Oncology (General Cancer)/enlarged thymus

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ct scan 1
ct scan 1  

ct scan 2
ct scan 2  
Dr. Higby,

Hello and thanks in advance for all the time you put in to answering questions on this site.

I am 45 year old white male in otherwise good health, no history of cancer myself except for recent "superficial basal-cell carcinoma" on arm which was removed.  
I went to dr. recently for some burning in the chest which she now thinks was reflux (which I've had for some time).  To make long story short, they did precautionary x-ray, which she saw some nodes on so she sent me for a CT.  Then on CT an enlarged thymus was found, then sent for PET - see attached CT and PET scans.  btw, I will send you PET scan in a follow-up question shortly - they only allow u to attach 2 documents

Then, sent me to oncology / hematology guy who said gave me upcoming appt. (7/18) for heart/lung surgeon who will decide to either biopsy the thymus, or remove it.

So, my questions are:
- what are your thoughts on my condition and attached scan results?
- does it make sense to go to local heart / lung surgeon next, and have them remove it if they think that's best?  Or, is thymus removal a complicated, rare surgery that I should have done at a more experienced center (such as Sloan-Kettering, which is only 2 hours away since I live near NJ)?

thanks again,

Steve

Answer
I've looked over the results you sent, including the PET scan through a second submission.  Basically you have a suspicious situation, but from the data, it doesn't appear to be rapidly growing.  Thymic tumors may be lymphomas or thymomas.  Thymomas can be like lymphomas, or can be epithelioid, which means they look more like a regular cancer under the microscope.  However, the behavior of the tumor is usually a lot less aggressive.  In any event, a biopsy (at least) needs to be done, so that treatment planning can take place.  Thoracic surgeons are trained to remove thymomas, and if the thoracic surgeon got into the chest and thought it was easily removed, he probably would.  However, what usually happens is that the thoracic surgeon does a mediastinoscopy and biopsy, looking at regional nodes and whether the thymic tumor is invading other structures.  Based on that information further treatment planning (surgery, radiation, etc) can be done.  Obviously you might feel more comfortable going to Sloan-Kettering or one of the other major cancer centers, but if your thoracic surgeon has a good reputation you probably don't need to travel to get this done. I know many good surgeons who have no hesitation to refer patients to "superspecialists" when they feel it is indicated.  Good luck and keep me posted!

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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