Cautious Optimism

After another X-Ray, I saw Mr David Lawrence, the cardiothoracic surgeon, on Monday 9th July 2012 at the Heart Hospital.

Mr David Lawrence BSc(Hons) MBBS FRCS FRCS MS

Broadly speaking, it's good news. The tumour was removed intact (given it measured 7.5 by 5.25 inches at one point, that was no mean feat!) and has since had a through going over by the histopathologists. It seems that it was completely encapsulated, and had not invaded any parts of me. For thymomas, there are several types and stages:  type A is completely benign, and type C is malignant, fast growing and metatasizes. B1, B2 and B3 are in between and have malignant potential. Mine was a B2, on the cusp of malignancy but since it was fully encapsulated, it hadn't invaded any other tissue of organs. What a relief.

Cautious optimism though: there are still causes for concern: little Ridley had a healthy blood supply (which was why he hadn't felt the need to break out of the capsule and feed off me) provided by 2 pedicles. These were snipped and clipped during surgery. There are tumour cells at the incision site on the tumour, therefore probably also on my side. These can re-grow into new tumours. Even with the total resection of a thymoma, which I have just had, there is still a significant chance of recurrence.

There is no agreed clinical protocol on how to manage this situation because thymomas are rare and varied, and cancer management techniques are evolving very quickly so there's no point in looking at statistics from 20 years ago. Mr Lawrence seemed to think that a watch and wait approach was best, rather than subject me to any radio or chemotherapy: that is supported by the most recent research, which suggests that complete resection is the gold standard of treatment for a B2 thymoma, and that adjuvant therapy probably has no impact on the outcome where there is no invasion of neighbouring tissue. [1]

However, that's general guidance.  As a thoracic surgeon, he doesn't think he needs to refer me on to an oncologist, he will discuss the specifics of my case with the UCLH oncolgist Dr Dawn Carnell who has a special interest in thymomas and decide how to proceed after that.

The other cause for concern is that while the medics were working out what was wrong, I had a biopsy. A needle biopsy of a thymoma can "seed" a new tumour in the mediastinum, often near the biopsy site. Still, the biopsy seemed to be the best decision at the time, in order to reach a definitive diagnosis after so many false leads. If I keep having scans, any new tumour will hopefully be picked up nice and early and dealt with promptly.

So we're not out of the woods yet, but we can see the open fields: and although the next bit of the path might meander a bit, there's a lot more metaphorical sunlight sparkling in the air now than there was a few weeks ago. Sadly, no actual sunlight, just variations on the drizzle/downpour spectrum, but you can't have everything.

Next step: see what Dr Carnell says about usefulness of adjuvant therapy or otherwise, then probably another CT scan and appointment in 3 months.

1."Which stages of thymoma benefit from adjuvant chemotherapy post-thymectomy?" Attaran S. et al.  http://icvts.oxfordjournals.org/content/early/2012/05/01/icvts.ivs133.full