The thymus is a gland located in the center of the chest (in the breastbone), in front of the lungs. Its main function is to make thymosin mature and produce immune system cells (T cells), in order to fight infections and prevent these cells from attacking the body (causing so-called autoimmune diseases). The thymus gives birth to most of the T cells since puberty, after which it begins to shrink and is replaced by fatty tissue. Thymoma is a cancer that grows slowly from the epithelial cells of the gland and accounts for 90% of tumors that form in the thymus. It is rare and is diagnosed in around 50 people in Italy every year (most between the ages of 40 and 60). By knowing the symptoms to look for and the diagnostic tests related to this disease, you can know when to see a doctor and what to expect from the diagnostic process.
Steps
Part 1 of 2: Recognizing the Symptoms of Thymoma
Step 1. Find out if you have breathing problems
This tumor can put some pressure against the windpipe, causing difficulty getting air into the lungs. Notice if you often feel short of breath or if something is stuck in your throat, causing a choking sensation.
If you experience breathlessness after exercising, notice if you produce a wheezing sound like a wheeze as you catch your breath. It could be asthma
Step 2. Notice if you cough
This tumor can irritate the lungs, trachea and nerve centers that regulate the cough reflex. See if you have had a chronic cough for several months or years without getting any relief from taking antitussive drugs, steroids, and antibiotics.
- If you suffer from gastric reflux when you eat spicy, fatty or acidic foods, be aware that chronic cough can be caused by this disorder. If by changing your diet you can reduce the phenomenon, it is probably not a thymoma.
- If you live in or have traveled to an area where there is a high incidence of tuberculosis (TB) and have suffered from chronic cough, if you have noticed blood in your sputum (blood and mucus leaking together), if you have If you have experienced night sweats and fever, it is likely that you have contracted tuberculosis, so you should see a doctor immediately.
Step 3. Notice if you have chest pain
Since the tumor presses on the chest wall and heart, it is likely that chest pains characterized by a sensation of pressure localized exclusively in the center of the side are likely to occur. They can also develop behind the breastbone and be felt when pressure is applied to this point.
If you feel tightness in your chest and suffer from sweating, palpitations (which make you feel like your heart is leaping out of your chest), fever, chest pain as you move or breathe, you may be suffering from lung disease. or underlying cardiac. Regardless of the root cause, a medical examination would be advisable to evaluate these symptoms
Step 4. See if you have trouble swallowing
The thymus can grow and push against the esophagus, causing difficulty in swallowing. Notice if you are having a hard time swallowing what you eat or if you have recently been consuming more liquid foods because they are easier to swallow. This problem can also manifest itself as a sense of suffocation.
Step 5. Weigh yourself
Since thymoma can become cancerous and spread throughout the body (albeit very rarely), weight loss is likely to occur due to the growing demands of the cancerous tissue. Monitor your weight and compare the results over time.
If you lose weight unintentionally and for no apparent reason, consult your primary care physician. Weight loss is one of the symptoms of many cancers
Step 6. Check if you have superior vena cava syndrome
The superior vena cava is a large blood vessel that carries blood from the veins in the head, neck, upper limbs and upper torso to the heart. When it becomes clogged, it prevents the blood flowing within them from getting to the heart. This syndrome involves:
- Swelling on the face, neck and torso. Notice if your upper body looks redder.
- Dilation of the veins in the upper body. Look closely at the veins running down your arms, hands, and wrists to see if they seem more raised or dilated. They are usually the darker venous branches we see on the hands and arms.
- Headache due to dilation of the veins that supply blood to the brain.
- Lightheaded or lightly numb. As the blood flows back, the heart and brain get less oxygen. When the heart pumps less blood to the brain, or when the brain is supplied with a poorly oxygenated blood supply, one feels slightly dizzy or light-headed and runs the risk of falling. By lying down, you will alleviate the force of gravity that the blood must oppose to reach the brain.
Step 7. Notice if you have the typical symptoms of myasthenia gravis (MG)
MG is one of the most common paraneoplastic syndromes, presenting a set of symptoms associated with the formation of tumors. In the case of MG, the immune system produces antibodies that inhibit the chemical signals to force the muscles to move. As a result, widespread muscle weakness is felt. About 30-60% of people with thymic cancer also suffer from myasthenia gravis. Pay attention to:
- Diplopia or blurred vision
- Eyelid ptosis (drooping eyelid);
- Difficulty in swallowing
- Breathing difficulties due to muscle weakness in the chest and / or diaphragm;
- Disturbances in speech.
Step 8. Identify the symptoms of erythroid aplasia
It involves the premature destruction of red blood cells, causing the symptoms of anemia. If moderate, it causes lack of oxygen throughout the body. It occurs in approximately 5% of patients with thymoma. Pay attention to:
- Respiratory difficulties;
- Exhaustion;
- Stunning;
- Weakness.
Step 9. Check if you have the typical symptoms of hypogammaglobulinemia
It is a defect in the immune system that occurs when the body decreases the production of gamma globulins, antibodies to proteins used to fight infections. About 5-10% of patients with thymoma develop hypogammaglobulinemia. About 10% with hypogammaglobulinemia have thymoma. When it occurs together with thymoma, we are faced with a case of Good's syndrome. Look for signs of:
- Recurrent infections;
- Bronchiectasis, which includes symptoms such as chronic cough, copious saliva production which may contain foul-smelling mucus, difficulty breathing and wheezing, chest pain and hippocratic fingers (swollen fingernails and toenails)
- Chronic diarrhea;
- Mucocutaneous candidiasis, a fungal infection that can cause thrush (an oral infection that causes white patches or "curd-like" growths on the tongue);
- Viral infections, such as herpes simplex virus, cytomegalovirus, varicella zoster (St. Anthony's fire), human herpesvirus 8 (causative agent predisposing to Kaposi's sarcoma), which is a usually associated tumor of the underlying skin tissues AIDS.
Part 2 of 2: Diagnosing Thymoma
Step 1. Consult your doctor
It will collect all the information necessary to produce a detailed medical history, including previous family cases and symptoms. He will ask you questions about your symptoms, including those related to myasthenia gravis, erythroid aplasia and hypogammaglobulinemia. He can feel you to see if any swelling in the lower mid-neck is associated with overgrowth of the thymus.
Step 2. Get your blood drawn
There are no laboratory tests to diagnose thymoma, but there is a blood test that detects myasthenia gravis (MG), called anti-cholinesterase. MG is so common in patients with thymoma that it is considered a strong indicator of this tumor before going on to more expensive tests. About 84% of people under 40 who have a positive AB cholinesterase test suffer from thymoma.
Before operating to remove the thymoma, your doctor will prescribe treatment for MG because, if left untreated, it can cause problems during the anesthesia scheduled for surgery, such as respiratory failure
Step 3. Get an X-ray
To find a tumor, your doctor will first order a chest X-ray. The radiologist will look for a mass or shadow near the middle of the chest towards the base of the neck. Some forms of thymoma are small and are not detected by X-rays; If your doctor still has any suspicions or if he finds an abnormality on the x-ray, he may prescribe a CT scan.
Step 4. Get a CT scan
It provides a large number of more detailed images in cross sections, from the lower to the upper chest. You are likely to be given a contrast agent to highlight the structures and blood vessels of the body. The images offer a more accurate understanding of all abnormalities, including the stage of the thymoma or its spread.
If you need to take the contrast medium, it is preferable to drink plenty of fluids to eliminate it
Step 5. Get an MRI scan
This technology uses radio waves and magnets to produce a series of highly detailed images of the chest on a computer screen. Often, a contrast agent called gadolinium is given intravenously before the exam to get a better look at the details. Chest MRI allows a closer look at the thymoma and is performed when the patient does not tolerate or is allergic to the contrast agent used for the CT scan. The images produced are especially useful for identifying cancers that may have spread to the brain or along the spine.
- The MRI machine is very noisy and cramped, which means you will have to lie down in a large cylindrical space. Therefore, in some people it can generate a feeling of claustrophobia (fear of closed spaces).
- The exam can take up to an hour.
- If you have been given a contrast agent, it is best to drink plenty of fluids to get rid of it.
Step 6. Undergo a PET scan
This is a scan that uses glucose (a type of sugar) "tagged" with radioactive molecules to detect thymoma. Cancer cells assimilate the radioactive substance and a special camera captures images of the areas that relate to the distribution of glucose in the body. They are not as detailed as those on a CT scan or MRI scan, but they can provide useful information about the whole body. This test can help determine if a tumor seen through an image is actually a tumor or even if it has spread to other parts.
- When evaluating thymoma, doctors prefer to combine PET and CT scans instead of using PET alone. In this way they are able to compare the areas affected by the radioactive atoms with the more detailed images of the CT scan.
- You will be given an oral preparation or an injection of radiolabelled glucose. You will have to wait 30 to 60 minutes for the body to assimilate the substance. You may want to drink plenty of it afterwards to get rid of the tracer fluid from your body.
- The scan takes approximately 30 minutes.
Step 7. Allow the doctor to perform a needle biopsy
Using a CT scan or ultrasound machine to visually orientate, the doctor inserts a long, hollow needle into the chest up to the suspected tumor mass. He will extract a small sample that will be examined under a microscope.
- If you are taking blood thinners (such as coumadin or warfarin), your doctor may instruct you to stop it a few days before the exam and not to eat or drink on the day of the surgery. If you decide to have general anesthesia or intravenous sedation, you will likely be asked to fast the day before your biopsy as well.
- A possible disadvantage of this procedure is that it is not always possible to obtain a quantitatively sufficient sample that allows the doctor to make an accurate diagnosis or to have a clearer idea about the spread of the tumor.
Step 8. Ask for a biopsy of the tumor mass after surgery
Sometimes doctors can do a surgical biopsy (remove the tumor) without needle biopsy if they have overwhelming evidence that thymoma is present (thanks to laboratory tests and imaging tests). Other times he may perform a needle biopsy to confirm that it is a thymoma. After surgery, the sample is sent to the laboratory to validate the diagnosis.
The preparation before the exam day (such as fasting and so on) is similar to that of needle biopsy, except that an incision will be made on the skin to access the tumor mass and remove it
Step 9. Have the stage of the thymoma analyzed and, based on the results, undergo the necessary treatments
The stage of the cancer relates to the degree of spread to other organs, tissues and distant sites in the body. Therefore, it is essential to evaluate it to determine the best therapy. The most commonly used tumor staging method for thymoma is the Masaoka classification.
- Stage 1: occurs when the tumor is encapsulated and does not involve obvious or microscopic invasions. The most chosen treatment is surgical excision.
- Stage 2: This is a thymoma with a macroscopic invasion of the mediastinal fat, pleura or a microscopic invasion of the capsule. Treatment usually consists of complete excision with postoperative radiotherapy to reduce the incidence of relapses.
- Stage 3: Occurs when the tumor has invaded the lungs, larger blood vessels and the pericardium. In this case, a complete surgical excision is necessary in addition to postoperative radiotherapy, so that a recurrence does not occur.
- Stages 4A and 4B: this is the final stage, in which there is a pleural or metastatic spread. Treatment involves a combination of surgical excision, radiation and chemotherapy.
