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Whether a thymus cancer (thymoma or thymic carcinoma) can be resected (removed) with surgery is one of the most important factors in determining treatment options.

The type of tumor is also important. Thymic carcinomas are more likely to grow and spread quickly than thymomas. They often require more aggressive treatment.

Cancers that can be removed with surgery

Cancerous tumors that can be surgically removed (resected) include almost all stage I and II thymus tumors, most stage III tumors, and a small number of stage IV tumors. For people with these cancers, surgery offers the best chance for long-term survival. Surgery includes removing the entire thymus. It may also include removing parts of nearby organs or blood vessels depending on whether the disease has spread.

If doctors see that a thymoma may be removed after imaging tests, they try to avoid doing a biopsy beforehand. Disturbing the tumor's outer covering, called the capsule, can risk spreading tumor cells. A biopsy that goes through the lining of the lung (a transpleural approach) carries the risk of spreading the cancer within the chest. For this reason, surgery to remove the whole tumor is often done first. Then the tissue is sent for diagnosis afterward.

Tumors that cannot be resected

Some tumors cannot be removed with surgery. This may be because they that are too close to vital organs, nerves, or blood vessels. Or it may be because the cancer has spread too far to be removed completely. Many stage III and most stage IV cancers are in this category. People who are too ill for surgery also cannot have their cancer removed.

People with these cancers will often have a biopsy before treatment to confirm the diagnosis.

In some cases, doctors may suggest chemo as the first treatment. You may hear this called neoadjuvant therapy. This may shrink the tumor enough for surgery. If it shrinks enough, surgery is then done, usually followed by radiation therapy.

For people who can’t have surgery, chemo and radiation therapy are the main treatments. If chemo is no longer helpful, other drugs that work in different ways might be options.

Because these cancers can be hard to treat, taking part in a clinical trial of a newer treatment may be worth considering.

Thymus cancer that comes back

When cancer comes back after treatment it's called a recurrence. A recurrence can be in or near the same place it started (local) or it can have spread to organs such as the lungs, liver, or bones (distant).

Thymomas most often come back locally. Thymic carcinomas can also come back locally and in nearby lymph nodes. But they may also spread to other parts of the body, such as the liver, lungs, and bones.

Treatment for thymus cancer that has come back after treatment depends on where it recurs and on what the original treatment was. If the recurrence isn't too widespread, surgery might be an option. It may offer the best chance for long-term survival. But most often, the main treatment options are radiation therapy and/or chemo. These treatments can often help control the cancer for a time, but they are very unlikely to result in a cure. If chemo is no longer helpful, other drugs that work in different ways might also be used.

Because recurrent cancers can be hard to treat, clinical trials of new types of treatment may be a good option.