Signs and Symptoms of Thymus Cancers

Symptoms caused by the tumor

The thymus is in the middle of the chest, near the airways and certain blood vessels. Tumors in the thymus can press on nearby structures, causing symptoms such as:

• Shortness of breath
• Cough (which may bring up bloody sputum)
• Chest pain
• Trouble swallowing
• Loss of appetite
• Weight loss

The thymus is near the superior vena cava, the main blood vessel bringing blood from the head and upper body to the heart. Tumors that press on this vessel can cause symptoms of superior vena cava syndrome, which can include:

• Swelling in the face, neck, and upper chest, sometimes with a bluish color
• Swelling of the visible veins in this part of the body
• Headaches
• Feeling dizzy or light-headed

Paraneoplastic syndromes

These are conditions that are related to the cancer but that are not caused directly by the tumor mass. For example, people with thymomas may develop autoimmune diseases, where the immune system starts to attack the body itself. Part of the normal function of the thymus is to help keep the immune system in check, which may help explain why this happens.

Myasthenia gravis: About 30% to 65% of people with thymomas also have myasthenia gravis (MG). This is by far the most common autoimmune disease associated with thymomas. In this disease, the immune system forms antibodies that block the chemical signals that signal the muscles to move. This causes severe muscle weakness. People with MG tire easily. They may notice problems climbing stairs or walking long distances.

Although patients have decreased muscle strength throughout the body, symptoms caused by weakness of the muscles of the eyes, neck, and chest may be the most troublesome. Weakness of the eye muscles can cause blurred or double vision and drooping eyelids, while weak neck muscles can lead to problems with swallowing. Weakness of the chest muscles and diaphragm can cause problems breathing and shortness of breath.

Many people with thymomas have MG, but most people with MG don’t have thymomas. Many people with MG have other, noncancerous abnormalities of the thymus gland. Myasthenia gravis can be treated by removing the thymus (whether or not a thymoma is present) or with medicines that either strengthen the chemical signals to muscles or weaken the immune attack on the muscles.

Red cell aplasia: Red cell aplasia, in which the body’s ability to make new red blood cells is severely reduced, occurs in about 5% of thymoma patients. Red blood cells carry oxygen from the lungs to other tissues of the body. Reduced red blood cell production causes anemia (low red blood cell counts). Symptoms of anemia can include weakness, dizziness, shortness of breath, and tiring easily. The usual treatment is to remove the thymus gland.

Hypogammaglobulinemia: Hypogammaglobulinemia is a disorder in which the body makes low amounts of infection-fighting antibodies (also known as gamma globulins). This leaves the person susceptible to infections. About 5% to 10% of thymoma patients develop hypogammaglobulinemia. About 10% of patients with hypogammaglobulinemia have a thymoma. Removing the thymus does not help correct this disease.

Other autoimmune diseases: Many other autoimmune diseases have also been linked to thymomas. However, they are much less common than myasthenia gravis, pure red cell aplasia, or hypogammaglobulinemia. Some examples include:

• Systemic lupus erythematosus
• Polymyositis
• Ulcerative colitis
• Rheumatoid arthritis
• Sjogren (Sjögren) syndrome
• Sarcoidosis
• Scleroderma

Most people who have these autoimmune diseases do not have a thymoma.