thymoma

Question 1

What is thymoma associated with

Answer 1

myasthenia gravis in 30%
Also polymyositis and dermatomyositis
red cell aplasia
hypogammaglobulinaemia

Send ANA, serum electrophoresis & anti-AChR antibodies

manage myasthenia ahead of surgery

Question 2

What is the staging of thymoma

Answer 2

1 - no capsular invasion
2a - microscopic capsular invasion of capsule
2b - microscopic invasion of mediastinal fat/pleura
3 - macroscopic invasion of adjacent structures - great vessels, mediastinum, lung
4A - pleural or pericardial mets
4B - distant mets

Question 3

what is the management according to stage

Answer 3

stage 1 - surgery
stage 2-3 - surgery + PORT if positive margin or aggressive disease
stage 4 & % - surgery + PORT or chemo (if R2 resection)

Question 4

what is the dose of adj RT

Answer 4

45 in 25 if clear margins
50.4/28 otherwise

Question 5

when is adj chemo indicated and what regimen

Answer 5

macroscopic residual disease
CAP or cis/etopo

Question 6

How is unresectable disease managed

Answer 6

pre-op chemo then reassess for surgery
CRT or RT alone
Radical RT dose - 60/30

Question 7

How is recurrent disease managed

Answer 7

chemo - CAP or cis/etopo - >50% RR

Question 8

How is thymoma histology classified

Answer 8

A - medullary
AB - mixed thymoma
B1 - predominantly cortical
B2 - cortical
B3 - well differentiated
C - thymic carcinoma