my lung and constrict my breathing so that I wake up in a gasping panic.

Today, after 48 hours of solid do-nothing rest, I am just now semi-recovered enough from the trip to try and contemplate what to do.

On the bright side, I'm still alive and able to write.

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How wretched @anotherfinemass. I simply cannot imagine making such a trip in your state all in vain. Can the chemotherapy be done locally?

REPLY

Hello @rosez

I am sorry to hear about your daughter's most recent problem with cancer of the Thymus. You mentioned that "she just informed me that they have to replace the right valve going to her heart because of the tumor pressing on it." Will she be having surgery in the near future?

How is she dealing with this added complication of her cancer diagnosis?

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@hopeful33250

Hello @rosez

I am sorry to hear about your daughter's most recent problem with cancer of the Thymus. You mentioned that "she just informed me that they have to replace the right valve going to her heart because of the tumor pressing on it." Will she be having surgery in the near future?

How is she dealing with this added complication of her cancer diagnosis?

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Yes, she is waiting for a date

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@rosez

Yes, she is waiting for a date

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Hello @rosez,
Thanks for your response. I praying for her to have the best results possible. Shall we keep in touch and follow her progress?

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In reply to @rosez "Sure" + (show)
@rosez

My daughter's surgery is October 9th. My heart is so broken because I can't be there. She is in California and I am in Florida. Because of the virus, I can't go there. There is the chance that I could bring it to her or back to my husband who has cancer. I feel as if I am being ripped in half needing to be with both of them.

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@rosez

My daughter's surgery is October 9th. My heart is so broken because I can't be there. She is in California and I am in Florida. Because of the virus, I can't go there. There is the chance that I could bring it to her or back to my husband who has cancer. I feel as if I am being ripped in half needing to be with both of them.

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Your broken heart is easy to understand, @rosez. Our environment does not allow us much travel, does it? I really appreciate your posting about the date of your daughter's surgery. I will certainly pray for her.

Does your daughter have a good support system in California? Family, friends, church, etc.?

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