Thymus Cancer: Surgery
Surgery is commonly used to treat thymus tumors. One of the first things your healthcare providers will do is figure out if all of the tumor can be removed.
Different kinds of surgery may be done. Which type you have depends on how big the tumor is, whether the cancer has spread, and how close the tumor is to key tissues (like nerves and blood vessels). It also depends on your overall health and other factors.
When might surgery be used for thymus tumors?
Surgery is the main treatment for thymus tumors, if it can be done. The goal is to remove the tumor and often all of the thymus. In some cases, you may need surgery for a diagnosis.
Your healthcare provider may recommend surgery even if they don’t think all of the tumor can be removed. Here, the goal is to take out as much of the tumor as possible (called debulking). This might help other treatments, like radiation and chemotherapy, work better. Not all healthcare providers agree with this, though.
Types of surgery for thymus tumors
Thymectomy
The main type of surgery for thymus tumors is called a thymectomy. This is when the tumor and the rest of the thymus gland is removed. If the cancer has reached nearby structures, such as blood vessels, the lining of your lung (pleura), lining around your heart (pericardium), or a lung, these are also taken out.
This type of surgery is often done through a cut made in skin on the front of your chest and then a cut through the middle of your breastbone (sternum). This is called a median sternotomy.
Less often, the surgery might be done through several small cuts (incisions). A long, thin, lighted video camera (called a laparoscope) is put in one of the cuts to see inside your chest. Then special long, thin surgical tools are put in through the other cuts to do the surgery. This approach should be done only by surgeons at centers that have a lot of experience with this technique.
Possible risks, complications, and side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Risks from surgery for a thymus tumor
Along with the risks above, thymus tumor surgery can sometimes cause other problems. These can include:
Getting ready for your surgery
Before you go for surgery, you’ll meet with your surgeon to talk about the procedure. At this time, you can ask any questions and discuss any concerns you may have. This is also a good time to review the side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask how you'll feel after surgery and when you can expect to return to your normal activities. After you’ve discussed all the details with your surgeon, you'll sign a consent form that says the surgeon can do the surgery.
On the day of your surgery, you may be asked to arrive at the hospital admission area a couple of hours before your surgery is supposed to start. There, you'll complete the needed paperwork and then go to a pre-op (pre-operative or before surgery) area. You’ll undress and put on a hospital gown. Your healthcare team will meet you there. They'll ask you about your medical history, the medicines you take, and any allergies you have. They’ll also talk about the surgical procedure. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes.
While you’re in the pre-op area, an anesthesiologist or a nurse anesthetist will evaluate you. They will explain the anesthesia you'll be given during surgery. The purpose of the anesthesia is to put you into a deep sleep so you won't feel any pain during the surgery. Be sure to answer all the questions well and honestly. This helps prevent complications. Also ask any questions you have about your anesthesia. You’ll have to sign a form that states that you understand the risks involved.
Your surgeon will also see you in the pre-op area. Ask any last-minute questions you have. This can help put your mind at ease.
What to expect during surgery
When it’s time for your surgery, you’ll be taken into the operating room. There will be many people there, including the anesthesiologist, surgeon, and nurses. Everyone will have on a surgical gown and a face mask.
Once you’re in the room, medical staff will move you onto the operating table. Your anesthesiologist or nurse will put an intravenous line (IV) into your arm. This requires just a small skin prick. (Sometimes the IV may be started in the pre-op area instead.) Someone might put special stockings on your legs to help prevent blood clots. Electrocardiogram (ECG) wires with small, sticky pads on the end will be attached to your chest to monitor your heart. A blood pressure cuff will be wrapped around your arm. When all the preparation is done, a mask might be put over your nose and mouth. You’ll be given the anesthesia and will fall asleep.
During surgery, a catheter may be placed through your urethra and into your bladder. This is a soft, hollow tube used to drain urine into a bag. You’ll also have a breathing tube put in your windpipe. A breathing machine (ventilator) will control your breathing during surgery. Also, a nasogastric (NG) tube may be put in your nose. This tube goes into your stomach to drain its contents.
What's removed during surgery and where the incisions (cuts) are made depend on the type of surgery you have.
After surgery, medical staff will move you to the recovery room. There, they'll monitor you for a few hours. When you wake up, don't be alarmed by the number of tubes and wires attached to you. These are normal post-op (post-operative or after surgery) monitors. When you’re fully awake in the recovery room, your family or other support people will be able to see you for a short time. Once you’re awake and stable, you'll be moved to a regular hospital room.
What to expect after surgery
When you first wake up, you might have some pain. Your healthcare provider will give you pain relievers as needed to help you feel more comfortable. The pain medicines will also help you get up and walk soon after your surgery. This is important for your recovery.
You’ll likely stay in the hospital for a few days. It will take time to get back to eating normally and having regular bowel movements. You may still have the catheter in your bladder to drain urine. It allows your healthcare providers to measure your urine output. This helps to keep track of your fluids and make sure you're drinking enough liquids. It’s usually taken out before you go home.
When you're up and about, feeling better, and your pain is controlled, you'll be able to go home. You can slowly return to most normal activities once you leave the hospital. But don't lift heavy things for several weeks. You'll be taught how to care for your incision, when to use your pain medicines, what problems to watch for, and when to call your healthcare provider. Always follow the instructions you get from your healthcare team.
After surgery, you may feel weak or tired for a while. The amount of time it takes to heal from an operation is different for each person. But you may not feel like yourself for many months. Your healthcare provider will give you instructions about whether and when you can get your incisions wet. You likely won't be able to drive for a while, as directed by your healthcare providers.
Talk to your healthcare team
If you have any questions about your surgery, talk to your healthcare team. They can help you know what to expect before, during, and after surgery.
Ask your healthcare provider what signs of problems you should watch for and when to call. Know how to get help after office hours and on weekends and holidays.