Areas of Expertise
A thymoma is a tumor that arises in the thymic gland, an organ that resides under the breastbone on top of the heart and great vessels. Thymomas can be benign or malignant, meaning some of them are surrounded by a capsule and are self-contained, while others invade the structures in the chest or spread into other areas of the body.
Thymomas are commonly associated with a condition known as myasthenia gravis, an autoimmune disease characterized by muscle weakness, difficulty swallowing, and blurry vision. Approximately 30% of patients with a thymoma have myasthenia gravis. However, not everyone with myasthenia gravis develop a thymoma – it occurs in 10% of all myasthenia patients.
- Robotic thymectomy using the da Vinci® system, a minimally invasive surgical approach that avoids a sternotomy or splitting of the breast bone
- True multidisciplinary care at the USC/Norris thoracic oncology clinic, where the patient can be seen by a thoracic surgeon, oncologist, and radiation specialist all in one visit.
- Nurse navigator who coordinates the diagnostic evaluation and treatment plan
- Extensive expertise and experience in the management of thymomas, including complex tumors with invasion of the chest structures or metastatic disease
- Renown expert neurology faculty who assist in the management of patients with myasthenia gravis to allow safe treatment
Thymomas often do not cause symptoms, in which case they are picked up incidentally by imaging studies performed for other reasons. When symptoms do occur, they are not specific, and include vague chest pain, difficulty breathing, or cough.
Radiographic or imaging studies are the mainstay of diagnosis. In many instances the finding of a mass in the location of the thymic gland is all that is required to justify its removal, since benign or encapsulated thymomas can progress over time into invasive or malignant thymomas. If tissue confirmation is required, a CT-guided biopsy is usually performed.
Surgical resection is the mainstay of treatment for a thymoma. The conventional technique of removal requires a sternotomy, which is an incision that splits the breastbone to gain access into the anterior chest cavity. However, USC thoracic surgeons currently utilize robotic technology with the da Vinci® system when appropriate, which is a minimally invasive option for many patients. Robotic thymectomy typically involves 3 tiny incisions between the ribs on the right chest, through which a camera and flexible robotic arms pass and help the surgeon perform the operation without having to cut the breastbone or rib. This revolutionary approach has less scars, faster recovery, and decreased pain following the operation. USC is one of the few centers in the United States that is routinely performing robotic thymectomy. This option is also offered to patients with myasthenia gravis who do not have a thymoma, since removal of the thymic gland itself usually improves symptoms significantly and often allows the patient to stop myasthenia drugs altogether.
The multidisciplinary thoracic oncology team at USC reviews every thymoma patient to ensure treatment success. When a thymoma is aggressive or invasive, radiation and/or chemotherapy is necessary for improving outcomes. Moreover, for large tumors or thymomas that invade structures in the chest, chemoradiation is typically administered before the operation to maximize the chance of a successful operation. It is imperative that patients with thymoma receive the kind of multispecialty care that is routine at USC for the best outcomes.
Thymomas represent a very complex and diverse spectrum of disease with a wide range of clinical behavior. For this reason, USC physicians take a team approach to tailor the treatment to the individual patient’s circumstances and utilize surgery, chemotherapy, and/or radiation for successful long term outcomes.
Robotic thymectomy has been a major advance in the surgical treatment of thymomas. Patients typically stay in the hospital a fraction of the time that is required with a sternotomy. Their recovery is quite rapid and there are no issues of allowing the breast bone to heal over many weeks. Pain medication use is uncommon after the first week.